Deciding Between Mastectomy or Lumpectomy

It may be hard to decide whether to have mastectomy or 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, study your options. Weigh the risks and benefits of each surgery and choose the one that’s right for you. Survival is the same no matter which option you choose [2-3].

Neoadjuvant (preoperative) therapy

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 lumpectomy becomes an option to mastectomy.

Sometimes, the lymph nodes in the underarm area are enlarged 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 and breast cancer recurrence

Survival

Survival with lumpectomy plus radiation therapy is the same as with mastectomy [2-3]. They both lower the risk of dying from breast cancer and the risk of dying from any cause by the same amount [2-3].

Breast cancer recurrence

The risk of breast cancer recurrence (return of breast cancer) varies greatly from person to person. For example, the risk of recurrence varies by the stage of the breast cancer at diagnosis and the biology of the tumor.

Most people diagnosed with breast cancer will never have a breast cancer recurrence. However, everyone who has had breast cancer is at risk of recurrence.

Compared to mastectomy, there’s a slightly higher risk of local recurrence (the cancer returning within the breast) with lumpectomy [2]. 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 [2].

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.

Risks and benefits of mastectomy versus lumpectomy plus radiation therapy

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 mastectomy.

Radiation therapy has some side effects and requires daily trips to a treatment center. If you can’t get to a radiation treatment center, or if you can’t have radiation therapy, mastectomy is usually a better option than lumpectomy.  

Figure 5.3: Total mastectomy versus lumpectomy plus radiation therapy
	Total mastectomy	Lumpectomy plus radiation therapy
Treatment for early breast cancer	Very effective	Very effective
Amount of tissue removed	Entire breast	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, or local anesthesia with sedation
Hospital stay	At least one overnight hospital stay is needed	Most people go home the same day as surgery
Radiation therapy	Sometimes done	Almost always done
Temporary soreness of chest, underarm and shoulder	Yes	Yes
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)	Yes	Yes

What to expect after surgery

Pain and numbness

With both mastectomy and lumpectomy, you will have some soreness in your chest, underarm and shoulder. If you have breast reconstruction at the same time as mastectomy, there can be more discomfort.

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, you’ll 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’re likely to have numbness along the surgical scar.

Learn more about the management of surgery-related pain.

Lymphedema

If axillary lymph nodes are removed during surgery, there’s 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.

Chemotherapy, hormone therapy and HER2-targeted therapy

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, such as hormone receptor status and HER2 status, not the type of surgery you have.

For example, whether or not you will need hormone therapy and/or HER2-targeted therapy depend on the biomarkers hormone receptor status and HER2 status.

Learn about tumor characteristics and other factors that affect these treatment options. 

Differences in lumpectomy rates

Personal preferences

Personal preference matters a lot when deciding between lumpectomy and mastectomy. Some women very much wish to keep their breasts, while for others, 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 more likely to have a mastectomy [8]. Women who live far from a center that offers radiation therapy (needed for lumpectomy) may prefer to have a mastectomy.

Talk with your health care provider about surgery options

Not all women can have a lumpectomy plus radiation therapy. 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 you’re getting the best care possible.

Second opinions

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:

• Instill confidence in the first provider by confirming a course of treatment
• Give a different insight into your treatment
• Increase your options for care
• Give you a chance to meet with another provider, who may be better suited to treat your cancer

Learn more about getting high-quality care.