Once you have been diagnosed with breast cancer, usually treatment starts first with surgery. There are generally two components to the operation: 1) the breast, and 2) the axilla (armpit).
In the breast, there are two choices: 1) lumpectomy (removing the cancer lump and some surrounding tissue), or 2) mastectomy (removing the entire breast). Just a quarter of a century ago, almost all patients had mastectomy, even if their breast cancer is small. But over the past few decades, it has been demonstrated that for small cancers, lumpectomy followed by radiation treatment is just as good as mastectomy. Now, “small” is a relative term. The goal of a lumpectomy is that the breast would still look like a breast after all the treatment is done. In someone with small breasts, a “small” cancer may occupy a significant portion of her breast. An adequate lumpectomy in this case may result in an unacceptable cosmetic outcome, and the patient may actually prefer having mastectomy with plastic surgery reconstruction. Another factor is the number of cancers in the breast. Usually, mastectomy is required for multifocal cancer (cancer discovered in two or more locations in the same breast)
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