Hi Bluefootedbooby,
Lumpectomy does not guarantee for anybody that the surgeon will get all the cancer, but truthfully, neither does mastectomy. That's why they do the radiation - to catch any seeds of cancer that have broken away from the primary site into the surrounding tissues or the lymph system.
While with mastectomy you might be able to avoid radiation, there are considerations other than that and reconstruction. With mastectomy they remove a lot more tissue, and that means a lot more damage to the lymph system with the possibility of resultant problems. Also a lot more initial challenge to the body - longer time under anesthesia, a greater chance of infection, and more demands on the body for greater tissue healing. With lumpectomy they try not only to save breast tissue, but to keep as much of the lymph system intact as possible - the lymph system is the major cleansing network for the body - our chests need that protection. With mastectomy, that protection will be removed. Surgeons take all that into account when they recommend breast-conservation (lumpectomy) and radiation, but I think patients have a right to be informed of those risks as well.
I had a large tumor located very high in the tail of my left breast (almost totally up under the arm. I had a lumpectomy - left quite a large divot on the outside border of my breast, but I am fortunate in that I did not need reconstruction. We already knew I had some lymph node involvement going into surgery; unfortunately, there were cancer cells in the margins of the tissue the surgeon took out, so I had to have another surgery and have more lymph nodes removed. After both surgeries, I made an effort to take good care of my arm, and had no signs of lymph edema going into radiation several months later. With radiation, I began to get lymphedema - more lymph nodes were being damaged by the radiation and I just didn't have enough left to provide adequate drainage. I chose to stop the radiation about half-way through, preferring to take my chances that the cancer might recur rather than moving forward with the pretty definite knowledge that the few remaining functioning lymph nodes I had left might also be irreversibly damaged and that I might have to live with a constant severe lymphedema. (My livelihood depended upon use of my hands and arms - for me the choice was one of quality of life rather than quantity.)
So obviously lumpectomy is not a guaranteed easier ride for everyone, but at the outset, surgically it does present fewer risks. And there always is the option of having more breast tissue removed in future. However, radiation presents immediate risks other than just burning of the skin, and radiation makes future surgery possibly not go as well - that's a consideration, also.
In late 2007 we found nodules in my lungs, in Feb 2008 I had a surgical biopsy with definite diagnosis of metastatic breast cancer. 6 1/2 years after my breast surgeries, I am now a survivor in remission due to alternative treatment, and planning to stay that way! My future is not guaranteed ( no one's is!), but if I had to choose again with the possibility of a different outcome, I believe I would make the exact same choices, because they were the choices that brought me the most peace then, and I am at peace with them now.
Quite possibly you have a "gut feeling" about what you want to do, but are trying to make the most logical and well-informed choice. But listen to your gut feeling, too; seriously take into consideration the way you "feel" about your choices - sometimes our inner being has some pretty good wisdom of its own.
I wish you well with however you decide to go. Please keep us informed of your progress. We will offer you support, and do the happy dance with you as you get through each step!
Sincerely,
Tre