Deciding between lumpectomy and prophylactic bilateral mastectomy for DCIS on one side, intermediate to high grade.
Doctor Answers 4
Choosing between lumpectomy and mastectomy surgeries
most people think that mastectomy is "better" than lumpectomy- but studies have shown that survival is the same for both lumpectomy and mastectomy. The key question I would ask is: how large an area of DCIS do we think is present in your breast? It may be that if the area is small enough, that you could have such a high chance of success with lumpectomy that mastectomy might be much more than you need. Not many patients are counseled that living with mastectomy surgery results for some patients isn't comfortable or easy on a day to day basis (just look at the many questions about fixing mastectomy scars, chronic pain and other complaints here on RealSelf!). Lumpectomy is sometimes actually the better choice if the chance for cure with lumpectomy is high. While you may be worried about the possible chances of having to recuperate from a mastectomy in years to come if you have additional cancer in the future, that may be far less of a problem than living with whatever postmastectomy symptoms you may on a daily basis while caring for your family now. The most important thing is choosing a oncologic breast surgeon to remove the cancer who has low necrosis rates and can deliver the best possible outcome no matter what you choose! Good luck!
Unilateral lumpectomy + radiation vs. Bilateral mastectomy
There are many factors that should be considered in this scenario from both an oncologic, reconstructive, and patient preference standpoint. Unilateral lumpectomy plus radiation vs. bilateral mastectomy are both reasonable oncologic options in many cases, but those options depend on the specifics of your individual case and personal goals. There are also several breast reconstructive options that can be considered congruently with the oncologic options. I would recommend a thorough multidisciplinary discussion with the various involved specialties (medical oncologist, radiation oncologist, oncologic breast surgeon, reconstructive plastic surgeon, etc.) to decide which treatment course is best for your specific case.
Ziyad Hammoudeh, MD
These decisions are made best after meeting with all the specialists involved from, medical oncology, surgical oncology, and plastic surgery before deciding surgical option and ultimately a reconstructive option.
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