Mastectomy and conservative treatment: finding balance between therapeutic efficiency and quality of life

Abstract

Objective: This study aimed to describe the points of balance between the approaches of conservative surgery and radical mastectomy in the treatment of breast cancer, based on treatment and quality of life. Methodology: This is a narrative review of the literature in which studies were selected from the PubMed, Scielo, and Virtual Health Library databases. We used the descriptors: mastectomy, breast cancer, Halsten mastectomy, conservative surgeries, associated with
Boolean operators, and that helped in expanding the research. Results: There are several mechanisms available for the
treatment of breast cancer, depending on the stage of the disease and the patient’s condition, requiring individualized
assessment of the patient to obtain a better prognosis. Thus, the radical mastectomy proposed by Halsten, its modified
versions, and conservative treatments stand out. In relation to radical mastectomy, which is more aggressive but eligible in advanced diseases, there is resection of the breast, including skin and glands, pectoral muscles, and axillary lymph
nodes, while conservative surgery removes only part of the mammary gland that contains the tumor. With regard to conservative surgery, even if there is no mutilation of the organ, it was analyzed that there is an increase in the rates of local
recurrence of the tumor when compared with mastectomized patients. When evaluating impacts on a woman’s quality
of life (QL), mastectomy presents numerous problems mainly due to the imagery aspect, which leads to depressive conditions, resulting in lower biopsychosocial functioning. Conclusion: The treatment of breast cancer must be individualized,
taking into account the possibility of recurrence, QoL, and the staging of the neoplasm. Mastectomy reduces the chance
of recurrence. However, it has a greater chance of generating grief related to the loss of the breast, reducing QoL. On the
contrary, conservative surgery has a better biopsychosocial aspect, but recurrences are more common.