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Q. "What are the side effects of both surgical treatments? What's the worst-case scenario?"
A. When considering what kind of surgery to have, it is important to know that there are potential side effects common to all surgical procedures. Any surgical procedure carries a risk of infection, poor wound healing, bleeding, or a reaction to the anesthesia. Also, pain and tenderness in the affected area is common, usually in the short term. Because nerves may be injured or cut during surgery, most women will experience numbness and tingling in the chest, underarm, shoulder, and/or upper arm. Women who undergo lumpectomy usually find that these changes in sensation improve over 1 or 2 years, but may never completely resolve.
Most women who have lumpectomy with radiation will still have sensation in the breast, whereas women who have had a mastectomy with reconstruction -- either with implants or her own tissue -- will not have much (or perhaps any) sensation in their breast mounds, because the nerves to the breast skin have been cut. And, although nipples can be reconstructed, they will not have sensation.
Removal of lymph nodes under the arms is usually performed with both lumpectomy and mastectomy. This can lead to pain and arm swelling ("lymphedema") in up to 30 percent of patients.
The side effects of treatment vary for each person. Some people may experience many side effects or complications, others may experience very few. Pain medication, physical therapy, and other strategies can help. However, in addition to the side effects of the mastectomy and lumpectomy, there are complications related to reconstruction. For example, implant manufacturers have reported that two-thirds of reconstruction patients with saline implants have at least one serious complication within three years. (Complications with silicone implants are expected to be similar, but the studies have not been conducted.)