It may be hard to decide whether to have a mastectomy or a lumpectomy (also called breast conserving surgery). First, talk to your surgeon to see if you have a choice between lumpectomy plus radiation therapy and 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
In select cases, neoadjuvant (preoperative) therapy can change a woman’s surgical options. Neoadjuvant therapy may shrink a tumor enough so that a lumpectomy becomes an option instead of a mastectomy.
Learn more about neoadjuvant therapy.
Survival and recurrence with mastectomy versus lumpectomy plus radiation 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 and the main cause of breast cancer death) is the same for both procedures .
Learn more about breast cancer recurrence.
Learn more about metastatic breast cancer.
Risks and benefits of mastectomy versus lumpectomy plus radiation therapy
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
|Treatment for early breast cancer
|Amount of tissue removed
||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 or regional anesthesia
||Overnight hospital stay needed
||Often go home on same day as surgery (if axillary dissection is not done)
|Temporary soreness of chest, underarm and shoulder
|Chance of breast cancer 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)
What to expect after surgery
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.
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.
Chemotherapy, hormone therapy and targeted therapy after surgery
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.
Regional differences in lumpectomy rates in the U.S.
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 regional differences in rates is due to personal preferences that can vary based on where you live. 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 offers peace of mind. However, differences in rates also can occur when health care providers do not encourage women who can have 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 .
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 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 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.