hi Dr. Steen here I am a surgical oncologist in California I have many
hi Dr. Steen here I am a surgical oncologist in California I have many

patients diagnosed with breast cancer who are overwhelmed with the decision
patients diagnosed with breast cancer who are overwhelmed with the decision

between lumpectomy or mastectomy this video is to help you form a larger
between lumpectomy or mastectomy this video is to help you form a larger

overview between the two surgeries to help make a decision about which one may
overview between the two surgeries to help make a decision about which one may

be best for you first of all is important to understand the basic
be best for you first of all is important to understand the basic

terminology a lumpectomy is the term for a surgery that removes a portion of the
terminology a lumpectomy is the term for a surgery that removes a portion of the

breast containing the tumor with the rim of normal breast tissue around it this
breast containing the tumor with the rim of normal breast tissue around it this

is done through a cut in the skin which is sewn shut afterwards
is done through a cut in the skin which is sewn shut afterwards

lumpectomy is always combined with radiation after surgery a mastectomy is
lumpectomy is always combined with radiation after surgery a mastectomy is

removal of all of the breast tissue the majority of mastectomies removed the
removal of all of the breast tissue the majority of mastectomies removed the

nipple and the skin around the nipple with an ellipse of the skin
nipple and the skin around the nipple with an ellipse of the skin

let's talk about survival the first point is that for the properly selected
let's talk about survival the first point is that for the properly selected

patient a lumpectomy with radiation and a mastectomy are considered equivalent
patient a lumpectomy with radiation and a mastectomy are considered equivalent

in regards to how long somebody will survive from their breast cancer
in regards to how long somebody will survive from their breast cancer

lumpectomy has a risk of the tumor regrowing in the same breast because you
lumpectomy has a risk of the tumor regrowing in the same breast because you

left some remaining breast behind if you had a lumpectomy for breast cancer and
left some remaining breast behind if you had a lumpectomy for breast cancer and

radiation to the breast after surgery the risk of cancer regrowing in the same
radiation to the breast after surgery the risk of cancer regrowing in the same

breast is around 10% a mastectomy usually does not need radiation after
breast is around 10% a mastectomy usually does not need radiation after

surgery and the local recurrence rate after a mastectomy is less than 1% since
surgery and the local recurrence rate after a mastectomy is less than 1% since

there is no breast tissue left behind after a lumpectomy with radiation we
there is no breast tissue left behind after a lumpectomy with radiation we

watched closely with mammograms and if something does regrow we catch it early
watched closely with mammograms and if something does regrow we catch it early

and at that point you would need a mastectomy because these recurrences are
and at that point you would need a mastectomy because these recurrences are

caught early and treated before they become dangerous the survival is the
caught early and treated before they become dangerous the survival is the

same as if the entire breast was removed initially and it only becomes an issue
same as if the entire breast was removed initially and it only becomes an issue

of having a regrowth in about 10% of patients so the other 90% will never
of having a regrowth in about 10% of patients so the other 90% will never

have another cancer in the breast this is why lumpectomy is probably the most
have another cancer in the breast this is why lumpectomy is probably the most

common approach to a small breast cancer here are some other differences between
common approach to a small breast cancer here are some other differences between

the two approaches let's talk about surgery on the lumpectomy side the pros
the two approaches let's talk about surgery on the lumpectomy side the pros

are that it's a day surgery you can go home after the surgery mastectomy
are that it's a day surgery you can go home after the surgery mastectomy

typically requires one night in the hospital lumpectomy is a small cut so it
typically requires one night in the hospital lumpectomy is a small cut so it

has a lower risk of wound problems such as skin infections or bleeding
has a lower risk of wound problems such as skin infections or bleeding

mastectomy has a much longer incision and it removes a lot more tissue so
mastectomy has a much longer incision and it removes a lot more tissue so

there is a higher risk of bleeding or wound infections or problems with
there is a higher risk of bleeding or wound infections or problems with

healing of the skin if you need chemotherapy after surgery problems with
healing of the skin if you need chemotherapy after surgery problems with

wound healing can delay chemotherapy which could be bad for your cancer
wound healing can delay chemotherapy which could be bad for your cancer

