IS LUMPECTOMY THE RIGHT TREATMENT FOR ME?

Mytien Goldberg, MD, FACS • November 26, 2023

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MYTIEN GOLDBERG, MD, FACS

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IS LUMPECTOMY THE RIGHT TREATMENT FOR ME?

Mytien Goldberg, MD, FACS • November 26, 2023

5 Minute Read:

I have been diagnosed with breast cancer and given two choices, mastectomy and lumpectomy? Which is the right surgical choice for me?

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WHAT SHOULD YOU KNOW ABOUT BREAST CANCER STATISTICS?

Breast cancer is the second most common cancer for women in the United States (following skin cancer). 1 in 8 women will be diagnosed with breast cancer in her lifetime. Due to screening mammograms and improved personalized treatment options, breast cancer survival rates have been steadily increasing in the last 10 years. 



The overall five-year survival rate is 100% for stage 0 and 1, 93% for stage II, 72% for stage III, and 22% for stage IV. 

WHAT ARE MY TREATMENT OPTIONS?

Surgery is the choice treatment for most early-stage breast cancer patients. Surgery is a curative treatment option done along with chemotherapy, radiation, or hormonal treatment options. 


Once a woman is given a diagnosis of breast cancer, she is referred to an oncologic breast surgeon. The breast surgeon will advise her whether she is a candidate for a lumpectomy or mastectomy along with lymph node biopsy. 


Lumpectomy is a partial removal of the breast containing the breast cancer whereas mastectomy is the complete removal of breast tissue. The choice between these two surgical options is individualized and based on medical recommendations along with the patient’s personal preference. 


Mastectomy is still a very common surgical treatment for large size breast tumor. 


Breast conservation therapy (lumpectomy) is becoming a common surgical treatment in breast cancer even in larger tumor size due to effectiveness of neoadjuvant chemotherapy (chemotherapy given prior to surgery in an attempt to reduce the tumor size). 


Therefore, many patients are given two options of lumpectomy or mastectomy as part of their cancer surgical treatment. 


Patients will often ask Dr. Mytien Goldberg which surgical option is the right one for them. 


This blog will help guide her patients and other breast cancer patients in their decisions considering breast cancer recurrence, chronic pain, cosmetic results, surgical side effects, radiation side effects, breast reconstruction success rate, and overall patient’s satisfaction. 

WHAT SHOULD A PATIENT KNOW ABOUT LUMPECTOMY?

A patient has to understand that with lumpectomy, postoperative radiation is part of the treatment. Studies have shown lumpectomy without radiation has a much higher cancer recurrence rate compare with lumpectomy with radiation (39.2% versus 14.3%). 


Radiation to the remaining breast tissue will result in future breast atrophy, scarring, and changes in surrounding tissue including the skin, lung, and heart.


Studies on patient’s reported outcomes showed patient’s satisfaction depends on the volume of the lumpectomy. The larger the lumpectomy volume, the lower the satisfaction rate. 


You should discuss with your breast surgeon regarding the anticipated size of the lumpectomy in relation to your overall breast size. Studies have shown lumpectomy volume of greater than 100 gm, or breast to resected tissue ratio of exceeding 10:1 will likely result in poor cosmetic results. 


Up to 30% of patients undergoing lumpectomy reported residual deformities, such as indentation, scar retraction resulting in pain, breast asymmetry, nipple areola retraction, and loss of breast volume as illustrated in the case below.

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*This patient underwent left breast lumpectomy without reconstruction and subsequent whole breast radiation. You can see the nipple retraction, scar indentation, breast asymmetry, and painful scar tissue in the lateral chest wall from radiation. 

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* Patient with left breast cancer underwent left breast lumpectomy and reconstruction with local tissue rearrangement, resulting in a small lift. 

Tumor location also affects the cosmetic outcomes of lumpectomy. Tumor located in centrally or medial quadrant tend to have the worst aesthetic results. 


The best candidate for lumpectomy will be relatively small tumor size to breast ratio, breast ptosis (sagginess), and large breast size. 

In these patients, lumpectomy combined with reconstruction of the lumpectomy defect using local breast tissue will yield a pleasing aesthetic result. 


This technique is becoming more and more popular as illustrated in the case below. The patient had left breast cancer with the tumor located in the upper outer quadrant. 


Lumpectomy was performed 10 days prior to the definitive reconstruction using local tissue rearrangement. The reasons for performing lumpectomy prior to reconstruction is to ensure all the tumor was removed and negative margins are obtained. 


