Should I have a Lumpectomy or Mastectomy?

If surgery to remove breast cancer is a part of your treatment plan, you’re likely to have questions about what’s best for you. When it comes to removing breast cancer, there are two primary types of surgery to choose from a lumpectomy, which leaves your natural breast intact, and a mastectomy, a procedure that removes the entire breast and sometimes part of the chest wall muscles. Each has important differences to note, and what's best for one patient may not be right for another. Let's look at these two types of breast cancer surgeries and how you and your breast cancer care team will help you decide the best path forward.

What is a Lumpectomy?

A lumpectomy, also called breast-conserving surgery, removes the cancer and a margin of surrounding healthy tissue. Removing a margin of healthy tissue helps ensure that all cancer cells have been removed. This surgery may also be referred to as a wide local excision, segmental resection, or partial mastectomy.

Most women who have a choice prefer the less invasive lumpectomy. Research shows that a lumpectomy plus radiation therapy treatment is as effective as a mastectomy for most women with early-stage breast cancer. Removing all the breast tissue (mastectomy) isn’t considered more effective for patients who qualify for a lumpectomy.

If a lot of breast tissue was removed to be sure the cancer was completely eliminated, it could affect the breast’s appearance. A breast cancer surgeon, like the ones at Compass Oncology, may be familiar with oncoplastic lumpectomy techniques that use plastic surgery methods to reshape the breast and make it look as symmetrical with the other breast as possible.

There are also methods that can be used to keep scaring to a minimum and preserve the nipple when possible.

Radiation therapy, given by a radiation oncologist, is recommended after a lumpectomy to help reduce the risk of breast cancer coming back (recurrence).

Good candidates for radiation following a lumpectomy:

• Have early-stage breast cancer that hasn’t spread beyond the breast or underarm lymph nodes
• Have one relatively small tumor
• Prefer to keep as much natural breast tissue as possible
• Want to avoid mastectomy and breast reconstruction
• Can commit to daily radiation treatments over a period of a few weeks
• Do not have a gene mutation such as a BRCA or ATM mutation, which could increase the chance of a second breast cancer. Learn more about genetics and breast cancer.
• Are not currently pregnant

Pros and Cons of a Lumpectomy

Advantages of lumpectomy:  

• Preserves your breast, including appearance and sensations
• Less invasive, which often means an easier and shorter recovery time
• Usually, a one-day procedure that lets you return home following surgery
• Preserves the potential to breastfeed

Disadvantages of lumpectomy:

• Radiation therapy is usually required 5 days a week for 5 to 7 weeks, which can affect the timing of reconstruction surgery and result in potential side effects.
• Scars, indentation, dimpling, or other changes may become noticeable as the skin heals.
• There is a chance of recurrence due to cancer cells remaining in the breast after surgery and radiation. A relatively low percentage of lumpectomy patients require a second surgery because of cancer cells found in the margins.  
• Fluid buildup in the space where the tissue was removed (seroma) is normal after surgery; it may require draining.

What is a Mastectomy?

Mastectomy is breast cancer surgery that removes the cancer by removing the entire breast and sometimes tissue in the chest wall area. Most often, only the breast that had cancer will be removed. For some patients with a genetic mutation that makes them more likely to have a breast cancer recurrence, both breasts may be removed even though cancer was only found in one. Removing the breast that was cancer-free is called a preventive mastectomy and is only suggested if you’re in this high-risk category.

You are a candidate for a mastectomy if:

• You have 2 or more breast cancer tumors in one breast
• The cancer has spread throughout the entire breast
• There is one large tumor relative to the size of the breast
• The tumor is just below the nipple. The way the lumpectomy would make the breast look in that case may be a concern.
• Radiation therapy can’t be given to the patient

There are several different types of mastectomy. You and your breast cancer specialists will work together to decide which is best for your individual situation. During this surgery, you might also have lymph nodes removed so they can be tested for cancer.

Radiation therapy is not usually needed after a mastectomy because all of the breast tissue is removed. 

With both a lumpectomy and mastectomy, chemotherapy, hormone therapy, targeted therapy, or immunotherapy may be used before and/or after surgery. This is dependent on the type of breast cancer.

Breast reconstruction may be done at the same time as the mastectomy (immediate reconstruction) or at a later date after healing is completed (delayed reconstruction). Most of the breast skin, nipple, and areola will be left intact with immediate reconstruction. If you prefer to “go flat,” surgical closure will create a smooth chest wall. Prosthetic breast forms can provide the appearance of breasts under clothing.

Pros and Cons of a Mastectomy

Advantages of mastectomy:

• Greater peace of mind for some women knowing that there will be no cancer recurrence.
• Less chance of needing radiation therapy after a mastectomy.
• The reconstructed breast can be made to match the other breast. There is also an opportunity for the healthy breast to be reduced in size to match the reconstructed breast for those who were a candidate for breast reduction.
• If you have a genetic mutation that increases cancer risk in your other breast, both breasts are removed to reduce the risk.

Disadvantages of mastectomy:

• Mastectomy surgery takes longer and is more extensive than lumpectomy resulting in a longer recovery time.
• More post-surgery side effects than lumpectomy include pain and nerve pain, tenderness, swelling, limited mobility in the affected area, and blood accumulation at the surgery site.
• Psychological effects from permanent loss of a breast.
• Loss of sensation in the breast or nipple area because nerves in the breast skin, nipple, and areola are damaged or removed during mastectomy.
• Additional surgeries to reconstruct your breast after mastectomy may be needed, even if you have immediate reconstruction.
• Breast reconstruction after mastectomy will require long-term maintenance. Implants typically need replacement every ten years. Additional surgeries may be needed to maintain symmetry between the reconstructed and natural breast.

Deciding Which Breast Cancer Surgery is Best for You

You will discuss the best option for you with the breast cancer surgeon, who has consulted with the medical oncologist and radiation oncologist so they can review where the tumor is located, the stage of cancer, and your overall health condition.

Before making a decision, you might want to take a couple of things into consideration: 

• Do you want to keep your breast? If your condition allows for either surgery, you may prefer lumpectomy instead of mastectomy if that's important to you. 
• Do you want the same size breasts as much as possible? Most women have good cosmetic results with lumpectomy. Reconstruction is available for either surgical technique.  
• Are you anxious about breast cancer recurring? Removing the entire breast may help reduce your anxiety. 

Together you and your breast cancer care team will develop a treatment plan that’s best for you, including the type and timing of surgery.

In some cases, treatments like radiation therapy, chemotherapy, or hormone therapy are given before surgery to reduce the size of the cancer and the amount of breast tissue that has to be removed.

If your medical oncologist suggests this, it’s for a good reason. By reducing the size of the tumor, there will be a smaller area removed in a lumpectomy. And if mastectomy was the only option before treatments, a lumpectomy could become an option if the tumor shrinks as expected.

Breast Cancer Surgical Oncology Services in Portland-Vancouver

The breast cancer doctors at Compass Oncology serve the Portland, Oregon, and Vancouver, Washington area providing advanced, personalized breast cancer treatment. They specialize specifically in breast cancer surgery and treatments.

Our cancer center is also a high-risk breast clinic for patients at increased risk of breast cancer. Request a consultation with one of our specialists. Second opinions are also available.  

Originally published in April 2022. Updated May 2023.