Lumpectomy or Mastectomy

[cupcake2]

I am a 59 year old postmenopausal woman with no breast cancer in family who has been diagnosed with infiltrating duct cell carcinoma 3x1.5 cm. tumor close to pectoral muscle. I have been advised to have six months of chemotherapy followed by lumpectomy and radiation. Would this be better than having lumpectomy first? Would it be safer? Nobody has recommended mastectomy. Would that be safer long-term and eliminate the need for chemotherapy? Plesae advise. Surgeons have different opinions than breast diagnostician and oncologist. Thank you.

[CCF-RN,MSN-rf]

Dear cupcake2:  There is no absolute correct answer.  It may be that preoperative chemotherapy is recommended to try to reduce the tumor size - given its closeness to the pectoral muscle.  You see, when a tumor is removed, either with lumpectomy or mastectomy, there should be a safe margin where there are no cancer cells.  By shrinking the tumor before surgery, the distance from the muscle may increase offering a better chance of a safe margin without involving the muscle.  A mastectomy may be an option as well.  This might eliminate the need for radiation after surgery but it will not change recommendations for chemotherapy.  Most surgeons assume that women prefer breast conservation surgery.  This is not always the case.  It is a very personal choice.  You should certainly discuss this with your surgeon.