Surgery is a common treatment option for most breast cancer patients. Depending on the tumor’s size, location and spread, the procedure performed may be a lumpectomy (removal of the tumor, surrounding breast tissue and possibly nearby lymph nodes) or a mastectomy (removal of one or both breasts, along with nearby lymph nodes).
City of Hope offers the latest advances in surgical approaches to treating breast cancer. Our leading-edge technology and our surgeons' expertise means you can achieve outstanding outcomes that are not possible elsewhere. This includes breast cancer surgeries with fewer and smaller incisions, reducing discomfort and recovery time. Our minimally-invasive approach also allows patients to be treated sooner with post-surgery treatments, such as follow-up radiation and drug therapy.
Listen as Amy Polverini, MD discusses your Surgical Options for Breast Cancer to find the one that best suits your cancer and your lifestyle.
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Lumpectomy vs Mastectomy: Making the Decision
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Learn more about Amy Polverini, MD
Amy Polverini, MD
Amy Polverini, MD graduated summa cum laude from Loyola Marymount University in Los Angeles, where she was the recipient of multiple honors and awards, including a scholarship from the Department of Biology Bioethics and Science Research Fellowship at USC Keck School of Medicine. Dr. Polverini went on to receive her medical doctorate from Keck School of Medicine, followed by a general surgery residency at Harbor UCLA. She completed her training in breast surgical oncology at City of Hope.Learn more about Amy Polverini, MD
Transcription:
Lumpectomy vs Mastectomy: Making the Decision
Melanie Cole (Host): If you’ve recently been diagnosed with breast cancer and as surgery is a common treatment option for many breast cancer patients, decisions about what type of surgery may depend on many factors. My guest today is Dr. Amy Polverini. She’s an Assistant Clinical Professor in the Division of Surgical Oncology in the Department of Surgery at City of Hope. Welcome to the show, Dr. Polverini.
Dr. Amy Polverini (Guest): Hi, thank you.
Melanie: Let’s start with this diagnosis of breast cancer and the decision about surgery, how do you speak to patients about the many types of surgery out there and which type might be best for them?
Dr. Polverini: In general for patients, especially with early stage breast cancer, there’s two main treatment branches that I discuss. The first would be breast conserving therapy, which basically means we take out the tumor, but we’d leave the majority for the breast tissue behind so the patient still has their own breast. The other option is a mastectomy, which means removing the breast in its entirety, and we can do that with or without reconstruction. Generally, a lot of this comes down to a personal decision for the patients, especially in early stage breast cancer as they’re likely candidates for both, but other things that would influence this are things like breast size, how extensive is the cancer within the breast, so all of those things come into play when patients have to have this decision.
Melanie: Certainly if it’s a very aggressive type you’re going to recommend one type versus the other, but let’s start with lumpectomy, what is involved in a lumpectomy?
Dr. Polverini: A lumpectomy, or breast-conserving therapy -- and those are used interchangeably -- with the lumpectomy, the patient -- most of the time they undergo some sort of localization preoperatively, especially if the cancer is small, where a Radiologist will place a wire or some sort of localizing device into the cancer that needs to be removed, and the patient will be taken to the operating room, and we dissect down, identify where the tumor is, and remove the tumor. We like to include a small margin of healthy tissue. Following that, the patient’s breast tissue is closed up. Everything is closed from the inside-out. Generally, this tends to be an outpatient surgery as long as the patient doesn’t have any severe other medical conditions going on and the patient’s allowed to return home the same day. Patients tend to recover really well from this operation, maybe some soreness, but overall a lumpectomy is definitely a great option when we can proceed with that.
Melanie: Women hear the word mastectomy, they hear in the media about prophylactic mastectomies, but then they hear things like nipple-sparing mastectomies, so speak about that word, which can be so scary for women, but might not be quite as much as it used to be.
Dr. Polverini: Absolutely, absolutely. With the mastectomy – so we’re talking about removing all of the breast tissue – there’s different ways that we can do that. Most commonly -- there’s something called a simple mastectomy, or a total mastectomy, and in that procedure, we remove all of the breast tissue along with the nipple and the areola, which is the pigmented skin around the nipple, and then most of the skin of the breast. Then we close the breast layers back together so that – the breast tissue’s been removed, the nipple is gone, and it’s basically a flat incision on the chest wall. There’s other types of procedures that we do now, as well. One is called a skin-sparing mastectomy, and the other is a nipple-sparing mastectomy. These are generally mastectomies where we do an immediate reconstruction with a plastic surgeon at the same time.
