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Breast Cancer Treatment: Mastectomy, Yes or No? A Woman’s Choice

By Dr. Marissa Howard-McNatt

My patients are some of the best-informed women I’ve ever met. They can quote from the latest breast cancer research. They know that some cancers are triggered by hormonal receptors and others determined by a genetic path leading back to their great-great grandmothers. And they want a say in their breast cancer treatment.

In my surgical practice, I rely on a pivotal study that dates all the way back to 1976, when researchers started tracking breast-cancer patients to find out the best surgical breast cancer treatment for those with early-stage breast cancer. About half the patients underwent a mastectomy; the rest were treated with a lumpectomy followed by radiation. After 20 years, the survival rate for both groups was the same. Now, more than 30 years later, that’s still the case.

[Read about Types of Breast Cancer Surgeries.]

That means that my patients have a real choice in their breast cancer treatment.

I can remove the tumor in a procedure commonly called a lumpectomy, which preserves the patient’s breast. In most cases patients who choose this option are treated with radiation. Or I can remove the breast in a procedure known as a mastectomy and that day, if the patient chooses, a plastic surgeon can follow me into the operating room and reconstruct the patient’s breast.

[Read more about Breast Cancer Diagnosis & Treatment at the Breast Care Center.]

Breast cancer treatment choice isn’t an option for all patients. Some have more advanced cancer, and for them the safer option is mastectomy. In some cases, the tumor is simply too large for lumpectomy. And women with a family history of breast cancer may be better off with a mastectomy. But for most women with early-stage breast cancer the choice is theirs. I may be their surgeon, but the breast cancer treatment decision isn’t mine. And there is no right answer.

So, when presented with a real choice, one that does not compromise their health, how do women choose? Some women, especially older women, don’t want the choice. They’ve come all the way to Wake Forest Baptist Health and they want me to tell them what I think they should do. I’m happy to do that. But usually my patients know what’s best for them.

Some women know immediately that they want to preserve their breast and they are relieved to know that they can make that choice without risking a recurrence. Others know with equal certainty that they want a mastectomy. They understand the research, but they know they’ll never have peace of mind if they keep their breast. My patients know their own hearts and their own minds. If my patient is going to be sitting up at night for the rest of her life wondering whether the cancer will come back, there’s no sense in preserving the breast. That’s not for me to judge.

Once a woman decides on mastectomy, more choices follow. The patient meets with me and a plastic surgeon who specializes in breast reconstruction and together we decide on the best breast cancer treatment plan. My patients are often relieved to know that the reconstructive surgery can be done right after I finish the mastectomy, same hospital, same day, and same operating room.

We offer reconstructive surgery to all my patients. Earlier this year, an 80 year-old patient decided she would have a mastectomy. But she didn’t want to live the rest of her life with a missing breast. I didn’t see why her age should stand in the way. Older women recover from reconstructive surgery as well as younger women. Again, it’s their choice. On the other side, some women don’t want to bother with more surgery. They can live with the missing breast and they don’t want to face more surgery and longer recovery. It’s their choice.

Plastic surgeons can rebuild a breast using one of two basic methods. The first uses an implant made of silicone and filled either with saline solution of silicone gel. In the second method, surgeons remove skin and muscle from one part of the patient’s body, usually her abdomen, and use that tissue to form a new breast. We explain the risks and benefits of both procedures. Implants may not last a lifetime and there’s a small risk that they may rupture, but the operation is simpler and the recovery shorter. The second procedure, commonly called tissue flap, requires two incisions and longer recovery. In some cases, the surgeon will recommend one procedure over the other, but in most cases it’s the woman’s choice.

[Read about Reconstructive Breast Surgery.]

These decisions usually don’t take long. My patients know they have breast cancer. They’ve been studying the Internet and talking to their friends. These women are knowledgeable. I tell them they can’t make a wrong decision. In the end I find that most of my patients are satisfied with the breast cancer treatment choices they make. 

Learn more about the Cancer Center at Wake Forest Baptist Health.

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Last Updated: 09-06-2017
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