It may be hard to decide whether to have a mastectomy or lumpectomy (also called breast conserving surgery). First, you need to talk to your surgeon and see if you are eligible for lumpectomy plus radiation, or if you need a mastectomy. If both are options, then you will need to make a choice. It is important to know that lumpectomy (plus radiation) and mastectomy have the same overall chance of survival. If you choose lumpectomy, however, you will have a higher rate of cancer returning in the breast (called local recurrence). Such a local recurrence must then be treated. Risk of cancer that spreads to other organs (called distant recurrence and the main cause of breast cancer death) is the same for both procedures. For more on breast cancer recurrence, see the Return of Breast Cancer section.
There are risks and benefits to consider when choosing between mastectomy and lumpectomy with radiation. These are outlined in Figure 5.2 below. The main benefit of lumpectomy with radiation is that the breast is preserved as much as possible. This avoids the impact that having an entire breast removed might have on your emotions and your appearance. The main benefit of mastectomy is that radiation therapy may not be needed. If you live in a remote area without access to radiation treatment centers, or if you cannot have radiation therapy, this can be an especially important benefit. You may avoid radiation therapy and its side effects, as well as daily trips to a radiation therapy facility.
Figure 5.2: Comparing Total Mastectomy with Lumpectomy plus Radiation
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Total Mastectomy
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Lumpectomy plus Radiation
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Effectiveness as treatment for early breast cancer
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Very effective
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Very effective
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Amount of tissue removed
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Entire breast
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Part of breast (tries to maintain the original look of the breast)
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Extent of surgery
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Major surgery with general anesthesia
Hospital stay and longer recovery time
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Less extensive surgery with general anesthesia
Can usually go home on same day as surgery (if axillary node dissection is not done)
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Radiation therapy
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Often not done
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Routinely done
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Temporary soreness of chest, armpit and shoulder
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Yes
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Yes
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Chance of local recurrence
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Generally low for early stages of breast cancer
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Generally low for early stages of breast cancer (but higher than with mastectomy)
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Chance of lymphedema (if axillary dissection performed)
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Yes
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Yes
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With either type of surgery, you are likely to have temporary soreness in your chest, armpit and shoulder. For more information on management of surgery-related pain, visit the Pain Management section. If lymph nodes are removed during surgery, you may also have areas of numbness or later develop lymphedema. Lymphedema is a condition where fluid collects in the arm, causing it to swell. For more information, visit the Lymphedema section.
Regional Differences in Lumpectomy Rates across the United States
The percentage of women with early breast cancer having lumpectomy plus radiation varies greatly across the United States, with the highest rates in the Northeast [4]. For example, women in Connecticut are more than three times as likely as women in Iowa to have lumpectomy instead of mastectomy [5]. Part of this difference is due to personal preferences that can vary based on location. For instance, women who live in areas with few facilities that offer radiation therapy (needed for lumpectomy) may prefer to have mastectomy. Other factors also play a role. Younger women may prefer to have lumpectomy. And for some women, mastectomy offers peace of mind. However, differences in rates also can occur when women who are eligible for lumpectomy are not encouraged by their health care providers to consider the procedure.
You should learn about all possible surgery options and talk openly with your health care providers about your treatment. It is important for you to feel confident that you are getting the best treatment possible. You should never hesitate to seek a second and possibly a third opinion from health care providers at different hospitals or practices. This is especially important if you are not satisfied by the explanations for your treatment plan. Find more information on Getting Good Care.
Updated 09/12/09
