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Local treatment aims to remove the cancer cells in the breast and regional lymph nodes. Two different types of surgery are used to achieve this goal:
A mastectomy removes the tumor along with nearly all the tissue in the breast, while a lumpectomy removes the tumor along with a surrounding rim or margin of normal tissue. In both cases, the axillary lymph nodes (the armpit lymph nodes) are sampled or removed.
The main difference between the two surgeries is that with mastectomy – which removes nearly all the breast tissue – there is no risk for an in-breast recurrence. An in-breast recurrence following lumpectomy can be treated successfully with mastectomy. However, women do not always have a choice about which surgery they will undergo. For example, if a tumor is extremely large or there is extensive calcification in the breast tissue, some patients may require a mastectomy for optimal treatment.
Radiation is usually prescribed after a lumpectomy. If the tumor is large or the lymph nodes are positive for breast cancer, radiation to the chest wall and lymph node regions may also be prescribed after a mastectomy.
Sometimes radiation is given to women with metastasis of cancer to other parts of the body (for example: bone) in order to shrink the cancer and reduce symptoms.
Mastectomy vs. Lumpectomy
In long periods of follow-up, survival rates are equivalent (no difference in risk of distant metastasis or death) no matter which type of surgery a woman undergoes.
Because of the very high risk for a second (or third) breast cancer diagnosis, some women who are diagnosed with hereditary breast cancer choose bilateral mastectomy (surgical removal of both breasts) rather than lumpectomy and radiation. Studies have shown similar survival rates for women with BRCA mutations who undergo lumpectomy and radiation as compared with women who undergo mastectomy. However, mutation carriers who undergo mastectomy are less likely to develop a second breast cancer since the at-risk breast tissue has been removed.