I don't know Ann, the surgeons obviously think lumpectomy is 'best', but
perhaps patients don't.

I personally feel that breast-conserving surgery is perfectly appropriate
where the tumour is a very small part of the breast, but I have always been
concerned that the idea pandered more to fear than clinical sense.

When faced with this choice, the natural first reaction is to look for an
escape, a way to deny the body-change, something you can do once which will
be permanent and means you never need to change your own body-image.  At
first sight lumpectomy seems to offer this.  When my wife first had cancer,
as it turned out there was no choice but mastectomy, but in the research we
did, I soon realised that whatever happened, things would never be the same
again, and the choice was not between learning to live with a body change,
or no change but some short-term complications; it was between learning to
live with a change, or learning to live with a change -plus- the
complications.

Whether or not that is true, it is likely that other patients are picking up
on this as we did.  Add to that the extra feeling of security, getting rid
of the scare for once and for all, and I think you can understand why some
women opt for it.

Another question is whether surgeons are also biased the other way.
Surgeons are mostly men, perhaps they put more value on conserving women's
approximate body shape than do the women themselves, and have less awareness
of the practicalities for the patient.

I notice that the article makes a similar observation regarding
reconstruction, that women who had it generally reported lower quality of
life than those who didn't.  That also was the impression we got, (again, as
things turned out there was no opportunity anyway) on the face of it
reconstruction sounds wonderful, a way to get back to the pre-cancer
situation, and forget about it.  But when you take into account all the
extra surgery and complications, the numbness and changed feelings, changes
with aging and so on, you realise that you will never be truly be as you
were and able to forget about it, all you will ever be able to do is fool
others into thinking that you can forget about it.  It's still really only
cosmetic, and prosthesis is really not bad.

Tim Jackson