Making Decisions About Surgery
After diagnosis, you will need at least one surgery to remove the breast cancer. The surgery may be a breast-conserving surgery, called lumpectomy, or mastectomy, which removes the entire breast or breasts.
In some cases you have a choice about which surgery to get. There are advantages and disadvantages to each type of surgery.
When you have a choice of surgeries, it may be a relief, or it might feel nerve-racking and uncertain. Please know either response is normal. If you feel uncertain at all, it’s OK to ask why you have both options. This is also the best time to discuss options for rebuilding your breast, or breast reconstruction, if this is of interest to you.
1. How important is it to you to keep your breast? Is your breast essential to your self-image and identity? Consider the role of your breast in your relationship with your partner or future partners. If you want, ask for your partner’s input (but remember, this is your decision).
2. What is the risk of this cancer coming back in a distant area of the body? What were the outcomes in past clinical trials for people who had the surgery you want?
3. How do you feel about your risk for local recurrence? In some cases, lumpectomy may put you at higher risk than mastectomy for the cancer coming back in the same place. If so, what is the difference in risk?
4. How would you feel if removing the cancer takes more than two surgeries? What if only one more surgery would be needed?
5. How does the size of the cancer compare to the size of your breast? Ask how your breast is likely to look following lumpectomy. Your doctor may even have photos. Are you pleased with the outcome, or would you rather have a mastectomy with reconstruction?
6. How could your other treatments impact your choice of surgery? Ask if treatment before surgery is an option and, if so, whether you could then get a lumpectomy. Radiation therapy could affect the choice and timing of reconstruction.
7. Can you have radiation therapy? Lumpectomy must be paired with radiation for you to get the benefit you would receive from mastectomy alone.
8. Where is the cancer in your breast? Your mammogram may show calcifications, tiny clusters of hard calcium associated with ductal carcinoma in situ or DCIS and invasive cancers. If they are in more than one area, you may need more surgery.
9. Are you at very high risk for a future breast cancer? Possible reasons include a known BRCA mutation or a strong family history of breast or ovarian cancer. Are there other ways to improve your chances for living cancer-free?
10. Will removing your breast (or breasts) make you less worried about your risk for recurrence? Even if lumpectomy and mastectomy work equally well in cases like yours, you may simply feel better removing your breast.