It is important to get a second opinion and involve a plastic surgeon early on at the time of breast cancer diagnosis. Your lumpectomy defect can be reconstructed using your own remaining breast tissue 



If you have chosen lumpectomy and do not like your results or are having residual asymmetry, pain, and scar tissue, there are several option of correcting the lumpectomy deformity. One of the most common procedure will be lumpectomy defect reconstruction using your own skin and fat from anywhere in your body. 


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*As illustrated in patient #1, she presents to Dr. Goldberg for with left breast pain and significant deformity. She underwent lumpectomy defect reconstruction using her own abdominal tissue called the DIEP flap. 

HAVE YOU BEEN DIAGNOSED WITH BREAST CANCER? LEARN MORE ABOUT YOUR RECONSTRUCTION OPTIONS

If you are recently diagnosed with breast cancer and are looking for a plastic surgeon to perform your breast reconstruction, Dr. Goldberg is your plastic surgeon. 


And if you have had breast cancer and are dissatisfied with your reconstruction results, the first step is to schedule a comprehensive in-office consultation with Dr. Goldberg. After the exam, Dr. Goldberg can create an individualized plan to address your specific concerns and answer any questions you may have.

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For many women in southern California and around the country, Dr. Mytien Goldberg is the plastic surgeon of choice for breast reconstruction, revision, and correction procedures. 

