Double Mastectomy vs. Lumpectomy

Getting a breast cancer diagnosis is one of the most traumatic times in a woman’s life. It can be incredibly scary and emotional, and on top of that, there will be a million decisions you need to make and potentially not a lot of time to make them. One of the decisions you will need to make is choosing the best cancer removal surgery for you. Depending on the tumor size, location, and if it has spread, you may consider a lumpectomy, unilateral mastectomy (removing just one breast), or double mastectomy (removing both breasts). These surgical options, though all can be effective in treating breast cancer, differ significantly in surgical approach, physical and mental impact, and long-term aesthetic outcomes.

Differences Between a Double Mastectomy vs. Lumpectomy

While you have more choices than just a double mastectomy vs lumpectomy, we’re going to focus on the two opposite ends of the spectrum to give you the broad strokes of differences between these two procedures; but remember you have additional options. Consult with your oncologist, breast surgeon, and plastic surgeon to find the best course of treatment to secure your health and future happiness with your whole care plan from cancer removal to final restoration.

A double mastectomy after a cancer diagnosis involves the surgical removal of both breasts, including all breast tissue, sometimes preserving the nipple-areolar complex depending on the individual circumstance, and possibly the overlying skin as well. In some cases, a double mastectomy is performed prophylactically to reduce the risk of future breast cancer occurrences. This is an option for women with breast cancer detected in only one breast (contralateral prophylactic mastectomy) or those with a high genetic risk of developing breast cancer, such as carriers of the BRCA1 or BRCA2 gene mutations.

A lumpectomy, also known as breast-conserving surgery or oncoplastic reduction, involves the removal of only the tumor and a surrounding small margin of healthy tissue. Unlike a mastectomy, the goal of a lumpectomy is to preserve as much of the breast as possible. This procedure is typically followed by radiation therapy, which eliminates any remaining cancer cells and reduces the risk of breast cancer recurrence.  Oncoplastic reconstruction is used at the time of lumpectomy to reshape the breast to avoid post lumpectomy/radiation deformities, such a contour depression of nipple-areolar complex displacement.

Deciding Between a Double Mastectomy vs. Lumpectomy

There are multiple aspects to consider when deciding between a double mastectomy vs. lumpectomy; the best course of action is for you to consult with both your oncologist and plastic surgeon early on in the deliberation process. Discussing your options for surgery and any possible reconstructions will help you make better-informed decisions and help you regain a sense of power and autonomy in this difficult time.

Women might consider a double mastectomy in several situations:

Reasons To Choose a Double Mastectomy
Genetic Risk	Women with BRCA1 or BRCA2 mutations or a strong family history of breast cancer may choose a double mastectomy to significantly reduce their risk of developing the disease.
Bilateral Cancer	If cancer is detected in both breasts, a double mastectomy may be the most effective treatment option to ensure the complete removal of all cancerous tissues.
Personal Preferences	Some women opt for a double mastectomy to avoid the possibility of a future breast cancer diagnosis, the need for additional radiation treatments down the road, or additional tissue removal surgeries. For many women, the psychological relief from knowing that the risk of recurrence is minimized plays a major role in ultimately choosing a double mastectomy.

On the other hand, a lumpectomy may be the preferred option for women under the following circumstances:

Reasons To Choose a Lumpectomy
Early-Stage Cancer	For women with early-stage breast cancer, where the tumor is small and localized, a lumpectomy followed by radiation can be as effective as a mastectomy.
Well-Defined Tumor	If there are only a few localized tumors in one breast that are accessible with clear margins, a lumpectomy can offer an effective treatment while preserving the natural breasts.
Cosmetic and Psychological Considerations	Women who prefer to maintain their original breast appearance and feel (as much as possible, depending on tumor size and location) may choose a lumpectomy. Lumpectomy surgery is less invasive and has a shorter recovery time than a mastectomy.

A decision like this will have lasting impacts on your health and emotional well-being for decades to come. That’s why it’s so important to work with a healthcare team with professionals dedicated to empowering women to make the decisions that are the best for their unique circumstances.

Prophylactic Double Mastectomy: Reducing Risk and Anxiety

For some women who would otherwise be good candidates for a lumpectomy, a prophylactic double mastectomy might be the right choice to prevent further anxiety or future breast cancer development. Getting a prophylactic double mastectomy can reduce the risk of future breast cancer by up to 95% in high-risk women, offering significant peace of mind. The decision to undergo a prophylactic mastectomy is incredibly personal and will be based on your personal medical history, family history, and what you consider an acceptable level of stress while you undergo additional monitoring after a lumpectomy.

While a double mastectomy can provide considerable psychological relief and a sense of control over one’s health, it is important to note that this procedure does not improve overall survival rates compared to lumpectomy with radiation. Studies have shown that the 5-year survival rate is similar for women who undergo a double mastectomy and women who opt for a lumpectomy. However, the advantage of a double mastectomy is the elimination of future breast cancer scares, the need for radiation therapy, and the possibility of further breast tissue removal surgeries.

Consult with the Reconstruction Experts at Harris Plastic Surgery

Choosing between a double mastectomy vs. lumpectomy, or any of the treatment options in between, is a deeply personal decision that should be made based on trusted medical advice, your individual risk factors, and personal preferences. While a double mastectomy offers the benefit of reducing the risk of recurrence and alleviating the fear of future cancer diagnoses, it does not offer a higher 5-year survival rate compared to lumpectomy.

Ultimately, the decision should be guided by thorough discussions with expert healthcare providers, like those at Harris Plastic Surgery, who have decades of experience working with women. The surgeons and staff at Harris Plastic Surgery can help you determine the potential physical and emotional impacts of your breast cancer surgery and reconstruction choices; they have a deep understanding of the long-term outcomes associated with each option.