Which breast cancer surgery is right for you?

When someone receives a breast cancer diagnosis, the news can be overwhelming, and it may be difficult to make decisions about what to do next. In some cases, a patient faces a decision between lumpectomy and mastectomy to remove a tumor.

"I explain to patients that my job is to tell them what the options are when there are options," said Jill S. Oxley, MD, FACS, a breast surgeon at Cape Cod Healthcare (CCHC) Breast Surgery - Hyannis and director of Breast Care Services at CCHC. "Fortunately, most women are candidates for a lumpectomy, which goes hand in hand with radiation for the majority of patients. We call that breast-conserving therapy, which is the standard of care for early-stage breast cancer."

Some patients are surprised to learn that studies have shown that there is no difference in survival between breast-conserving therapy versus mastectomy.

"More recent observational studies show there may be a survival advantage to breast-conserving therapy over mastectomy for early-stage breast cancer, although those studies are limited by the fact that they're retrospective," said Dr. Oxley.

Dr. Oxley usually meets patients after they have a diagnosis of breast cancer.

"Sometimes I've met them before the biopsy, but usually they've already had the biopsy," she said. "If the patient comes through our Cuda Women's Health Center, one of the nurse practitioners or physician assistants over there has reviewed their diagnosis with them. They know the diagnosis and they've been given a very basic overview of what may or may not be part of their treatment plan. So, when we are having an initial consult, we're talking about everything, how we got to this point and what to expect moving forward.

"Sometimes there may be more to the diagnosis phase. For example, some women may need an MRI, which is a more sensitive test for women with dense breast tissue, before we make the final surgical decision."

A lumpectomy is outpatient day surgery with a short recovery time, she said.

"Many women prefer the lesser surgery. For women who have early-stage breast cancer and have the option of a lumpectomy, it becomes a personal choice."

A mastectomy is often recommended if the tumor is large relative to the size of the breast, if you are not a candidate for radiation due to a previous lumpectomy or other contraindications, or if you have inflammatory breast cancer, she said.

"Some women who have strong family histories of breast cancer and/or known gene mutations in the family may wait for the results of their genetic testing to make the decision between lumpectomy and mastectomy," said Dr. Oxley.

"I tell patients that we want to keep moving forward. They don't have to decide by the time they leave the office, but the sooner the better," she said. The goal is to perform surgery withing 60 days of diagnosis, for most patients, she added.

In the end, patients need to make the decision that's right for them, said Dr. Oxley.

"Some patients will talk to friends and family, but we always give our newly diagnosed breast cancer patients information about support groups that are available, whether it's through the Cuda Women's Health Center or the American Cancer Society." Patients are also given information about Cape Wellness Collaborative [which provides patients with integrative therapies, nourishing meals, and emotional support services]. The patient or any member of the care team can also reach out to the social workers at the cancer center, if needed.

"There are lots of resources available, but in the end, it is a personal choice," she said.

Dr. Oxley explains in this video why she decided to focus on breast surgery.