It may be hard to decide whether to have a mastectomy or a lumpectomy (also called breast conserving surgery). First, talk to your surgeon and see if you are a candidate for lumpectomy plus radiation, or if you need a mastectomy. If both are options, weigh the risks and benefits of each surgery and choose the one that is right for you.
Neoadjuvant therapy and surgery options
Even if you are not a candidate for lumpectomy upfront, your oncologist may discuss neoadjuvant (preoperative) therapy. For some women, neoadjuvant therapy may shrink the tumor enough so a lumpectomy becomes an option instead of a mastectomy.
Learn more about neoadjuvant therapy.
Survival and recurrence with lumpectomy and mastectomy
Survival
Overall survival with lumpectomy plus radiation is the same as with mastectomy [7].
Recurrence
With lumpectomy, there is a slightly higher rate of the cancer returning in the breast (called recurrence or local recurrence) [7]. Any recurrence must be treated.
The risk of cancer spreading to other organs (called metastasis and the main cause of breast cancer death) is the same for both procedures [7].
Learn more about breast cancer recurrence.
Learn more about metastatic breast cancer.
Risks and benefits of mastectomy and lumpectomy
There are risks and benefits to consider when choosing between mastectomy and lumpectomy plus radiation. These are outlined in Figure 5.3 below. The main benefit of lumpectomy with radiation 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.) If you do not need radiation therapy, you avoid its side effects and the 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, this is an important benefit.
| Figure 5.3: Total Mastectomy versus Lumpectomy plus Radiation |
| |
Total Mastectomy
|
Lumpectomy plus Radiation
|
| Treatment benefit for early breast cancer |
Very effective |
Very effective |
| Amount of tissue removed |
Entire breast |
Part of breast (tries to keep the original look of the breast) |
| Extent of surgery |
Major surgery with general anesthesia |
Less extensive surgery with general anesthesia or regional anesthesia |
| Hospital stay |
Overnight hospital stay needed
Longer recovery time than with lumpectomy plus radiation |
Often go home on same day as surgery (if axillary dissection is not done) |
| Radiation therapy |
Sometimes done |
Routinely done |
| Temporary soreness of chest, armpit and shoulder |
Yes |
Yes |
| Chance of recurrence |
Very low for early stages of breast cancer |
Low for early stages of breast cancer (but slightly higher than with mastectomy) |
| Chance of lymphedema (if have axillary dissection) |
Yes |
Yes |
What to expect after surgery
With either type of surgery, you are likely to have temporary soreness in your chest, armpit and shoulder. Learn more about the management of surgery-related pain.
If lymph nodes in the armpit (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.
Regional differences in lumpectomy rates in the United States
Lumpectomy rates vary greatly across the United States. Lumpectomy is more common among women who live on the East and West Coasts, with the highest rates in the Northeast [8-9]. For example, women in Connecticut are more than three times as likely as women in Iowa to have lumpectomy instead of mastectomy [10].
Part of the regional differences in rates is due to personal preferences that can vary based on where you live. For example, if you live far from a center offering radiation therapy (needed for lumpectomy), you may prefer to have mastectomy.
Other factors also play a role. Personal preference matters a lot. Some women very much wish to keep the breast while for other women, mastectomy offers peace of mind. However, differences in rates also can occur when health care providers do not encourage women who are candidates for lumpectomy to consider the procedure.
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 [11].
Talking to your health care provider about surgery options
It is important to learn about your surgery options and talk openly with your health care provider about your treatment. You should feel confident you are getting the best treatment possible. Never hesitate to seek 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 Good Care.
Updated 04/17/12
