Many people with early breast cancer can choose between breast-preserving surgery called lumpectomy or complete breast removal, a mastectomy. You may also need radiotherapy.
In most cases, a lumpectomy and radiotherapy provides a person with a similar long-term chance of survival as a mastectomy.
The choice between the two procedures depends on many personal and medical factors, including the person’s previous medical history and concerns about recurrence and cosmetic issues.
In this article, we explain lumpectomies and mastectomies in more detail, including their effects and the risk of recurrence. We also discuss some of the pros and cons of each option and list other treatment options for breast cancer.
Lumpectomies and mastectomies are similar surgeries, but they have different follow-up treatments and recovery times.
In a mastectomy, a surgeon removes the entire breast.
There are different types of mastectomies. According to the
The American Cancer Society includes:
- Simple or complete mastectomy: The surgeon removes the entire breast, including skin, areola, and nipple. You can also remove some lymph nodes under your arms. Most people are able to go home the day after surgery.
- Skin-friendly mastectomy: The surgeon keeps most of the skin above the breast intact and only removes the breast tissue, nipple, and areola. They remove the same amount of tissue as with a simple or complete mastectomy. The surgeon can then use tissue from other body parts or implants to reconstruct the breast.
- Nipple-friendly mastectomy: The surgeon removes breast tissue but keeps the skin and nipple intact. You can look for cancer cells in breast tissue under the nipple. When they find cancer cells, they also remove the nipple.
- Modified radical mastectomy: This procedure involves removing the entire breast, as with a simple or full mastectomy. The surgeon also removes the lymph nodes under the arms.
- Radical mastectomy: During this operation, the surgeon removes the entire breast, the lymph nodes under the arm and the pectoral muscles under the chest. Surgeons usually recommend less extensive surgeries that have fewer side effects but are just as effective. However, you can still perform this operation on people with large tumors that grow into the pectoral muscles.
- Double mastectomy: Surgeons can perform this operation, which involves removing both breasts, as a risk-reducing measure for people with a very high risk of breast cancer. Most double mastectomies are simple or total mastectomies, but some can be nipple-friendly.
Learn more about mastectomy types here.
In a lumpectomy, a surgeon removes the breast tumor and part of the healthy tissue surrounding it. A lumpectomy is technically a partial mastectomy because it removes part of the breast.
The amount of breast tissue that the surgeon removes depends, among other things, on the size and location of the tumor and the size of the breast.
For example, a person may undergo a type of lumpectomy called quadrantectomy, in which the surgeon removes about a quarter of the breast.
A person is likely to need radiotherapy after a lumpectomy and may also need other treatments such as chemotherapy or hormone therapy.
A lumpectomy may result in scars or dimples in the area where the tumour was before it was removed. It can also cause pain and sometimes a type of swelling in the arm area called lymphedema. Some people opt for reconstructive surgery after the procedure.
Learn more about breast lump removal here.
Decisive Factors For
People with breast cancer who have the choice of treatment, many prefer less invasive lumpectomy over mastectomy. Anyone who has to make a decision should consider various factors.
- Breast support: A person who wants to keep their breast may opt for a lumpectomy with radiation.
- Lower risk of recurrence: A person who is very afraid of breast cancer returning may opt for a mastectomy. A lumpectomy has a higher risk of local recurrence than a mastectomy.
- Lower costs: If a person is concerned about the costs of their treatment, they may opt for a lumpectomy. A 2016 study found that a mastectomy with reconstruction was significantly more expensive than other options.
- Cosmetic factors: For people who want their breasts to match as closely as possible, a lumpectomy may be preferable as this surgery usually has a good cosmetic result. However, reconstructive surgery is usually possible after both lumpectomies and mastectomies.
Some people with breast cancer aren’t candidates for a lumpectomy. A person must talk to their doctor to determine whether a lumpectomy is possible for them.
Learn more about Medicare coverage of mastectomies here.
