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Patient education: Choosing surgical treatment for early-stage breast cancer (The Basics)

Patient education: Choosing surgical treatment for early-stage breast cancer (The Basics)

What are the treatment choices for early-stage breast cancer? — Your doctor will tell you what your treatment choices are, based on your unique situation. The 2 main types of treatment are:

"Local treatment" – This is treatment directly to the breast with surgery or radiation.

"Systemic treatment" – This is the name for medicines that treat the whole body. Chemotherapy is an example. There are other medicines, too. They destroy cancer cells or stop them from growing. They also lower the chances that the cancer will return anywhere in your body.

For surgery, people can often choose between these 2 options:

Mastectomy – This is surgery to remove the whole breast. Most people who have a mastectomy can also have surgery to reconstruct the breast that is removed.

Breast-conserving therapy (also called "lumpectomy") – This is surgery to remove the cancer and a section of healthy tissue around it (called a "margin"). People who choose this option keep their breast. But they usually must have radiation therapy after surgery to kill any cancer cells that might still be in the breast area.

During lumpectomy or mastectomy, most people also have surgery to remove 1 or more lymph nodes under the arm. Lymph nodes are bean-shaped organs that filter and trap cancer cells (figure 1). Depending on what kind of cancer you have and how far it has spread, you might also need systemic treatment with medicines that can slow or prevent the growth of cancer.

This article focuses on decisions about breast surgery, not on systemic treatments or lymph node surgery.

Will my choice of surgery affect how long I live? — No. Studies show that people who choose lumpectomy live just as long as those who choose mastectomy.

Will my choice of surgery affect the chances that cancer will come back? — No. In the past, studies suggested that a person treated with a lumpectomy would have a slightly higher chance of having the cancer come back. But more recent studies suggest that the chances are similar, whether a person has a lumpectomy and radiation or a mastectomy.

Is lumpectomy always an option? — No. Lumpectomy is not an option for some people. For example, lumpectomy might not be an option if you:

Have more than 1 tumor in different areas of the same breast, which cannot be removed with a single cut

Have cancer that has spread throughout the breast tissue, and the surgeon can't get all of the cancer out with a margin of normal tissue around it

Cannot have radiation therapy, for example, because you are pregnant or have certain skin conditions

Already had radiation to that area of your breast (more radiation to the same area can cause too much damage)

How do I decide between the 2 surgery options? — First, make sure that you understand the different treatment options (table 1). Ask your doctor any questions you might have. Think about how you feel about these issues:

The way you will look – Is it important to keep your own breast? How would you feel if your chest was flat or you had to wear a plastic breast in your bra? Ask to see pictures of people who have had the different kinds of surgery. Remember, if you choose mastectomy, you can choose to have your breast reconstructed (figure 2). If you have small breasts and a large tumor, a lumpectomy might make your breast look quite different. In this case, mastectomy with reconstruction might be a better option.

Some people are OK with having a flat chest after mastectomy and choose not to have reconstruction.

The risk that the cancer will come back – People who choose lumpectomy live just as long as those who choose mastectomy. They also have about the same chances of cancer returning in the breast. Most people whose cancer comes back after lumpectomy later have a mastectomy.

The time involved, and the side effects of radiation – After lumpectomy, most people must have radiation therapy. This usually involves getting treatments 5 days a week for 3 to 6 weeks, depending on your age and other factors. Shorter treatments might be appropriate in some cases.

This type of radiation will not make your hair fall out, but it might make you tired. It will tan and possibly even burn the skin on your chest. This burn is like a sunburn and goes away fairly quickly. Near the end of treatment, radiation can make you feel a little tired, but this is not very common and usually doesn't last long.

Recovery from surgery

If you have a lumpectomy, you can go home from the hospital the same day as your surgery. For a week or 2 after surgery, you will need to rest and avoid sports, swimming, and heavy lifting.

If you have a mastectomy, you will stay in the hospital for 1 to 2 days after surgery. If you also have breast reconstruction, you might stay a day or 2 longer. You will go home with drains that must be emptied twice a day. After about 2 weeks, the surgeon will take the drains out in the office. If more fluid or blood builds up after the drains come out, the doctor will drain it with a needle in the office. During the draining process and for a few weeks more, you will need to rest and avoid sports, swimming, or heavy lifting. Even after you recover, you will not have normal feeling in your chest after a mastectomy. You can choose to have your breast reconstructed right away or later, or not at all.

-No matter which surgery you have, you will probably need to have biopsies of your lymph nodes. This part of the surgery usually does not cause problems and is often done during your breast surgery. But in some cases, it can cause arm swelling, pain, or stiffness, shoulder pain or stiffness, or a nerve injury. If any of these happen to you, you might need to do special exercises or work with a physical therapist (exercise expert) to get back to normal.

How do I work with my doctor to make a decision? — Tell your doctor how you feel about the different treatment options. If there is something specific that worries you, tell your doctor about that, too. Listen to what your doctor says about their experiences with people who had similar situations. Together, you can decide which treatment option is right for you. When you choose your treatment, you can learn more details about that option.

More on this topic

Patient education: Breast cancer (The Basics)
Patient education: Mastectomy (The Basics)
Patient education: Breast reconstruction after mastectomy for cancer (The Basics)
Patient education: Breast cancer screening (The Basics)
Patient education: Common breast problems (The Basics)
Patient education: Cancer screening (The Basics)
Patient education: Breast biopsy (The Basics)
Patient education: Sentinel lymph node biopsy for breast cancer (The Basics)
Patient education: Seroma (The Basics)

Patient education: Breast cancer guide to diagnosis and treatment (Beyond the Basics)
Patient education: Surgical procedures for breast cancer — Mastectomy and breast-conserving therapy (Beyond the Basics)
Patient education: Breast cancer screening (Beyond the Basics)
Patient education: Treatment of early-stage, hormone-responsive breast cancer in postmenopausal women (Beyond the Basics)
Patient education: Treatment of early-stage, hormone-responsive breast cancer in premenopausal women (Beyond the Basics)
Patient education: Treatment of early HER2-positive breast cancer (Beyond the Basics)

This topic retrieved from UpToDate on: Feb 02, 2024.
Disclaimer: This generalized information is a limited summary of diagnosis, treatment, and/or medication information. It is not meant to be comprehensive and should be used as a tool to help the user understand and/or assess potential diagnostic and treatment options. It does NOT include all information about conditions, treatments, medications, side effects, or risks that may apply to a specific patient. It is not intended to be medical advice or a substitute for the medical advice, diagnosis, or treatment of a health care provider based on the health care provider's examination and assessment of a patient's specific and unique circumstances. Patients must speak with a health care provider for complete information about their health, medical questions, and treatment options, including any risks or benefits regarding use of medications. This information does not endorse any treatments or medications as safe, effective, or approved for treating a specific patient. UpToDate, Inc. and its affiliates disclaim any warranty or liability relating to this information or the use thereof. The use of this information is governed by the Terms of Use, available at https://www.wolterskluwer.com/en/know/clinical-effectiveness-terms. 2024© UpToDate, Inc. and its affiliates and/or licensors. All rights reserved.
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