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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.
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 as well.
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 after breast cancer, survival rates are similar for women who undergo lumpectomy and mastectomy.
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. Despite similar survival rates for women with mutations who undergo lumpectomy and radiation as compared with women who undergo mastectomy, mutation carriers who undergo mastectomy are less likely to develop a second breast cancer since the at-risk breast tissue has been removed.