It may be hard to decide whether to have a mastectomy or a lumpectomy (also called breast conserving surgery). First, talk with your surgeon to see if you have a choice between mastectomy and lumpectomy plus radiation therapy. If both are options, weigh the risks and benefits of each surgery and choose the one that is right for you.
In select cases, neoadjuvant (preoperative) therapy can change a woman’s surgical options. Neoadjuvant therapy may shrink a tumor enough that a lumpectomy becomes an option instead of a mastectomy.
Learn more about neoadjuvant therapy.
Overall survival with lumpectomy plus radiation therapy is the same as with mastectomy .
Compared to mastectomy, there is a slightly higher rate of the cancer returning to the breast (called recurrence or local recurrence) with lumpectomy . Any recurrence must be treated.
The risk of cancer spreading to other organs (called metastasis or distance recurrence) is the same for both procedures .
Learn more about breast cancer recurrence.
Learn more about metastatic breast cancer.
For a summary of research studies on mastectomy versus lumpectomy plus radiation therapy and overall survival, visit the Breast Cancer Research Studies section.
There are risks and benefits to consider when choosing between mastectomy and lumpectomy plus radiation therapy. These are outlined in Figure 5.3 below.
The main benefit of lumpectomy plus radiation therapy is that the breast is preserved as much as possible.
A potential benefit of mastectomy is that radiation therapy may be avoided. Although some women will need radiation therapy after mastectomy, many will not. (Ask your health care team if you are likely to avoid radiation therapy if you have a mastectomy.)
Radiation therapy has some side effects and requires daily trips to a treatment center. If you live in an area without access to radiation treatment centers, or if you cannot have radiation therapy, mastectomy is usually the better option.
Figure 5.3: Total mastectomy versus lumpectomy plus radiation therapy
Lumpectomy plus radiation therapy
With either type of surgery, you are likely to have temporary soreness in your chest, underarm and shoulder. Learn more about the management of surgery-related pain.
After mastectomy (with or without breast reconstruction), you will be numb across your chest (from your collarbone to the top of your rib cage). Unfortunately, this numbness is usually permanent. You may get some feeling back over time, but it will never be the same as before surgery.
After lumpectomy, you are likely to have numbness along the surgical incision (scar).
If lymph nodes in the underarm area (axillary nodes) are removed during surgery, you may also have some numbness in your arm and there is some risk of lymphedema. Lymphedema is a condition where fluid collects in the arm (or other area such as the hand, fingers, chest or back), causing it to swell.
Learn more about lymphedema.
The type of surgery you have does not affect whether you will have chemotherapy, hormone therapy or targeted therapy. These drug therapies are given based on the characteristics of the tumor, not your surgery.
Learn about tumor characteristics and other factors that affect these treatment options.
Lumpectomy rates vary across the U.S. Lumpectomy is more common among women who live on the East and West Coasts, with the highest rates in the Northeast [9-10]. For example, from 2000 to 2006, about 72 percent of women in Connecticut with early breast cancer had a lumpectomy versus about 54 percent of women in Iowa .
Part of the differences in rates is due to preferences that can vary based on where a woman lives. For example, women who live far from a center offering radiation therapy (needed for lumpectomy) may prefer to have mastectomy.
Other factors also play a role. Personal preference matters a lot. Some women very much wish to keep their breasts while for other women, mastectomy can offer peace of mind.
Among women with equal access to health care, there does not appear to be a difference in rates of lumpectomy between African-American and white women .
For a table showing differences in U.S. rates of mastectomy, visit the Breast Cancer Research Studies section.
Lumpectomy plus radiation therapy is not an option for all women. Talk with your health care provider about whether it is an option for you. Learn about the risk and benefits of your surgery options. Talk with your provider about which treatments are best for you: this can help you feel confident that you are getting the best care possible.
Never hesitate to get a second or even a third opinion from providers at different hospitals or practices. This is especially important if you are not satisfied with the rationale for your treatment plan.
Learn more about getting a second opinion.
Learn more about getting good care.
* Please note, the information provided within Komen Perspectives articles is current as of the date of posting. Therefore, some information may be out of date at this time.
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