Lumpectomy vs. Mastectomy: Only You Can Choose

PJ Hamel Health Guide October 19, 2006
  • Though a diagnosis of breast cancer–-any cancer–is shocking, you’ll find that you’re not allowed to remain immobilized by that shock for very long. The clock has started ticking… your cancer needs to be treated. And although breast cancer is one of the slower-growing types–-that tumor may have been growing for as long as eight years before it became detectable–-you still won’t want to wait too long before hopping onto the treatment train.

    Sometimes your particular cancer is straightforward enough that the treatment path is clear: the tumor is too big for a lumpectomy, so you have a mastectomy. Or you’ve got a very small DCIS, and all kinds of research shows that a lumpectomy should do the trick for you. But other cancers are more involved: a small tumor in a tough place to reach, a couple of identified tumors, the possibility of lymph node involvement… Thus, one of the first decisions you may be asked to make is, lumpectomy or mastectomy?


    Wait a minute–what do you mean, ME make a decision? Won’t my doctor tell me what to do? Surprisingly, no. We’re used to going to the doctor with a sore throat, a skin rash, or a sprained ankle, and being offered a solution: take this medicine, rub on this cream, wear this splint. But here you are, facing a life-or-death decision, and the doc will give you options, then back off and wait for you to choose. And boy, isn’t that a scary prospect! What if I make the wrong choice? What if I have a lumpectomy, and it comes back? What if I have a mastectomy, and it never would have come back? What should I do?

    First and foremost, despite the fact the doctor and surgeon are waiting for an answer, give yourself a few days. You’ll find yourself certain you want a mastectomy (“Just take the whole thing off so I can stop worrying!”), and just as certain you want a lumpectomy (“A lumpectomy spares my breast; I can always have another surgery if the cancer comes back…”) If you’re married, you’ll probably ask your husband what he thinks; and he’ll probably tell you to do what you think is best! If you ask your friends, it can turn into a full-blown debate, each certain her answer is the right one. In the end, the final decision will be made by one person: you.

    So how do you make this decision? You could start by assessing your level of fear. You might hate the fact that there’s cancer in your body. You desperately want it to be gone, every trace of it. A lumpectomy doesn’t sound thorough enough to you; what if a few cells have escaped, and are setting up shop somewhere else in your breast? Or you may be reluctant to expose your body to the radiation that usually accompanies a lumpectomy. You opt for a mastectomy.

    Or you could start by gauging the importance of your body image. You may be very anxious to conserve your breast. You don’t want to wear a prosthesis, or have a reconstructed breast that doesn’t quite match its sister. Your fear of recurrence is secondary to these other considerations, and you opt for a lumpectomy, usually with radiation.


  • Take the time to look deep into yourself for the treatment option that feels right. If you need help, ask your doctor if there’s a service at the hospital that deals with medical decision-making; and if there is, use it. You may be waffling right up to the moment you make that phone call to the surgeon; that’s OK, too. When push comes to shove, you’ll make a decision. Go forward with enthusiasm; don’t second-guess yourself. Have you made the right decision? Yes. You’ve made the decision that’s right for YOU.