Q: My breast cancer was diagnosed early, but my physician says that I need surgery. Which operation is better - lumpectomy or mastectomy?

A: Although lumpectomy (removal of the tumor and its margins) - combined with radiation therapy - has gained favor as a treatment for early breast cancer, there are some important instances in which mastectomy is a better option. For example, if the tumor lies directly behind the nipple, it may be difficult for the surgeon to remove without significantly altering the shape of the breast. If this is the case, mastectomy may be a better alternative when followed up by breast reconstruction. In addition, women with small breasts may achieve better cosmetic results with mastectomy followed by breast reconstruction.

Q: Does it matter when I have surgery?

A: If breast cancer has been diagnosed and surgery is proposed, it certainly is advisable to have the operation sooner rather than later. But breast cancer is rarely a surgical "emergency." So it is better to explore surgical options and get a second opinion before scheduling a procedure. Such leeway will permit you to make a more informed decision about your surgery; such as having breast reconstruction at the time of mastectomy, rather than during a separate operation.

Q: I am scheduled to have a lumpectomy. How can I be sure that the surgeon will remove only the lump and not my entire breast?

A: A lumpectomy is - by definition - an operation in which only the cancerous 'lump' is removed, along with a small border of cancer-free tissue (roughly 3/4 in.) and the nearby lymph nodes. This is the surgery to which you have consented. If you still have any questions about surgery - for example, "What will the surgeon do if more cancer than expected is found during surgery?" - discuss them with your surgeon beforehand to avoid any misunderstandings.

Q: What will my chest look like after breast surgery?

A: Many women worry that they will have a "hollow" chest after breast cancer surgery. Fortunately, the operations that are performed these days are not likely to produce that kind of disfigurement. If you have a lumpectomy, you will probably have a small indentation in your breast. If you have a modified radical mastectomy or a simple mastectomy, your chest will be flat on the side where the breast was removed. Depending upon the location of your tumor, the scar on your chest wall may be horizontal or diagonal.

Q: I am frightened by the idea of radiation therapy. Will I lose my hair or experience any other side effects?

A: Radiation therapy for breast cancer does not affect the hair on your head, although some hair loss may occur in the armpit area. Some women develop sunburn-like redness and/or skin peeling in the treatment area, whereas others do not. You may be able to predict what to expect by your personal tolerance of sunlight.

Q: Because my cancer has spread, my physician says that I should have chemotherapy. What kind of side effects should I expect, and how long will I have them?

A: The medications that are used for chemotherapy mostly affect rapidly dividing cancer cells, but they also can injure normal cells. In particular, the rapidly dividing cells of the hair follicles and the lining of the oral/digestive tract may be damaged, causing hair loss and oral/digestive complaints, respectively. Other side effects - some of which are treatable - include nausea, anemia, repeated infections, bleeding, fatigue, and changes in the menstrual cycle. Side effects usually disappear after chemotherapy has ended.

Q: Is it safe to become pregnant during breast cancer therapy?

A: Most physicians advise women to wait at least 3 years before trying to get pregnant; however, if you are already pregnant or have special considerations, there may be a different answer to this question. There is no overwhelming evidence that pregnancy causes adverse effects in women with breast cancer. But being pregnant while taking the hormone tamoxifen may interfere with the drug's activity and increase the likelihood that your breast cancer will return. It is especially important to practice birth control when taking tamoxifen, as use of this drug is associated with a slight risk of abnormality in the unborn child.

Because many women have had normal, healthy babies during breast cancer therapy, the final decision about pregnancy remains a personal choice.