By Mytien Goldberg, MD, FACS March 7, 2025
Are you considering breast implant removal options but still want natural breast enhancement after implants? Do you wonder what your breasts will look like without implants? If so, you're not alone—and there are solutions to help you achieve a beautiful, natural shape. Embracing Your Body at Every Stage As we enter our 50s and 60s, we become more in tune with our bodies, appreciating the journeys they’ve carried us through—whether it’s childbirth, breastfeeding, or simply the ups and downs of life. Over time, some women find that breast implants no longer feel right. They may seem like a foreign material that no longer aligns with their bodies, prompting the decision to remove them and seek a more natural alternative. However, many women feel uncertain about breast explant surgery and how their breasts will look post-explant. Will they be saggy? Will they still have cleavage? These concerns are valid because, at any stage of life, we want to feel confident, empowered, and beautiful in our own skin. The good news? There are several breast implant removal options that allow women to maintain fullness and a natural shape using their own tissue. Your Options for Breast Implant Removal with Natural Fullness Option 1: Breast Implant Removal with Local Breast Tissue Rearrangement If you have a good amount of breast tissue with some skin laxity, this technique could be ideal for achieving natural breast enhancement after implants . The procedure involves removing the implants through a small incision in the breast fold. Dr. Goldberg then uses the lower breast tissue to enhance fullness and create natural cleavage. This method offers a soft, natural result without the need for artificial implants. Option 2: Breast Implant Removal with Lateral Chest Fat Transfer For women who do not have enough breast tissue for the first option, this approach utilizes excess fat from the sides of the chest to restore fullness after breast explant surgery with flap transfer (living fat tissue) . Many women in their 50s and 60s have loose tissue on the lateral side of the breasts. This excess fatty tissue is repositioned into the breast to restore volume and projection. The benefit of this technique is that the tissue is a living tissue which is different than fat transfer . It is simply a superior technique. The result? A fuller, natural-looking breast while simultaneously sculpting the sides for a sleeker contour—truly a win-win! Option 3: Breast Implant Removal with Abdominal Tissue Transfer (DIEP Flap Reconstruction) This is the ultimate solution for women seeking a full-body transformation while achieving breast reconstruction after implant removal . Dr. Goldberg removes excess lower abdominal tissue and repurposes it as living tissue to reconstruct the breasts. This technique provides long-lasting fullness while also improving abdominal contour—similar to a tummy tuck, but with the added benefit of breast reconstruction. It’s a fantastic option for women experiencing issues like Breast Implant Illness (BII), recurring capsular contracture, or those desiring a "natural" mommy makeover. Your Journey to Natural Confidence If you're ready to say goodbye to implants and hello to natural breast enhancement after implants , you're not limited to just one approach. With modern techniques like breast explant surgery with microsurgical flap transfer , you can achieve a youthful, confident look that aligns with your body’s natural beauty. Dr. Goldberg specializes in breast reconstruction after implant removal and natural enhancement techniques, helping women regain confidence and comfort in their bodies. 🔹 Ready to explore your options? Schedule a consultation today to discuss the best breast implant removal options for you!
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By Mytien Goldberg, MD, FACS June 12, 2024
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By Mytien Goldberg, MD, FACS November 26, 2023
3 Minute Read:
By Mytien Goldberg, MD, FACS November 26, 2023
6 Minute Read: I received radiation treatment as part of my breast cancer treatment. What is the best breast reconstruction option for me: implant or autologous tissue breast reconstruction? If you have received radiation as part of your breast cancer treatment, I hope this blog is informative for choosing the best option for your breast reconstruction. After mastectomy, the goal of breast reconstruction is to recreate an aesthetic breast mound plus or minus the nipple and to establish symmetry with the remaining breast.
By Mytien Goldberg, MD, FACS November 26, 2023
A breast lift is a surgical procedure that raises the breasts and restores their firmness and youthful appearance. It can be done with or without breast implants. As a woman ages, her breasts may sag due to a natural loss of skin elasticity, pregnancy, breast feeding, weight changes, and gravity. Breast sagging is completely natural, but it’s also reversible with a breast lift. You might be asking, what is a breast lift and how does it differ from breast implants? Breast implants make the breasts bigger and, by default, they can fill up any excess skin to cause the breasts to lift. A breast lift is a procedure that has the specific goal of raising the breasts, usually using the existing tissue. Implants are not necessary for a breast lift, though some women may choose to get them. A breast lift without implants is for women who are comfortable with the size of their breasts or women who would like a small reduction in their cup size. This procedure is also called mastopexy. During surgery, the doctor removes excess skin and tightens the surrounding tissue to reshape and support the new breast contour. The volume of the breast that fills a bra is left in tact, but their shape and position will be noticeably improved. A breast lift may be part of a ‘mommy makeover’ to reverse the affects of pregnancy and breastfeeding on a woman’s body. Since no implant is added during mastopexy, the results can be quite natural looking. Every woman is different. An individualized approach is taken for each patient to ultimately give her back youthful, firmer breasts.
By Mytien Goldberg, MD, FACS November 26, 2023
Saline breast implant deflation occurs on average 4.3 to 6% at 10 years. A Study on silicone rupture rate (Inamed Silicone Breast Implant Core Study Results at 6 Years rupture rate published in Plastic & Reconstructive Surgery: December 2007 – Volume 120 – Issue ) was 3.5 percent overall at 6 year. Overall, the rupture rate of both silicone and saline implants are equivalent. The difference is detection of rupture. For saline implants, the rupture is detectable by the patient and physician almost immediately. However in case of silicone implants, the rupture is silent. It would require a radiographic study such as MRI or an ultrasound to detect silicone implant rupture. Retrospective study showed untreated silicone gel fill implants are harmless conditions (Plastic & Reconstructive Surgery: July 2004 – Volume 114 – Issue 1). Unlike a silicone implant, saline implant ruptures result in an immediate deflation of the implant and skin envelope of the breast. If the deflation goes untreated, the breast skin envelope would retract back while the other breast envelope continues to be expanded. Over time, you would have significant asymmetry in your breast that may require additional procedure to the unaffected breast such as a lift. Therefore, if you have breast implants and note any changes in your breast shape or size, you should consult your plastic surgeon soon for diagnosis and treatment.  If it is a breast implant rupture, the two major breast implant manufacturers in the United States (Allergan and Mentor) provide a lifetime warranty for all of their implants. If an implant fails or ruptures during the first 10 years, both companies will provide a new implant and $1200 applicable toward operating room and anesthesia costs which can be upgraded to an extended plan providing up to $2400 for a small fee prior to surgery. All implants have a lifetime guarantee and will be replaced by the manufacturer if the problem is related to the implant.