With the skin-sparing mastectomy, what we’re able to do is, again, we remove all of the breast tissue, we remove the nipple and the pigmented area around the nipple, but then we keep the majority of the skin, so the envelope of the breast is still intact. When we do skin-sparing mastectomies – once the cancer surgeon is done removing the breast and the other things I mentioned, then the plastic surgeon comes in and they can do an immediate reconstruction, usually in the form of an implant, where they lift the muscles off of the chest wall, put in an implant, close everything up, and they are able to match it fairly well with the other breast. Now, with the nipple-sparing mastectomy, what we do is we actually keep everything in place, we do a small incision under the nipple or at the base of the breast, and then we remove the breast tissue, but patients get to keep all of their skin, their nipple, the areola, everything is in place, so it’s removed through a small incision, and again, that’s accompanied by reconstruction generally in the form of an implant. Those are the main types of mastectomy that we do.
Another type that patients will sometimes hear is something called a radical mastectomy. In this case, it’s a simple mastectomy, so we’re removing excess skin, nipple, areola, but we’re also including the removal of multiple lymph nodes in the underarm. That’s the modified radical mastectomy.
Melanie: And does that increase a women’s chance of lymphedema?
Dr. Polverini: Yes, the more lymph nodes that we remove, the chances of lymphedema are increased especially in the setting of adding any radiation in after surgery. Lymphedema tends to be something that’s very scary, it’s a scary risk for the patient, and rightfully so, but fortunately nowadays we’re becoming better and better in terms of how we treat lymphedema, and there’s a very proactive approach we take towards it. There’s even specialized surgeons now that do a microvascular surgery where they basically are able to help the lymphatic flow from the underarm by adding extra lymphatics for the arm to drain. But yes, lymphedema is something when we’re removing multiple, multiple nodes that we need to be concerned with after surgery.
Melanie: Dr. Polverini, you mentioned reconstruction at the same time that you’re doing surgery, and many patients might be unaware that breast cancer reconstruction surgery is an option.
Dr. Polverini: Absolutely. I always discuss reconstruction in the setting of a mastectomy. There are some patients who do not want reconstruction, and that’s totally fine. It’s a completely personal decision, but all patients are generally eligible to get a reconstruction especially in the immediate setting. When I say the immediate setting – if a patient – if there’s a thought that they will require radiation after their mastectomy, most of the time what we will do is we will do a reconstruction after their radiation is completed, so again, they are eligible for a reconstruction, absolutely, but we wait until after radiation is completed for them to proceed with that because radiating freshly reconstructed breasts increases risk for contraction and infection and things like that, so after radiation they would come back and proceed with a delayed reconstruction.
Melanie: So wrap it up for us, Dr. Polverini about the most appropriate type of surgery, how you discuss it, what you want patients to know about the personality of their cancer, and what’s acceptable to them in terms of a long-term peace of mind when you’re talking about breast cancer surgery?
Dr. Polverini: I approach this, and I always encourage patients to listen with an open mind and reinforce to patients that no two breast cancers are the same. Most of the time, because 1 in 8 women develop breast cancer, patients will come in with multiple friends or relatives that they’ve had experience with in terms of undergoing cancer treatments, radiation, surgery and they come in with this preset notion of how breast cancer acts and how it’s treated. I have to wipe the slate clean for all of my patients, and I just sit down and have a discussion regarding their specific cancer and what options for treatment are open to them.
The most common request I’ll get after speaking with patients is I will give them their surgical options and they say, “What would you choose?” And I always have to decline giving an answer because truly it is up to the patient and both options are there for the patient in terms of a lumpectomy versus a mastectomy. I think a lot of it involves the patient’s own concerns and risks in terms of cancer coming back and we know that no matter what you choose, the survival is the same. They’re both excellent options in the treatment of early stage breast cancer, so lumpectomy and mastectomy, the reason we give patients those options is they’re both great options, but when it comes down to it, some patients want to proceed with an outpatient surgery where the recovery time is quicker, and they get to keep their breast with the caveat that they will require, in most cases, radiation, but they’re comfortable with the fact that they get to keep their breast and it’s a smaller procedure in general.
