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When a woman’s breast cancer is small enough to make her a candidate for a lumpectomy followed by radiation, why would she choose a mastectomy?

With early detection, over 70% of women diagnosed with breast cancer may be candidates for a lumpectomy or other breast conserving surgery. Still, over half this number opt for mastectomies…why? The reasons are many and include:

  • Not knowing they have a choice
  • Living in a rural area and having to travel a substantial distance to access radiation Monday through Friday for 6+weeks would be a hardship
  • Cost- lumpectomy and radiation cost more in the short-term than a mastectomy and some insurance plans will not cover all the expenses related to breast conservation surgery. In keeping with the 1998 law mandating reconstruction coverage, insurance companies will cover reconstruction following a mastectomy.
  • Unable to have radiation therapy following a lumpectomy because of other medical conditions such as heart disease or lupus.
  • Fear of radiation and its side effects such as fatigue and skin burn
  • Fears about loss of work time, or inability to care for family during course of radiation treatment
  • Believing that a mastectomy offers greater protection from recurrence
  • Wanting to put the entire breast cancer experience behind them as quickly as possible

Hopefully, each woman who is a candidate for breast conservation therapy will have a surgeon who takes the time to review the pros and cons of both a lumpectomy and a mastectomy. Mastectomy would be the obvious choice when other medical conditions preclude radiation therapy. While travel distance, cost factors, and job and family responsibilities might also make a mastectomy the better choice, the surgeon may be able to allay a woman’s fears about recurrence rates by citing studies that demonstrate the recurrence rates following mastectomy and lumpectomy.

If a woman has the choice between a lumpectomy and a mastectomy, then she needs to have these procedures explained in detail, not only the surgeries themselves, but what she can expect following these surgeries. She needs to know  following a lumpectomy what her breast may look like following the surgery; following radiation, and what reconstruction options are available to her should she be dissatisfied with appearance of her breast. She needs to know the pros and cons of reconstruction if she choose to have a mastectomy. What will be the length of the surgery if she has reconstruction at the same time as having her breast removed? What are the chances of her needing multiple surgeries following the initial reconstruction?

While this is a large amount of information to sift through following a diagnosis of breast cancer, this information is critical if a woman is to make an informed choice.


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