If you’ve recently been told that you have breast cancer, a natural reaction can be to request bilateral mastectomies. That isn’t necessarily the wrong answer but in the majority of cases it is not a necessary step. Lumpectomy with radiation is equal to mastectomy from a survival perspective. Picture your cancer being a dandelion in your front yard. You can dig it up by the roots and it is gone (lumpectomy); or you can dig up your whole front yard and it is gone (mastectomy). Both methods got rid of the dandelion.
Who needs to have a mastectomy? Women who have a very large tumor in relationship to their breast volume and women with multiple cancers in their breast.
Who needs bilateral mastectomy? Women who have multiple tumors in both breasts. This is rare however. Women who do not carry a breast cancer gene as the cause of their breast cancer only have a 5% risk of getting breast cancer in the opposite side. Women who do carry a gene however are at greater risk of bilateral disease and may choose to do bilateral mastectomies with some form of reconstruction.
Can I just do lumpectomy without the radiation? It isn’t considered a wise choice for the majority of women unless you have a very, very tiny DCIS (noninvasive cancer) or are quite elderly. Without radiation, 40% of women will have breast cancer back in that same breast within 2 years of the lumpectomy surgery. (So the front yard needs to be treated with something to prevent dandelions from growing again.)
If I choose to do mastectomy can I then get out of chemotherapy? Nice try but no. Chemotherapy is systemic treatment. If needed, it is unrelated to the type of surgery done. It is based on your age, size of the invasive tumor, whether lymph nodes are involved, and other prognostic factors about the cancer itself.
If I have a mastectomy can I have reconstruction and is it covered by insurance? Yes and yes. Thanks to a federal law passed in 1998, reconstruction is a covered benefit and required to be so. There are lots of reconstruction options today too. Implants, as well as taking fat from other parts of your body to rebuild a breast—tummy fat and even hiney fat or thigh fat!! |
