The Long Term Cosmetic Differences between a Lumpectomy with Radiation Therapy & a Mastectomy with Reconstruction

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Choosing between breast conservation therapy (BCT) and mastectomy can be very difficult decision for a woman to make. Most women like the idea of preserving the majority of their breast and nipple with the hope of minimal cosmetic deformity in the long run. They might view a mastectomy with reconstruction to be more surgery than they would like to consider. Unfortunately, it is not a clear cut situation and sometimes a mastectomy with reconstruction can provide a better long term cosmetic outcome.

There are two major issues that Plastic Surgeons will consider when assessing the likely cosmetic outcomes of BCT. The first major issue is understanding the size of the tumor relative to the size of the breast. If the tumor is small and the breast is large, then only a small percentage of the breast would need to be removed, leaving a majority behind. For women with small or moderate sized breasts, however, even a small tumor could require removal of a significant amount of their total breast volume.  Taking a large portion of a breast can lead to deformity. The second issue to consider is the location of the tumor, as some tumors will be positioned better in order to conceal any resulting deformity. In general, tumors that are behind or below the nipple, or within the inner portion of the breast can result in significant deformity, especially if the tumor is on the larger size. In general, tumors that are on the outside of the breast tend to be the best for a reasonable cosmetic outcome.

The cosmetic rationale for mastectomy, especially with abdominal tissue reconstruction, is the ability for a woman to have a skin-sparing mastectomy which can limit the scars of the mastectomy. This allows for the Plastic Surgeon to “lift” the breast and fix the breast sagging that is common for women as they age. A balancing breast lift of the other breast can usually be performed at the same time as the breast reconstruction. This allows a women to go into surgery, have their mastectomy, undergo reconstruction with a lift on the other side, and wake up with two lifted or perky breasts. This frequently gives an optimal cosmetic result. And since radiation therapy is usually not indicated after a mastectomy, the reconstruction will remain stable and likely not change over time.