Other patients, they do not want to undergo radiation, that’s one reason, and sometimes just because they’re so fearful of cancer coming back that they proceed with a mastectomy knowing that this is a slightly larger procedure, but that they do have options with reconstruction and such. It really comes down to a very personal decision, and I think at the end of the day when patients hear and understand their cancer and understand their treatment options, they’re able to come to a really well-thought out decision. I really encourage patients to make their own decision from everything they’ve heard, and they’ve experienced with others, and as long as they’re making a decision that they feel comfortable with, I always reassure them that they are going to be followed and seen by a clinician. I typically see my patients every six months for the first few years after surgery, and that also helps to decrease their anxiety in regards to breast cancer developing or recurring once again, and they know that they’re followed very, very closely. It’s all a matter of the patient’s own comfort level and just reassuring them in terms of their own decision.
Melanie: Thank you, so much, Dr. Polverini, for being with us today. It’s really important, and such great information. You’re listening to City of Hope Radio, and for more information, you can go to CityofHope.org, that’s CityofHope.org. This is Melanie Cole. Thanks, so much, for listening.
Lumpectomy vs Mastectomy: Making the Decision
Melanie Cole (Host): If you’ve recently been diagnosed with breast cancer and as surgery is a common treatment option for many breast cancer patients, decisions about what type of surgery may depend on many factors. My guest today is Dr. Amy Polverini. She’s an Assistant Clinical Professor in the Division of Surgical Oncology in the Department of Surgery at City of Hope. Welcome to the show, Dr. Polverini.
Dr. Amy Polverini (Guest): Hi, thank you.
Melanie: Let’s start with this diagnosis of breast cancer and the decision about surgery, how do you speak to patients about the many types of surgery out there and which type might be best for them?
Dr. Polverini: In general for patients, especially with early stage breast cancer, there’s two main treatment branches that I discuss. The first would be breast conserving therapy, which basically means we take out the tumor, but we’d leave the majority for the breast tissue behind so the patient still has their own breast. The other option is a mastectomy, which means removing the breast in its entirety, and we can do that with or without reconstruction. Generally, a lot of this comes down to a personal decision for the patients, especially in early stage breast cancer as they’re likely candidates for both, but other things that would influence this are things like breast size, how extensive is the cancer within the breast, so all of those things come into play when patients have to have this decision.
Melanie: Certainly if it’s a very aggressive type you’re going to recommend one type versus the other, but let’s start with lumpectomy, what is involved in a lumpectomy?
Dr. Polverini: A lumpectomy, or breast-conserving therapy -- and those are used interchangeably -- with the lumpectomy, the patient -- most of the time they undergo some sort of localization preoperatively, especially if the cancer is small, where a Radiologist will place a wire or some sort of localizing device into the cancer that needs to be removed, and the patient will be taken to the operating room, and we dissect down, identify where the tumor is, and remove the tumor. We like to include a small margin of healthy tissue. Following that, the patient’s breast tissue is closed up. Everything is closed from the inside-out. Generally, this tends to be an outpatient surgery as long as the patient doesn’t have any severe other medical conditions going on and the patient’s allowed to return home the same day. Patients tend to recover really well from this operation, maybe some soreness, but overall a lumpectomy is definitely a great option when we can proceed with that.
Melanie: Women hear the word mastectomy, they hear in the media about prophylactic mastectomies, but then they hear things like nipple-sparing mastectomies, so speak about that word, which can be so scary for women, but might not be quite as much as it used to be.
Dr. Polverini: Absolutely, absolutely. With the mastectomy – so we’re talking about removing all of the breast tissue – there’s different ways that we can do that. Most commonly -- there’s something called a simple mastectomy, or a total mastectomy, and in that procedure, we remove all of the breast tissue along with the nipple and the areola, which is the pigmented skin around the nipple, and then most of the skin of the breast. Then we close the breast layers back together so that – the breast tissue’s been removed, the nipple is gone, and it’s basically a flat incision on the chest wall. There’s other types of procedures that we do now, as well. One is called a skin-sparing mastectomy, and the other is a nipple-sparing mastectomy. These are generally mastectomies where we do an immediate reconstruction with a plastic surgeon at the same time.
With the skin-sparing mastectomy, what we’re able to do is, again, we remove all of the breast tissue, we remove the nipple and the pigmented area around the nipple, but then we keep the majority of the skin, so the envelope of the breast is still intact. When we do skin-sparing mastectomies – once the cancer surgeon is done removing the breast and the other things I mentioned, then the plastic surgeon comes in and they can do an immediate reconstruction, usually in the form of an implant, where they lift the muscles off of the chest wall, put in an implant, close everything up, and they are able to match it fairly well with the other breast. Now, with the nipple-sparing mastectomy, what we do is we actually keep everything in place, we do a small incision under the nipple or at the base of the breast, and then we remove the breast tissue, but patients get to keep all of their skin, their nipple, the areola, everything is in place, so it’s removed through a small incision, and again, that’s accompanied by reconstruction generally in the form of an implant. Those are the main types of mastectomy that we do.