treatment lumpectomy preserves the sensation of the breast the skin and the
treatment lumpectomy preserves the sensation of the breast the skin and the

nipple after a mastectomy though the remaining breast skin is numb and that
nipple after a mastectomy though the remaining breast skin is numb and that

is permanent this can be an issue for some women lumpectomy surgery is usually
is permanent this can be an issue for some women lumpectomy surgery is usually

the only surgery you need for the breast cancer
the only surgery you need for the breast cancer

as long as the edges of the tissue are clear from tumor lumpectomy surgery is
as long as the edges of the tissue are clear from tumor lumpectomy surgery is

usually a good cosmetic outcome without any additional plastic surgery the
usually a good cosmetic outcome without any additional plastic surgery the

breast will look almost exactly the same after surgery and even after radiation
breast will look almost exactly the same after surgery and even after radiation

except for seeing a scar and maybe a little skin darkening from the radiation
except for seeing a scar and maybe a little skin darkening from the radiation

but certainly with clothes on mostly lumpectomy surgeries are not noticeable
but certainly with clothes on mostly lumpectomy surgeries are not noticeable

another common misconception is that mastectomy can be done with an immediate
another common misconception is that mastectomy can be done with an immediate

breast reconstruction and somebody will come out of the first surgery with an
breast reconstruction and somebody will come out of the first surgery with an

essentially normal-looking breasts but this is not the case even if somebody
essentially normal-looking breasts but this is not the case even if somebody

chooses to undergo a reconstruction at the same time of the mastectomy it is
chooses to undergo a reconstruction at the same time of the mastectomy it is

usually the first step of several more surgeries if there is an implant
usually the first step of several more surgeries if there is an implant

involved in the reconstruction the first thing placed in the breast is an
involved in the reconstruction the first thing placed in the breast is an

expander this expander is expanded with water then when it has stretched out the
expander this expander is expanded with water then when it has stretched out the

space after several weeks the final implant is put in frequently scars need
space after several weeks the final implant is put in frequently scars need

revision and nipples need a reconstruction and tattoos the point is
revision and nipples need a reconstruction and tattoos the point is

that even a breast reconstruction done immediately still take several more
that even a breast reconstruction done immediately still take several more

surgeries over the next three to six months in order to be finished the other
surgeries over the next three to six months in order to be finished the other

way to do a reconstruction after a mastectomy is to do a delayed
way to do a reconstruction after a mastectomy is to do a delayed

reconstruction which can occur many months or years later next let's talk
reconstruction which can occur many months or years later next let's talk

about radiation lumpectomy removes only a portion of the breast tissue and we
about radiation lumpectomy removes only a portion of the breast tissue and we

know that the remaining breast on that side tends to regrow cancerous cells
know that the remaining breast on that side tends to regrow cancerous cells

if radiation is not given even if the edges of the lumpectomy are clear of
if radiation is not given even if the edges of the lumpectomy are clear of

cancerous cells there is still the possibility of cancerous cells stuck
cancerous cells there is still the possibility of cancerous cells stuck

elsewhere in the breast perhaps they were traveling through
elsewhere in the breast perhaps they were traveling through

blood vessels or lymphatic channels radiation works very well to kill these
blood vessels or lymphatic channels radiation works very well to kill these

individual cells no matter where they are in the breast radiation does not
individual cells no matter where they are in the breast radiation does not

work well on the main clump of cancer cells since this represents millions of
work well on the main clump of cancer cells since this represents millions of

cells I like to explain it like this surgery removes 99.9% of the cancerous
cells I like to explain it like this surgery removes 99.9% of the cancerous

cells from the breast and radiation cleans up the remaining 0.1% of the
cells from the breast and radiation cleans up the remaining 0.1% of the

cells for most of these cases mastectomy removes all of the breast tissues so
cells for most of these cases mastectomy removes all of the breast tissues so

radiation would not be needed but there are situations where you would
radiation would not be needed but there are situations where you would

still need radiation even after a mastectomy if your doctor tells you that
still need radiation even after a mastectomy if your doctor tells you that