Advantages and disadvantages of lumpectomy
A surgeon may suggest a lumpectomy to treat early, localized, or operable breast cancer.
A person may also need other treatments, such as radiotherapy, chemotherapy, and hormone therapy.
The pros and cons of lumpectomy include:
- Surgeons may be able to maintain the appearance of the breast to a greater extent and maintain most of the sensation.
- The surgery is less invasive and people recover faster and easier.
- Surgery is less expensive than a mastectomy.
Disadvantages of lumpectomy
- People are likely to need 5-7 weeks of radiotherapy after a lumpectomy.
- When a person receives radiotherapy, it may affect the time of reconstruction and the options available.
- People are at higher risk of local recurrence if they opt for a lumpectomy instead of a mastectomy.
- If there is a recurrence, the breast cannot tolerate further radiotherapy, so the healthcare team will likely recommend a mastectomy.
- If doctors find more cancer cells in the breast after the initial operation, further surgery may be necessary.
Pros and Cons of Mastectomy
— and disadvantages of mastectomy are:
- It can be comforting to remove the entire breast and cancer site.
- Radiation therapy is less necessary than with a lumpectomy.
- probability of recurrence is lower than with a lumpectomy.
- A person is less likely to need further surgery if they choose not to undergo breast reconstruction.
- Mastectomies are more extensive than lumpectomies.
- The healing process is longer and a person may have more side effects after surgery.
- People may find permanent breast loss a nuisance.
- If the person decides to reconstruct, they will need additional operations.
Other treatment options
A person may receive other treatments for breast cancer, either before or after surgery, or without it. Treatment options include:
Radiation therapy uses X-rays or other types of radiation to kill cancer cells and prevent them from growing.
There are two types of radiotherapy:
Doctors use this therapy to treat breast cancer. A machine outside the body directs radiation to the cancer area.
Doctors use this therapy, also known as brachytherapy, to relieve bone pain from breast cancer that has spread to the bones. The doctor injects a substance called strontium-89 into a vein and reaches the surface of the bones. The substance releases radiation, which kills cancer cells in the bones.
Learn more about the side effects of radiation treatment for breast cancer here.
Chemotherapy uses drugs that healthcare professionals inject into a vein or muscle People can also take chemotherapy drugs orally.
When the drugs enter the bloodstream, they reach cancer cells throughout the body and kill them.
Learn more about oral chemotherapy for breast cancer here.
This treatment removes hormones or prevents them from working, preventing cancer cells from growing.
Doctors can test a sample of breast tissue to look for hormone receptors on the cancer cells. When these receptors are present, doctors may use surgery, radiotherapy, or medication to reduce the production of hormones or prevent them from working.
Doctors can use a treatment called ovarian ablation to prevent the ovaries from producing estrogen, the hormone that makes breast cancer grow.
Doctors use targeted therapy to identify and attack specific cancer cells.
Targeted therapies may be less harmful to normal cells than other therapies such as radiation and chemotherapy. Therefore, in some cases, they may cause fewer side effects.
Doctors may give this treatment in the form of medication.
Immunotherapy uses your own immune system to fight cancer. It is a type of biological therapy.
Immunotherapy uses synthetic substances or substances that the body produces naturally to direct, restore, or strengthen the body’s natural defenses against cancer.
Learn more about first-line breast cancer treatments here.
Lumpectomies and mastectomies are both effective treatment options for early-stage breast cancer. A person’s choice between them often involves their personal preferences and medical history, as well as the type of breast cancer.
Both options have advantages and disadvantages. Some people may opt for a lumpectomy to maintain the look of their breasts, save money, or avoid more extensive surgery.
Others may opt for mastectomy to have peace of mind, reduce the chance of radiotherapy, or reduce the risk of recurrence.
Other treatment options are available that a person may receive before, after, or without surgery. These options include radiotherapy, chemotherapy, hormone therapy, targeted therapy, and immunotherapy.