Choosing Between Mastectomy and Partial Mastectomy

© Steven C. Immerman, MD, FACS, 2000

Times When Partial Mastectomy Might Be Inappropriate
Deciding which of the two operations to choose is sometimes a difficult decision. There are certain situations in which partial mastectomy is not recommended, either because the cosmetic result would be too poor to justify the procedure, or the cure rate was not felt to be equivalent to mastectomy in that particular situation.

There are several situations that would provide a relatively poor cosmetic result with partial mastectomy:

• A tumor very close to the nipple which would require removal of the entire center of the breast, including the nipple.
• Removal of a very large tumor, in a small breast, which would leave very little breast remaining.

There are situations when it is unwise or dangerous to give radiation, making the option of partial mastectomy inappropriate.

• During the first six months of pregnancy.
• In a patient who has already had radiation treatments to the breast.

There are also situations that make preservation of the breast unwise because of cancer risk.

• We use the term multicentric cancer to describe the situation where the pathologist sees multiple separate areas of cancer within the biopsy specimen. When this occurs it concerns us because it may represent what is happening in other areas in the breast.
• If the mammograms suggest that there may be other areas of cancer in the breast.
• If negative margins were not obtained on the initial biopsy, and the surgeon is not confident that he will be able to get them with an additional operation.

If your situation is similar to any of those listed above, partial mastectomy may not be the best option for you.

Deciding Surgical Treatment
I have gone through this decision making process with many patients and can share with you some of the concepts that helped them decide how to proceed.

Patients usually choose mastectomy:

• If their concern with the cosmetic change after breast removal is minimal.
• If they live too far away from a facility that provides radiation therapy treatments to make daily travel for five to six weeks practical.
• If they have concerns regarding the long range affects of radiation treatments.
• If they are concerned about the loss of the breast but would prefer reconstruction rather than radiation.
• If their surgeon recommends mastectomy because of the biopsy findings.

Patients choose partial mastectomy:

• If the loss of the breast would cause a major change in their life-style and self image.
• If they truly accept the concept that partial mastectomy offers an equivalent cure rate to mastectomy, and they understand that they have not made the wrong choice if the cancer comes back in the future.
• If their tumor was small, their chance of cure is good, and the surgeon recommends partial mastectomy.