Another type that patients will sometimes hear is something called a radical mastectomy. In this case, it’s a simple mastectomy, so we’re removing excess skin, nipple, areola, but we’re also including the removal of multiple lymph nodes in the underarm. That’s the modified radical mastectomy.
Melanie: And does that increase a women’s chance of lymphedema?
Dr. Polverini: Yes, the more lymph nodes that we remove, the chances of lymphedema are increased especially in the setting of adding any radiation in after surgery. Lymphedema tends to be something that’s very scary, it’s a scary risk for the patient, and rightfully so, but fortunately nowadays we’re becoming better and better in terms of how we treat lymphedema, and there’s a very proactive approach we take towards it. There’s even specialized surgeons now that do a microvascular surgery where they basically are able to help the lymphatic flow from the underarm by adding extra lymphatics for the arm to drain. But yes, lymphedema is something when we’re removing multiple, multiple nodes that we need to be concerned with after surgery.
Melanie: Dr. Polverini, you mentioned reconstruction at the same time that you’re doing surgery, and many patients might be unaware that breast cancer reconstruction surgery is an option.
Dr. Polverini: Absolutely. I always discuss reconstruction in the setting of a mastectomy. There are some patients who do not want reconstruction, and that’s totally fine. It’s a completely personal decision, but all patients are generally eligible to get a reconstruction especially in the immediate setting. When I say the immediate setting – if a patient – if there’s a thought that they will require radiation after their mastectomy, most of the time what we will do is we will do a reconstruction after their radiation is completed, so again, they are eligible for a reconstruction, absolutely, but we wait until after radiation is completed for them to proceed with that because radiating freshly reconstructed breasts increases risk for contraction and infection and things like that, so after radiation they would come back and proceed with a delayed reconstruction.
Melanie: So wrap it up for us, Dr. Polverini about the most appropriate type of surgery, how you discuss it, what you want patients to know about the personality of their cancer, and what’s acceptable to them in terms of a long-term peace of mind when you’re talking about breast cancer surgery?
Dr. Polverini: I approach this, and I always encourage patients to listen with an open mind and reinforce to patients that no two breast cancers are the same. Most of the time, because 1 in 8 women develop breast cancer, patients will come in with multiple friends or relatives that they’ve had experience with in terms of undergoing cancer treatments, radiation, surgery and they come in with this preset notion of how breast cancer acts and how it’s treated. I have to wipe the slate clean for all of my patients, and I just sit down and have a discussion regarding their specific cancer and what options for treatment are open to them.
The most common request I’ll get after speaking with patients is I will give them their surgical options and they say, “What would you choose?” And I always have to decline giving an answer because truly it is up to the patient and both options are there for the patient in terms of a lumpectomy versus a mastectomy. I think a lot of it involves the patient’s own concerns and risks in terms of cancer coming back and we know that no matter what you choose, the survival is the same. They’re both excellent options in the treatment of early stage breast cancer, so lumpectomy and mastectomy, the reason we give patients those options is they’re both great options, but when it comes down to it, some patients want to proceed with an outpatient surgery where the recovery time is quicker, and they get to keep their breast with the caveat that they will require, in most cases, radiation, but they’re comfortable with the fact that they get to keep their breast and it’s a smaller procedure in general.
Other patients, they do not want to undergo radiation, that’s one reason, and sometimes just because they’re so fearful of cancer coming back that they proceed with a mastectomy knowing that this is a slightly larger procedure, but that they do have options with reconstruction and such. It really comes down to a very personal decision, and I think at the end of the day when patients hear and understand their cancer and understand their treatment options, they’re able to come to a really well-thought out decision. I really encourage patients to make their own decision from everything they’ve heard, and they’ve experienced with others, and as long as they’re making a decision that they feel comfortable with, I always reassure them that they are going to be followed and seen by a clinician. I typically see my patients every six months for the first few years after surgery, and that also helps to decrease their anxiety in regards to breast cancer developing or recurring once again, and they know that they’re followed very, very closely. It’s all a matter of the patient’s own comfort level and just reassuring them in terms of their own decision.
Melanie: Thank you, so much, Dr. Polverini, for being with us today. It’s really important, and such great information. You’re listening to City of Hope Radio, and for more information, you can go to CityofHope.org, that’s CityofHope.org. This is Melanie Cole. Thanks, so much, for listening.