Surgery for Breast Cancer: Lumpectomy or Mastectomy?

Surgery is a treatment option for many women with breast cancer. When breast cancer is found early, it can often be cured with surgery.

The two most common surgical options for breast cancer are:

• Mastectomy. With a mastectomy, the whole breast is removed. The most common type is called a modified radical mastectomy. This involves the removal of the entire breast, plus some of the lymph nodes from under the arm.
• Lumpectomy followed by radiation. This is also called breast-conserving surgery. In lumpectomy, only the tumor and a margin of healthy tissue are removed. This creates less scarring and preserves the look and shape of the breast. Radiation after surgery helps kill any cancer cells that might remain in the breast.

Most women with early-stage breast cancer (stage I or II) will have a choice between these two types of breast surgery. A mastectomy may be recommended for women with more advanced breast cancer.

With both surgeries, the surgeon will likely take some nearby lymph nodes to check them for cancer. This can be done in one of two ways:

• Sentinel node biopsy (removal of only the lymph nodes closest to the tumor)
• Axillary lymph node dissection (removal of about 10 to 40 lymph nodes from under the arm)

The procedure chosen depends on the:

• Size of the cancer and how far it has spread
• Type of surgery
• Experience of the surgeon

Is one type of surgery better than the other?
Doctors used to think that mastectomy was better than lumpectomy for all types of breast cancer. They believed that by removing more breast tissue, they reduced the chance that the cancer would return over time. But, in fact, long-term studies that compared lumpectomy with mastectomy for early stage breast cancer have shown that the survival rate is the same for both surgeries.

Because the outcome is the same for early stage breast cancer, many women opt to have lumpectomy and radiation so they can keep their breasts. Many factors are involved in making this decision. Every woman is different, and breast cancer is a complex disease. In some cases, mastectomy may be a better choice.

What you should know about lumpectomy

• Lumpectomy works best if the cancer is small and in one area near the edge of the breast.
• Lumpectomy may be done as an outpatient procedure, so you don't have to stay in the hospital.
• You will need about six weeks of radiation therapy after lumpectomy. Radiation can cause unpleasant side effects.
• Some breast tissue remains after lumpectomy, so there is a chance that cancer could come back in the same breast.
• If you get cancer again in the same breast, you will need to have a mastectomy.

What you should know about mastectomy

• Mastectomy may be recommended if the cancer is large, has recurred after a lumpectomy or is found in more than one area of the breast.
• Mastectomy requires a stay in the hospital and a longer recovery time than lumpectomy.
• Radiation may not be needed after mastectomy.
• Mastectomy removes the whole breast. This means the cancer can't come back in that breast.
• You can have the breast reshaped after mastectomy. This is called breast reconstruction.

How do I decide which is best for me?
Take some time to weigh the pros and cons of each type of surgery. Your feelings are an important factor in this decision. Discuss your choices with your doctor and your loved ones.

Lumpectomy may be best if:

• Your breast cancer is stage I or II (early stage).
• You are willing and able to go for radiation therapy after surgery. This may be hard if you live far from a treatment center.
• You feel strongly that you want to keep your breast.

Mastectomy may be best if:

• Your cancer is larger or more advanced.
• You can't have radiation. This might be the case if you are pregnant, you have already had radiation therapy to the chest or you have a serious lung or connective tissue disease.
• You are so worried about the cancer coming back that you would rather have all the breast tissue taken out now.

Related Articles Understanding Breast Cancer Staging Treatment Options for Breast Cancer Building a New Breast

External Sources Abeloff MD, Wolff AC, Wood WC, McCormick B, Weber BL. Cancer of the breast. Management of early invasive disease (stages I and II). In: Abeloff MD, et al., eds. Clinical Oncology. 3rd ed. Philadelphia: Elsevier Churchill Livingstone; 2004. American Cancer Society. Detailed guide: Breast cancer. Surgery for breast cancer. Accessed October 24, 2007. National Cancer Institute. Clinical trial results: Mastectomy no better than lumpectomy for women with small breast tumors. Accessed October 24, 2007. Veronesi U, Cascinelli N, Mariani L, et al. Twenty-year follow-up of a randomized study comparing breast-conserving surgery with radical mastectomy for early breast cancer. New England Journal of Medicine. 2002;347:1227-1232.

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