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Q: I was recently diagnosed with breast cancer. My surgeon says I can choose between breast conservation or a mastectomy. Which is right for me?

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When it comes to surgery, women face a choice between breast conservation or a mastectomy. In most cases, patients are given a choice because studies have shown survival rates to be the same for both procedures. Therefore, the choice is based on both personal factors and the most effective cancer treatment. The treatment of breast cancer has changed significantly over the years. Our increased understanding of how cancers grow has helped us have more effective treatment, prevention, and earlier detection. Surgeons can be less aggressive with surgery and still achieve excellent results.

Let’s look at each procedure, and some of the factors to consider when making a decision.

Breast Conservation (Lumpectomy)

Breast conservation is the removal of the tumor with some surrounding breast tissue.

When having a lumpectomy, the approach commonly accepted is an onco-plastic technique. This approach aims at complete removal of the tumor, in addition to some cosmetic techniques to preserve the contour of the breast. The onco-plastic approach usually requires a surgeon to have completed additional training, or to work jointly with a plastic surgeon. This technique allows women with larger tumors, who may traditionally have needed a mastectomy, to undergo breast conservation with better results. In addition to preserving the contour of the breast, the incision (where the surgeon will cut) is performed in a location where it will minimize the visibility of a scar. Many breast specialists will attempt to “hide” the scar. If your surgeon does not have experience with these techniques they can work with a plastic surgeon to achieve the same results.

The Mastectomy

A mastectomy is the complete removal of the breast. If you choose to have a mastectomy, the two most commonly cosmetically superior choices are: a nipple-sparing mastectomy or a skin-sparing mastectomy.

A nipple-sparing mastectomy is a procedure that preserves the entire skin overlying the breast (including the skin of the nipple and areola) while removing the breast and most of the ductal tissue beneath the nipple-areola complex. A skin-sparing mastectomy is when the entire breast is removed with the nipple and areola, while preserving most of the skin.

These surgeries can be performed via hidden scars around the nipple or at the fold of the breast, and are combined with immediate reconstruction to deliver excellent cosmetic results.

Remember; all breast cancer patients should have access to options for breast reconstruction. It is a state law.

Axillary surgery

This part of the surgery is when the surgeon checks if the cancer has spread to the lymph nodes in the arm pit region (axilla). In recent years, management of the axilla has changed. In the past, if a patient had a lymph node with cancer in it, the surgeon was required to take out additional lymph nodes. The problem with removing many lymph nodes versus a few is that it increases the risk of lymphedema (or swelling of the lymph nodes). Today, in certain patients, surgeons are no longer required to take out additional lymph nodes even if there is cancer in one or two of them. This makes the risk of lymphedema lower, and is possible because other types of treatments have improved and can help treat the cancer.

Factors to consider

Women should consider the various aspects of each surgical option, ensure that they are comfortable with their healthcare team, and work with their physician(s) to develop a personalized program for treatment.

Surgeons with advanced specializations may be able to provide better guidance and quality of care. Similarly, studies have shown that patients treated by surgeons with high surgical volumes are more satisfied with their care and have improved cancer outcomes. Finally, a multidisciplinary, team-oriented approach with an emphasis on minimally invasive surgery and better cosmetic outcomes also enhances quality of care and survivorship.

NYU Winthrop Hospital, which is a nationally accredited Center of Excellence by the National Accreditation Program for Breast Centers (NAPBC), has specialists trained to treat breast cancer in a multidisciplinary way.

To schedule an appointment, or learn more about the NYU Winthrop Breast Health Program, visit www.nyuwinthrop.org or call 1-866-WINTHROP.

Shubhada Dhage, MD, FACS

Dr. Dhage is the Director of Breast Surgery Services and the Associate Director of the NYU Winthrop Hospital Breast Health Program, an Assistant Professor in the Department of Surgery in the NYU School of Medicine and is fellowship trained in Breast Surgery. Prior to joining NYU Winthrop she was the Co-Director of the NYU Perlmutter Cancer Disparities Program. Dr. Dhage has conducted research in tumor genomics, patient decision-making, cancer survivorship, and surgical training. She serves on several national committees including the American College of Surgeons, the CDC Young Women with Breast Cancer Committee, and Young Survival Coalition. She has presented in national forums, published, and has received grant funding to support her work.