Mastectomy vs. lumpectomy

I am no doctor, I grant this, but I am a molecular biologist. And I have done extensive research and talked to many surgeons about this and none of them recomend mastectomy as a first treatment unless absolutely necessary. The consensus among the doctors I consulted is that those who shy from conservative surgery are the ones who do not have the skills to perform it. You say you are an old fashion doctor and it is probably true when you do not consider the impact of such a decision in the lives of the women you recomend this treatment. In a paternalist society the needs of a woman are not that important, are they?
Medicine, like other sciences, do progress and there is no need to remove the arm when it is your finger which is sick. I do not know if you have gone through a mastectomy yourself, but if not, think that it is easy to recomend this approach when it is not you who are facing this decision. It is terrible for your pacients, who are already in a very fragile state of mind, to be with a doctor so biased. How can they feel secure in your abilities to perform a good surgery if you do not consider safe to do a conservative surgery? You should present them with data, not your bias. The data shows no difference between the two options, so lead a woman to mutilate themselves is absurd. I know many women think that mutilation is too harsh, but that’s the wayI and a lot of other women view it. You should tell your pacients you do not feel confortable performing conservative surgery and send them to someone who is. But you should not influence them when the data contradicts you. Most women do not have access to information as I do and I feel very sorry for them, because when they go back to normal life, they will be constantly reminded in a very unpleasing way of their condition. If they can go back to normal life.
I am glad for my doctors who do not try to influence me, but give me the options supported by data.
The reality is that some women may not care about their physical apperance, but many of us do and that should be respected, specially by a doctor.

PS. I sent this so fast that I didn’t pass the spelling tool. So there are a lot of mistakes. Forgive me for them.

Denise rocks, as far as I’m concerned. But, I chose mastectomy for the reasons cited in the original article. It may not have been the best choice for my figure, but it was the best choice for my head.

I agree that women who are diagnosed with breast cancer should think about mastectomy. I’d bet there aren’t very many women who receive a diagnosis a bc who don’t think about mastectomy even if they decide for them that a lumpectomy is a better choice.

However, I disagree with this “The decision is yours, but choose to live healthy without fear and without a breast, than with a breast that can kill you in any moment”.

You are ignoring the fact that even if women choose mastectomy, their cancer can come back - at the mastectomy site, in the other breast which you say you would leave, or in a distant site.

You seem to imply that if the surgeon removes the affected breast that the woman is “CURED” of cancer. That’s simply not true.

For Denise:
As I said in another place: Thank you for your comments. There is no problem with the mistakes, I’m not a native English speaker and I understood very well what you said. So, as far as I’m concern, there are no big mistakes in your post.
I know there are people disagreeing with me. I can find thousands of articles and books and surgeons and patients. And I didn’t say I am definite right. I just said my opinion, based on my experience and I don’t have any refrences.
I know it’s an awful thing to lose a breast. I can’t even imagine the entire tragedy. Especially for a tumor in early stages. But that patients have the best chances of living free of disease. I saw many women treated with conservative surgery for early stage breast cancer and their cancer came back in a very short time.
I saw women who decided they want bilateral mastectomy because they had cancer in one breast and some benign lesions in the other. I admit I tried to show them other posibilities, because I belive this method is too much.
Concerning my patients. I present them only data, I leave them the decision, but if they ask me for my PERSONAL opinion I tell them what I wrote above. Many women don’t ask for my opinion. They want to know data, statistics and they decide for themselves, if they can choose (some of them are forced by their disease to accept a mastectomy). I never tried to influence that decision. But I can have my personal opinion as you can have yours.
Thank you for your message, it meant a lot for me and it really made me think. And that’s a great thing.
Cristiana

For Jennifer:
This article was written with my head forgetting about my heart. Because a doctor shoud think clear, his feelings are bad for his patients.
Thank you so much for your message.
Cristiana

