Surgery

Lumpectomy or Mastectomy?  What should you choose and why?  Well, actually, the decision sometimes isn't down to the patient and the surgeon may tell you that one is recommended rather than the other.  They will advise you on the best route for you clinically.  For example, if you have very small breasts and a large tumour, it may not be possible to have a lumpectomy.  However, you will be consulted and if you feel strongly about a certain route then you must discuss this with your team.

What are the differences?  Well, with a lumpectomy (called a "Wide Local Excision" WLE) you usually have about a 2" scar on your breast where the surgeon has removed the tumour.  With a mastectomy, all of the breast tissue is removed.  You will either be left "flat" or may be able to have immediate reconstruction.  Please see the reconstruction tab for more information.  For more information on what to expect with a lumpectomy, please see the tab above.

In both cases however, you are likely to have a further scar under your armpit of about 1" where the nodes are removed.  If you're very lucky you may have only one scar if the tumour and nodes are close together.

SURGERY - BEFORE OR AFTER CHEMOTHERAPY?

Now this is a very interesting question and it appears that there's no absolute answer. It depends on your surgeon and where you live!!!!! For example I had no idea that people could have chemotherapy first and surgery after. I was just given an appointment to see a surgeon and off I went and had the lumpectomy done!

There are positives and negatives with both routes:-

Surgery first / chemotherapy after:

  • Positives: With surgery first, once it's out, you're technically "cancer free" and the chemotherapy then mops up any cells that may be lurking in your body. The advantage is that you're not giving the cancer any time to spread and it's in your body for a much shorter time.
  • Negatives: Once the tumour is out, there's no way of knowing how effective the chemotherapy is. You can have the tumour tested to see which chemotherapy drugs it responds to but this is very costly.
Chemotherapy first / surgery after:

  • Positives: Your Oncologist will be able to see if your tumour is shrinking and whether the chemotherapy is working. This way round is also useful where a tumour is so large that it needs to be shrunk before removal and may mean that the patient can have a lumpectomy rather than a mastectomy.
  • Negatives: The cancer is in your body and if it doesn't respond to the chemotherapy, it may continue to grow. Obviously you would hope that your medical team would act swiftly in this case to change your drugs or move to surgery.