My own Sophie’s choice: lumpectomy or mastectomy?

Shortly after I turned 26 years old, I was faced with the decision of which surgery to get for my breast cancer treatment. My options were a lumpectomy, single mastectomy or double mastectomy. 

A lumpectomy is where they remove the tumor or tissue where the tumor used to be (if chemo was used first and shrunk the tumor). A single mastectomy is where they remove only the breast with cancer and a double mastectomy is where they remove both breasts. 

Because my BRCA genetic testing came back negative, meaning there are no known genetic components to my cancer, there was no strong indication for my risk of recurrence outside of what is known for my type of cancer. My doctors consulted with one another and some preferred a more aggressive approach while others preferred a more conservative approach. There was really no consensus on what type of surgery would be best for me, so they left it up to me.

So, how does a 26 year old make this decision? Not easily. This was the first and only time I ever looked at research and tried to use statistics to make an informed decision and let me tell you, it did not go well. It was the only time I actually freaked out about having cancer. For me, looking at the numbers did not help. There was just so much information out there about 5-year survival rates, risk of local recurrence (in the breast) and risk of metastases to other parts of the body. The black-and-white answer I was looking for wasn’t there.

I considered the impact each surgery would have on me. If the risk of recurrence wasn’t limited to my breasts, was it really worth it to me to remove my breasts? Being so young, I thought about how each surgery would impact my dating life. I also considered breastfeeding as a factor, even though I wasn’t even sure if I wanted kids at the time. 

The part that weighed heaviest though was the fear of making the wrong choice. What if I elected to have a double mastectomy and struggled with multiple surgeries, had infections or other complications, and still ended up with a recurrence? How would I feel having a double mastectomy if I did have kids and wanted to breastfeed but couldn’t? What if I chose the least aggressive option and ended up with a local recurrence? Would I blame myself? Would loved ones blame me? For better or worse, no one can predict the future.

There were numerous uncertainties but in the end I decided to choose the least aggressive option of a lumpectomy, which meant I’d also need radiation. I figured in the future if I wanted, after potentially breastfeeding, I could always choose to have a double mastectomy later on as a preventive measure. That is, assuming there was no recurrence before then. This felt like the best option for me and despite the fear, I felt confident in my decision.

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