For SharonK:
Tha majority of women who can choose lumpectomy are in early stages of cancer and they really are curable. Not all of them will be cured with mastectomy and I’m sorry I implied them. But, in my personal opinion, many of them would have a better chance.
I’m not ignoring the fact their cancer could come back, but I guess (or know) that is more likely to happen in the neighbourhud of the first tumor, in the same breast. And I try to reduce the chances, because I can’t protect my patients for good.
Thank you for your opinion, it is also important for me and my way of thinking.
Cristiana

Last year I was diagnosed with stage 4 metastatic breast cancer, after 8 years of remission from the primary bc. I have very early ductal carcinoma insito, stage one, 1 cm tumor, and the two lymph nodes tested showed no sighns of cancer. I was told all I needed was a lumpectomy, radiation, and then Tomoxafin.

If only I knew then what I know today. I’d have had a full mastectomy, and chemo without hesitation! The trouble is, I can’t do it over again, and with the metasized form of bc cancer spread to my lungs and ribs, even though this too was an early diagnosis, and with no real way to put the cancer this time in remission, though I can temporarily keep it at bay, whatever life I have ahead will be one chemo after another until there is little left to do about it. Aremedix and other hormone inhibitors have begun to fail after only a year.

We are fooled into thinking early detection will save our lives. Sure it will but only if we treat that cancer as aggressively as we do more advanced ones — with mastectomy, and definately with chemo. Two treatments though unpleasant and evasive might have preventive the reoccurance. I’ll trade the temporay loss of hair, and the permanent loss of one or both breasts for life any day.

Loraine Mirza

Dear Loraine,
Thank you for your kind words. Thank you for sharing your painful experience with me and my readers. That means a lot for me, because it shows me there are women understanding what I want to tell them. I don’t want to be part of any unneccesary mutilation, but I want for other women to know an opinion based on experience and, maybe, fear for life.
I only hope that soon a treatment for you will show up. You live in US where everything is possible. And if this treatment will appear, it will be in US. So don’t stop hopping, you know, things aren’t over until they are over.
It’s very true me and nobody can tell you that chemo and mastectomy then would have cured you. But I strongly believe the chances would have increased. Unfortunatelly we can’t turn the time back so we are living with the decisions we made.
Good luck for you. You are in my mind and prayers.
Cristiana

I was diagnosed with stage 2 DCIS in November of 2006 after my annual mammogram. I was considered “high risk” for breast cancer since my mother died of breast cancer at at the at of 25 in 1963. I am now 48 - so I’ve out lived my mother, but am still facing the dreadful disease that she did, but thankfully, cancer research has made some progression since these last 40 plus years. My mother had a radical mastectomy - something they did for every woman back at that time who was diagnosed with breast cancer. I had a lumpectomy right after Thanksgiving. The pathology report findings indicated that besides the original tumor that was excised, a satellite tumor was found, meaning that the cancer was beginning to spread. Additionally, there were many pre-cancerous cells that were starting to invade my lymph spaces (not nodes) and I would be subjected to any of these pre-cancerous cells growing into another malignant tumor. I also had a sentinel node dissection and the results were that I was node negative. I decided to have a second opinion done at UCSF and explore other options that were availble to me. I originally was determined to have another lumpectomy, but because of the invasive nature of my cancer, if I had a lumpectomy, it would mean that I could possibly need to go through numerous surgeries to remove additional tumors as they were discovered. I discussed the options with my oncologist. I learned that my cancer, flouished in the presence of estrogen, was not profoundly affected by chemotherapy (determined by the Oncotype Assay DX). My oncologist told me that after reviewing the results from the Oncotype test, chemotherapy would give me a 2% cure rate. Learning about the effects of chemo - I thought that going through chemotherapy would be a lot of work and possible damage to my body for only a 2% cure rate. My oncologist also advised me that if I were to have a mastectomy, the cure rate from the procedure would be 90% and I would not need to have radiation therapy. So, I opted to have a simple mastectomy with reconstruction on March 7, 2007. I am happy with the decision I made, however, it’s still taking me a bit to get used to the altered landscape of my body and realizing that things will never be the same again. I am also taking Femara, an aromatase inhibitor. I’ve read accounts from other women who have taken this medication and experienced undesireable side-effects. So far, I haven’t experienced much else but some muscle aches, hot flashes and fatigue and I’m hoping that’s all I’ll have to deal with. So - the question lumpectomy vs. mastectomy? I didn’t want to lose my breast, but thinking about what I would need to subject my body to, the mastectomy was the best choice for me.

