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 you have a choice, take time to study your options. Weigh the risks and benefits of each and choose the surgery that’s right for you. Survival is the same no matter which option you choose .
Also, the choice of surgery does not affect whether you will need chemotherapy, hormone therapy and/or HER2-targeted therapy. Drug therapies are given based on the characteristics of the tumor, not the type of surgery you have.
In some cases, neoadjuvant therapy (chemotherapy, hormone therapy and/or HER2-targeted therapy before surgery) can change a woman’s surgical options.
Neoadjuvant therapy may shrink a tumor enough so a lumpectomy becomes an option to a mastectomy.
Sometimes, there are enlarged lymph nodes in the underarm area (due to the spread of breast cancer to these lymph nodes). Neoadjuvant chemotherapy can shrink the tumors in the lymph nodes. This makes it easier to surgically remove these lymph nodes. In some cases, fewer lymph nodes will be removed.
Survival with lumpectomy (plus radiation therapy) is the same as with mastectomy . They lower the risk of death from breast cancer and the risk of death from any cause by the same amount .
Most people diagnosed with breast cancer will never have a breast cancer recurrence (return of breast cancer). However, everyone who has had breast cancer is at risk of recurrence.
The risk of recurrence varies greatly from person to person.
Compared to mastectomy though, there's a slightly higher rate of the cancer returning within the breast (called local recurrence) with lumpectomy . A local recurrence is treated with some combination of surgery, radiation therapy, chemotherapy, hormone therapy and/or HER2-targeted therapy.
The risk of cancer spreading to other parts of the body (called metastasis or distance recurrence) is the same for both procedures .
Learn more about treatment for local recurrence and treatment for metastasis.
For a summary of research studies on mastectomy versus lumpectomy plus radiation therapy and overall survival, visit the Breast Cancer Research Studies section.
Figure 5.3 below outlines some things to consider when choosing between mastectomy and lumpectomy plus radiation therapy.
The main benefit of lumpectomy plus radiation therapy is the breast is preserved as much as possible.
A potential benefit of mastectomy is 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 far away from a radiation treatment center, or if you cannot have radiation therapy, mastectomy is usually a better option than lumpectomy.
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 the 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
At least 1 overnight hospital stay needed
Often go home on same day as surgery (if axillary dissection is not done)
Almost always done
Temporary soreness of chest, underarm and shoulder
Chance of recurrence in the breast (local recurrence)
Very low for early stages of breast cancer
Low for early stages of breast cancer (but slightly higher than with mastectomy)
Chance of recurrence outside the breast (metastasis, distant recurrence)
Same as with lumpectomy plus radiation therapy
Same as with mastectomy
Chance of lymphedema (if have a sentinel node biopsy or axillary dissection)
With either type of surgery, you will have some soreness in your chest, underarm and shoulder.
If lymph nodes in the underarm area (axillary nodes) are removed during surgery, you may also have some numbness and a burning feeling under and behind your arm.
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 scar.
Learn more about the management of surgery-related pain.
If axillary lymph nodes are removed during surgery, 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/breast or back), causing it to swell.
The type of surgery you have does not affect whether you will have chemotherapy, hormone therapy or HER2-targeted therapy.
These drug therapies are given based on the characteristics of the tumor, not the type of surgery you have.
Learn about tumor characteristics and other factors that affect these treatment options.
Lumpectomy rates vary across the U.S. The highest rates are in the Northeast and the lowest rates are in the South [7-8].
For a table showing differences in U.S. rates of mastectomy, visit the Breast Cancer Research Studies section.
Personal preference matters a lot when deciding between lumpectomy and mastectomy. Some women very much wish to keep their breasts, while for other women mastectomy offers peace of mind.
Where you live may affect your surgery choice. Compared to women who live in urban areas, those who live in rural areas are less likely to have a lumpectomy . Women who live far from a center that offers radiation therapy (needed for lumpectomy) may prefer to have a mastectomy.
Not all women can have a lumpectomy (plus radiation therapy) instead of a mastectomy. Talk with your health care provider about whether lumpectomy is an option for you.
Learn about the risks and benefits of each surgery option. Talk with your provider about which treatments are best for you. This can help you feel confident you are getting the best care possible.
It's always OK to get a second opinion from a medical oncologist and/or breast surgeon at a different hospital or practice. Getting a second opinion can:
Learn more about getting good care.
Surgical Options Video
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