Choosing To Keep Them

Contrary to popular belief, breast conserving surgery is not inferior to a mastectomy and instead has equal survival rates.

Breast cancer has been around for years and is the most common cancer in women worldwide. According to World Cancer Research Fund International, breast cancer contributed 25.4% of the total number of new cases diagnosed in 2018 amongst women.

Over the years, young patients with early-stage breast cancer have increasingly been opting to get a mastectomy instead of a lumpectomy.

A lot of the time, patients believe that a mastectomy – a surgery that removes the entire breast – is superior to that of a lumpectomy, which is a surgery that removes breast cancer while preserving the breast.

Contrary to that popular belief, consultant general surgeon Dr Lee Ching Hong says this is simply not true. According to him, when proper procedure is followed, the survival rates for a lumpectomy and a mastectomy are equal.

Breast conserving is an option

While both lumpectomy and mastectomy procedures are effective, not everyone who has breast cancer can have a lumpectomy done.

A lumpectomy, also known as breast conserving surgery, is usually done in the earlier stages of breast cancer with the aim to preserve the breast and have it looking as close to natural as possible.

“Even for those who are at stage three of breast cancer, a lumpectomy can be done – provided they fit the necessary criteria and the cancer has shrunk after undergoing neoadjuvant therapy, which is treatment before surgery to help shrink the cancer, ” says Dr Lee.

During the surgery, the doctor will remove the tumour and any surrounding tissue that has been affected. After the procedure, patients will need radiation therapy to prevent a relapse and to destroy any remaining cancer cells.

As breast cancer is a disease that requires knowledge of various disciplines, it is very important that patients consult their doctor. Doctors (usually inclusive of the primary care doctor, an oncologist, radiologist, surgeon, etc) are the ones who will help patients decide if this is a possible option for them as there are a few factors to consider such as the location and stage of the cancer, as well as the patients’ characteristics and history.

Some of the favourable factors and conditions for a patient to undergo a lumpectomy are:

  • Younger in age
  • Smaller, monocentric tumours – preferably in the early stages
  • Not pregnant or at least in the first/second trimester
  • Has not had previous radiotherapy sessions for other illnesses – this is because the bones can become brittle and have a higher chance of fractures

Another possible solution

On the other hand, a mastectomy treats the cancer by removing the entire breast. There are five types of mastectomy procedures:

Simple mastectomy – The entire breast is removed, but none of the patient’s lymph nodes near her underarm or muscle beneath the breast is removed

Modified radical mastectomy – This procedure removes the entire breast along with some lymph nodes; however, no muscle is removed.

Radical mastectomy – This type of mastectomy removes the entire breast, underarm lymph nodes and muscles around the chest. It is the most invasive type of mastectomy and is only recommended if a patient’s cancer has spread to the chest muscles in and around the breast.

Partial mastectomy – This is where the portion of the breast affected by cancer is removed along with some surrounding tissue. While similar to a lumpectomy, this procedure removes more tissue.

Subcutaneous mastectomy – This procedure removes all the breast tissue, but preserves the nipple and the skin.

Although mastectomy removes the entire breast, women also have the option of reconstruction surgery which will help preserve their body’s image. There are two main techniques for reconstructing a breast:

Implant reconstruction – Inserting an implant that is filled with saline (salt water) or silicone gel

Tissue flap procedures – Using a patient’s own tissue taken from the abdomen, back, belly, thigh or bottom to create a mound to reconstruct the breast. Taking abdominal tissue is known as a TRAM flap, whereas taking tissue from the back is called a latissimus dorsi flap. Sometimes, the tissue being moved is kept attached to its blood supply. Other times, it is disconnected and then reconnected to a blood supply near the new location.

Dr Lee estimates the recovery period for both a lumpectomy or mastectomy to be anywhere from six months to a year – provided everything goes well during the post-operation and healing period.

“With any surgery, there is a risk of complications. In terms of surgery, both lumpectomy and mastectomy have the possibility of developing seroma – which is a collection of fluid that builds up in the cavity of the surgery site under the surface of your skin.

Besides that, other complications may be wound infections or even lymphedema, ” says Dr Lee. He goes on to elaborate that lymphedema is swelling that generally occurs in the arms caused by the removal of, or damage to lymph nodes as part of cancer treatment.

If a patient is considering surgery, Dr Lee advises to consider all the options available through consultation with doctors. “If you prefer to conserve your breast, you can always raise the question to your doctor and discuss your options.”

“In today’s world with our advanced technology, know that with proper procedure and care, both lumpectomy and mastectomy have equivalent outcomes and survival rates, ” he says.

Dr Lee Ching Hong is a consultant general surgeon with Ara Damansara Medical Centre.

For more information, call 03-5639 1212.

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