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Breast cancer

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Choosing between breast-conserving surgery and mastectomy

In most cases, a woman will be given a choice between breast-conserving surgery (BCS) and mastectomy.

Studies done over many years have shown that women with stage I or stage II breast cancer who have BCS combined with radiation therapy have the same survival rates as women who have a mastectomy. Having a mastectomy does not provide a better outcome or improve long-term survival in most cases. Given this body of knowledge, doctors will give women a choice between the surgeries, if there is no medical reason to recommend one surgery over the other. Most women with early stage breast cancer have breast-conserving surgery.

For some women, the choice is easy. Other women find making this choice difficult. Some women may want the doctor or a partner to make the decision for them. For many women, the main concern is having the cancer completely removed, so having a mastectomy may give them that peace of mind and assurance. For other women, their breasts are an important part of their identity and self-image as a woman, so breast-conserving surgery may be the best choice for them.

The choice between BCS or mastectomy is a very personal one. Individual preferences, priorities and lifestyle all play a part in making the decision.

BCS and mastectomy both have advantages and disadvantages. It may help to talk to different women who have had each type of surgery.

Advantages and disadvantages of each type of breast surgery
Type of Breast SurgeryAdvantagesDisadvantages

Breast-conserving surgery

BCS is equally effective as a mastectomy (when followed by radiation therapy), in terms of overall survival.

There is less change to the appearance of the breast, though there still may be a scar or changes to the shape of the breast.

BCS is less likely to affect a woman’s feelings about her body image and sexuality.

Some women may be concerned that not all the cancer was removed.

BCS is followed by 4–6 weeks of daily radiation treatments, which lengthens the time a woman receives treatment.

Some women may have difficulty finding transportation to the radiation treatment centre or may have to travel for treatment.

There are potential short- and long-term side effects of radiation therapy.

There is a slightly higher risk of developing a recurrence of the cancer in the remaining breast tissue.

Mastectomy

Mastectomy is equally effective in terms of overall survival as BCS followed by radiation therapy.

Some women may feel assured that there is a better chance that the cancer has been cured when the breast is removed.

In most cases, a woman who has a mastectomy does not require radiation therapy, so radiation treatment side effects can be avoided.

Mastectomy is a longer surgery with a longer recovery time and more potential side effects than BCS.

Surgery is longer if the woman has immediate reconstruction or she will need more surgery if she chooses to have breast reconstruction later.

In some situations, a mastectomy may need to be followed by radiation therapy, so the potential side effects will not be avoided.

The loss of a breast may affect a woman’s feelings about her body image and sexuality.

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