By Mytien Goldberg, MD, FACS November 26, 2023
In America and throughout the world, both men and women are expected to look healthy and young well into their 30’s, 40’s, 50’ and 60’s. While diet and exercise can play a large role in looking younger, the use of modern cosmetic surgery has become one of the most popular ways to beat back the clock. Getting surgical cosmetic procedures has become very commonplace, with an ever-growing percentage of the population opting in to get cosmetic surgery. Yet there is a large divide between women and men, and what procedures are most popular for each of the sexes. The American Society of Plastic Surgeons today released top line data from its 2011 plastic Surgery Statistics Report. The latest data shows breast augmentation is still the most common cosmetic surgery procedure for 2011. There were 307, 180 breast augmentation procedures performed in 2011, up 3.7% since 2010. Many of the common signs of aging that occur to a woman’s breasts as she gets older can be very devastating to her self esteem. Yet with today’s modern surgical options, there is a viable option for women to change the way they look. Second to breast augmentation, rhinoplasty is the most popular cosmetic procedure, with a total of 243,772 procedures being performed in 2011. The growing number of cosmetic procedures is an indication that even in this tough economic climate, more consumers are choosing cosmetic surgery as a way to look younger and feel better about themselves. We certainly see the same trend in our practice. More and more women are seeking improvements in their look. We support this trend as many of these procedures equate to improvements in their overall self-confidence and quality of life.
By Mytien Goldberg, MD, FACS November 26, 2023
A new study published in the Archives of Facial Plastic Surgery in February 2012, looks at perceived age after facial plastic surgery. This novel study attempts to quantify the degree of perceived age change after facial plastic surgical procedures . A total of 60 patients were enrolled in the study and divided into 3 groups: Group 1 patients had only facelift and neck lift (total of 22 patients); Group 2 patients had facelift, neck lift, upper and lower eyelid surgery (total 19 patients); and Group 3 patients had facelift, neck lift, upper and lower eyelid surgery, and brow lift (total 21 patients). The investigators then asked a group of first year medical student to estimate the patient’s age based on the Before and After pictures of each patient. The researchers tried to standardize the photographs by asking participants to not wear makeup. The researchers found that on average, the raters estimated that the patients looked 1.7 years younger than their actual age before surgery, and 8.9 years younger afterward. On average, the estimated age dipped by 5.7 years in group 1 (patients with neck and face lift), and by 8.4 years in the third group (patients with neck, face lift, upper and lower eyelid and brow lift). Therefore, the author of the study concludes that facial rejuvenation surgeries demonstrate a significant and consistent reduction in perceived age. This effect is more substantial when the number of surgical procedures is increase. The desire to improve one’s physical presentation and to maintain a youthful appearance is intrinsic in our evolution. Physical appearance and how we are perceived by others have implications for social and psychological functioning, as well as our sense of well-being, self-esteem, and self-confidence. Before you seek to have plastic surgery procedures, do your homework and check that the doctor is board-certified in plastic surgery. There is a lot of white-coat deception. Virtually any kind of doctor legally claims to be a plastic surgeon without any formal training in plastic surgery. As a board certified plastic surgeon, I have seen increasing numbers of patients who present with complications and unsatisfactory outcomes after having procedures done by non board certified plastic surgeon.
By Mytien Goldberg, MD, FACS November 26, 2023
Today’s society is one in which we can never seem to get enough. Everything is bigger, better, faster, and stronger. But what happens when you are blessed with too much of a good thing? While many women desire an increase in breast size, there are those who feel uncomfortable with size of their breasts. If a woman has large breasts, she may be considering breast reduction surgery for many reasons. Aside from feeling more comfortable in their bras and clothing, breast reduction surgery can help alleviate any number of symptoms. Women with large breasts often suffer from chronic back and neck and shoulder pain, chronic rashes and skin irritation under the breasts, deep grooves in the shoulders from bra strap pressure, poor posture and restricted activity, as well as poor self-image due to large breasts. Breast reduction surgery, also known as reduction mammoplasty, removes excess breast fat, glandular tissue and skin to help achieve a breast size that’s more proportionate to a woman’s body, as well as helping to alleviate the symptoms associated with overly large breasts. So who is breast reduction surgery for? Women of all ages have been known to have breast reduction surgery, even young women in their teens; however it’s strongly recommended that the patient wait until they are past the age of development. If a woman hasn’t started a family yet, or is still in the stages of family planning, it may be best for her to wait until pregnancy isn’t an issue yet, as pregnancy can change breast tissue. Results can be seen immediately, but it’s best to keep in mind that it can take months for the swelling to completely diminish and for the surgical scars to fade. For anyone considering breast reconstruction surgery, consult a Board Certified plastic surgeon. This is a very personalized procedure, and it’s important to understand everything that breast reduction surgery encompasses, including possible risks and complications, as well as set realistic expectations. I have insurance. Does that cover any of my procedure costs? If a patient has a history of chronic conditions, such as back, neck, or shoulder pain, or chronic skin conditions such as rashes or skin irritation in the breast issue, having a breast reduction may be considered medically necessary and is covered by most insurance plans. If approved, this means the patient’s insurance would cover the cost of the surgeon’s fee, as well as the cost of the facility and anesthesiologist. This is something that should be discussed and documented during a consultation with a board certified plastic surgeon. http://www.plasticsurgery.org/reconstructive-procedures/breast-reduction.html http://www.mayoclinic.com/health/breast-reduction-surgery/MY00778
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