Mastectomy and Breast Reconstruction

Mastectomy means breast amputation to many women.  It's a very scary concept to have your breast(s) amputated. Another option is lumpectomy with radiation.   Lumpectomy and radiation is thought to have the same outcome as mastectomy alone. Since lumpectomy and radiation leaves behind some of the breast tissue, many women prefer to take this route. What they don't seem to realize is that this is not some magical treatment that removes the cancer and leaves the breast alone. Lumpectomy is actually pretty deforming, and I see many women who after lumpectomy want to have a reconstruction because their breast has been deformed. It's smaller, indented, the nipple is displaced and distorted (depending on the location of the lump) and overall these women are just not happy. Unfortunately, because they've had radiation, reconstructive options are limited and their surgical risks are significantly increased. Radiation is very harmful. It is meant to kill cancerous cells. However, it is not a selective tool... meaning it kills and harms anything it comes in contact with. Radiation therapy works by focusing radiation on the cancerous cells while making sure that the surrounding normal tissues are not too damaged.... note the "not too damaged" part, because there always is damage. Plastic Surgeons are often asked to come and reconstruct areas that have been previously irradiated. As such, plastic surgeons have a lot of experience dealing with irradiated tissues. Irradiated tissues are hard/leathery, they do not heal well after surgery and have a significant increase in infection, wound breakdown (wound opening up), and these tissues do not tolerate implants (as in the case of implant breast reconstruction)
For this reason I would recommend a mastectomy with reconstruction to patients with breast cancer. Breasts can be reconstructed in many ways, and having a reconstruction in an area that has not been previously irradiated can have great results. If on the other hand you chose lumpectomy and radiation and then reconstruction, the result will be far inferior.