Are You Happy with Your Breast After Lumpectomy?

Most women diagnosed with breast cancer are candidates for breast conservation surgery, or lumpectomy. However, about one-third of the women who have lumpectomy are unhappy with the appearance of their breast after the surgery. Many would consider reconstruction surgery, according to a study presented at the American Society of Plastic Surgeons (ASPS) Plastic Surgery 2006 conference in San Francisco.

"I have patients walking into my office saying lumpectomy was supposed to save their breast but what's left doesn't look like a breast to them," said plastic surgeon Howard Wang, a co-author of the study. "Conservation is believed to be an acceptable way of saving a woman's breast. But many of these women are coming to plastic surgeons for help, saying it isn't so."
The researchers reported that 28 percent of the breast cancer patients stated they were dissatisfied with the cosmetic result of their lumpectomy. Of those patients, 46 percent said their physical appearance was worse or much worse after the surgery and that they were considering reconstruction. Only 9 percent of patients who were satisfied with the outcome stated they would consider reconstruction if it were offered.

Approximately 26 percent of patients were unhappy with their physical appearance after the lumpectomy but had an improved sense of body image. Plastic surgeons believe this might be due to the relief patients feel at being rid of the cancer, leading them to feel better about their bodies even though they were not happy with how their breasts looked.

Over the years, I've seen a wide range of responses from women about their conserved breast. Some are upset that there is an incision at all, even though it may be quite small and hard to see. They see it as a "defect" and are vocal with their unhappiness with it. Other women who had a large lumpectomy and whose breast looks quite distorted to me, are nevertheless happy because the nipple and areola were saved and they have sensation in their breast.
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All of this brings up the issue of whether a woman should have reconstruction, sometimes referred to as oncoplasty, after a lumpectomy.

Tell me your thoughts about this. Would you save your breast at any cosmetic cost? Would you prefer to have a skin-sparing mastectomy, even though you may not need it, if it provides a better cosmetic result?