Folks often don’t want to hear from those of us who have reoccurant bc because if it is the metastic form there isn’t at this time a lot of good news for us. So the great chants “I am a survivor” and cheer leaders running off to marathons and saying “Early Detection” almost means you can “beat this,” is no longer the refrain.

I’m not here to make you feel sorry for me. Just because I face my reality head on doesn’t mean I’m depressed or ready to pack it up.

So why I am here, being as outspoken as I am? Perhaps I can could possibly help those whose primary bc is detected in its early stages and save them from ending up as I am. The idea of mastectomy is unpleasant. Chemo is miserable. But giving up a breast or breasts could end up life saving. Look at all those women, just a bit older than I am who had the old treatments…. every breast cancer was treated with a mastectomy. Some of those women didn’t even get chemo, and those who did, got massive doses with horrible but temporary side effects and very little help in relief from those side effects. So why did more of these women live to ripe old ages? Mastectomy of course.

I also advocate chemo and since now-a-days there are less aggressive chemos and lots of meds to counter some of the side effects, it is well worth the temporary discomfort.

Now what about those hormone inhibitor meds such as Tomoxifan, Aremedix and Aromasin? If they are used after aggressive treatment, of course for those estrogen postive women they may give her an even better chance. The trouble is, often they are used in place of more aggressive treatment.

Best Regards, Loraine

Dear Mercy,
I’m sorry to hear about your diagnosis but I’m impressed how many things do you know about your disease, I believe you are recieving a great treatment and you have a great chance at defeating this damn disease.
Thank you for sharing your experience with me and my readers. I will keep you in my mind.

Dear Loraine,
You indeed are in my mind for a while now. I’m thinking about you every time I’m writing here and I’m thinking of you every time I talk with a patient with cancer. You helped me to understand many things about living with cancer and that’s extremly important for me.
Thank you,
Cristiana

Interesting reading here. And, of course each woman must make her own choice.

I was diagnosed in February 2007 with cancer in my left breast - did all my online homework before seeing a surgeon and had already made my decision.

I wanted both of those suckers gone!!! I’m not a very good patient to begin with, I have a terrible aversion to needles and surgery and I certainly wasn’t going to do that more than once. Too much of my research showed that even with a mactectomy on the affected side - it would later show up on the other side. I did have node involvement on the left side. No cancer was found on the right side. If my surgeon had not readily agreed to the bilateral - I’d have found another surgeon, but he was great and totally respected my wishes.

I realize a bilateral mactectomy has not necessarily cured me. I’m still undergoing chemo, and Herceptin and will do Arimidix.

I do not feel “mulitated”, I certainly do not feel less of a woman and my self confidence is intact.

Though our society promotes women’s breasts as the greatest thing since sliced bread - there is more to life. And, life is the whole point with me.

Iris

My surgeon called me last week to give me the news. I sure the same news that all of you have also been given. I had a biopsy for a 2cm tumor. I find out tomorrow the details of my bc, however my mind is made up. I plan on a bilateral macectomy. I am 44 years old - and I want to see what 84 years old looks like. I do not want to take the risk of a less agressive treatment. My life and health are more important to me than my breast. Last year I became a widow. I know that my husband would be supportive of this desicion. I really doubt that I will ever find another Mr. Right, but if my breast made a difference - then he is no Mr. Right. I know that I will feel the same about my body. I will have peace of mind that I can not have with out the bilateral macectomy. I know that it will not prevent bc from ever coming back, but I know of a lot of women much older than me that had the procedure years ago and are still cancer free. I just can not risk my life for the sake of my keeping “my girlish” figure.