Before cancer, could you have imagined wanting your breasts removed? Absolutely insisting on it, even if a doctor was shaking her head while you sat in front of her in your gown, and telling you “There is no medical advantage”?
Even once you’ve met the “bc” beast face to face, most breast surgeons will tell you, almost always, mastectomy vs. lumpectomy yields the same outcomes—no difference in prognosis moving forward.
Still, many women opt for mastectomy. Understandable; after this invasion, you just feel safer, like having the dead bolt on your front door. This stranger was never supposed to get inside, and now you want to do what you feel you can to keep it out.
I can relate to that fear and doubt, and need to take a full frontal approach. Wanting whatever can give you peace of mind.
Not much before my own diagnosis, I was telling a friend, “I have lumpy breasts. I don’t know a normal lump from a not-normal lump. What am I supposed to do? Go to my ob/gyn for a quick feel every month?”
That was just after the mammogram that, unbeknownst to me, missed the tumor. Three days before my biopsy, another mammogram missed it. (Though I ended up getting a sonogram since I had calcifications and a lump that was poking out of my skin).
After the biopsy, I came for my first pre-op with my pink boxer gloves on, ready for an aggressive plan. I wanted those breasts off. I didn’t trust the technology. I didn’t know my body so well to begin with. And now the girls were like total strangers to me.
But I heard my breast surgeon out when she told me prognosis is rarely different with mastectomy vs lumpectomy, at least for a small to mid size tumor. I did some reading. The studies backed what she was telling me. Mastectomy may increase your comfort level, and common sense tells me it cuts your chance for a second local breast cancer. But lumpectomy with radiation yields the same outcomes as mastectomy. At least as far as likelihood for recurrence in another place [which in the minority (ah, fortunately!) who have recurrence, it does return elsewhere].
It’s a personal choice, either way. I listened to my surgeon and went the lumpectomy route. Mine was a 3 cm-lump. It had spread to two lymph nodes, but taking the breast was not going to keep what had escaped to a couple of nodes from spreading further; that was chemo’s job. I wanted to keep my old body—minus the cancer.
Here are questions to ask yourself before choosing your surgical route (if you are already passed this decision-making bend along your path, maybe this can help someone you know. Or maybe you’ll want to reconsider your own choice moving forward):
How important is aesthetics?
If it’s important for your breasts to match perfectly, know that while it’s possible, no guarantees that reconstruction will yield as close a match as before mastectomy. With lumpectomy, unless you have a very large amount of tissue removed, they will likely look the same or just slightly different after surgery. I have a barely noticeable ding on the side of my breast after having my 3-cm tumor removed.
How much surgery are you willing to undergo?
You may have to go through multiple surgeries following mastectomy if you opt for reconstructive surgery. Though I don’t want to discourage anyone. I’ve talked to women who just LOVE their new ones. One of them was so happy, that when it was all over, she booked a trip to Italy to take the girls out.
How much does the likelihood of another breast cancer weigh on your mind?
Who doesn’t worry? But if removing the entire breast(s) will ease that worry some, it may be the way for you to go.
What are you willing to endure after lumpectomy or mastectomy?
You will more than likely have five to seven weeks of radiation, five days a week, after lumpectomy. Still, recovery is quicker than with mastectomy. Keep in mind though, that opting for radiation may affect whether you are a candidate for some reconstruction surgeries should you later decide on mastectomy and reconstruction.
It’s your decision, your body, your life. Go with what works for you.
Rachel Pappas is a freelance writer. She has a website: www.1UpOnCancer.com. She is also author of Hopping Roller Coasters, about her cancer journey, and her relationship with her daughter, not a normal story, but one with a universal message. http://www.1uponcancer.com/rachels-memoir/