a mastectomy is needed because the breast cancer is large say over five
a mastectomy is needed because the breast cancer is large say over five

centimeters or if there are multiple lymph nodes in the armpit that have
centimeters or if there are multiple lymph nodes in the armpit that have

cancer in them or the cancer is growing into the skin or the chest muscles then
cancer in them or the cancer is growing into the skin or the chest muscles then

radiation may still be used even after a mastectomy surgery well
radiation may still be used even after a mastectomy surgery well

what if you just can't have a lumpectomy some women can't safely be offered a
what if you just can't have a lumpectomy some women can't safely be offered a

lumpectomy even if they want one examples of situations where we cannot
lumpectomy even if they want one examples of situations where we cannot

safely offer a lumpectomy are as follows if you've had previous radiation to your
safely offer a lumpectomy are as follows if you've had previous radiation to your

breast area since we always need radiation after a lumpectomy and you
breast area since we always need radiation after a lumpectomy and you

cannot radiate the same part of the body twice in your life so if you've already
cannot radiate the same part of the body twice in your life so if you've already

had radiation to the breast we really can't offer a lumpectomy
had radiation to the breast we really can't offer a lumpectomy

people that cannot have radiation due to other medical problems such as
people that cannot have radiation due to other medical problems such as

scleroderma which is a skin disease radiation can cause too many problems in
scleroderma which is a skin disease radiation can cause too many problems in

these people what if you have cancer in multiple different parts of the breast
these people what if you have cancer in multiple different parts of the breast

doing two lumpectomies on opposite sides of the breast is not commonly done if we
doing two lumpectomies on opposite sides of the breast is not commonly done if we

know or suspect that cancer is in different locations in multiple
know or suspect that cancer is in different locations in multiple

quadrants of a breast we usually recommend mastectomy and lastly we don't
quadrants of a breast we usually recommend mastectomy and lastly we don't

offer lumpectomy surgery if a cancer is over five centimeters in size which is
offer lumpectomy surgery if a cancer is over five centimeters in size which is

about the size of a tangerine
about the size of a tangerine

let's talk a little bit about chemotherapy a very common misconception
let's talk a little bit about chemotherapy a very common misconception

is that women think if they choose a mastectomy that they won't need
is that women think if they choose a mastectomy that they won't need

chemotherapy this is not the case I like to explain it like this you just cannot
chemotherapy this is not the case I like to explain it like this you just cannot

out-operate the need for chemotherapy surgery and radiation treat the breast
out-operate the need for chemotherapy surgery and radiation treat the breast

and the lymph nodes but do not do anything outside of that area and breast
and the lymph nodes but do not do anything outside of that area and breast

cancer is really only dangerous when the cells grow outside of the breast and
cancer is really only dangerous when the cells grow outside of the breast and

they have metastasized to organs such as the liver or the brain or the lungs even
they have metastasized to organs such as the liver or the brain or the lungs even

at the time of your diagnosis if x-ray scans show no spread of cancer outside
at the time of your diagnosis if x-ray scans show no spread of cancer outside

of the breast there is a chance that some microscopic cancer cells are
of the breast there is a chance that some microscopic cancer cells are

floating around your body in the blood chemotherapy is the only treatment that
floating around your body in the blood chemotherapy is the only treatment that

gets these cells no matter where they are in your body because chemotherapy
gets these cells no matter where they are in your body because chemotherapy

goes into your blood and gets everywhere in the body so if we think you need
goes into your blood and gets everywhere in the body so if we think you need

chemotherapy to get these cells floating around your body any treatment we do to
chemotherapy to get these cells floating around your body any treatment we do to

the breast with surgery or radiation does not change that decision so this is
the breast with surgery or radiation does not change that decision so this is

a brief overview of some of the differences between lumpectomy and
a brief overview of some of the differences between lumpectomy and

mastectomy surgery that can affect the choices you make I do explain the
mastectomy surgery that can affect the choices you make I do explain the

individual surgeries a little bit more detail than some of my other videos on
individual surgeries a little bit more detail than some of my other videos on

the channel so don't forget to subscribe and check those out I hope this helped
the channel so don't forget to subscribe and check those out I hope this helped

take care you
take care you