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Mastectomy vs. Lumpectomy
Under certain circumstances, people with breast cancer have the opportunity to choose
between total removal of a breast (mastectomy) and breast-conserving surgery
(lumpectomy) followed by radiation.
Lumpectomy followed by radiation is likely to be equally as effective as mastectomy for
people with only one site of cancer in the breast and a tumor under 4 centimeters. Clear
margins are also a requirement (no cancer cells in the tissue surrounding the tumor).
Deciding factors
Although most women who have a choice prefer the less invasive lumpectomy, deciding
between lumpectomy and mastectomy depends on a how you feel about the following:
Do you want to keep your breast? If it’s important to you to keep your breast, you may
decide to have lumpectomy with radiation instead of mastectomy.
Do you want your breasts to match as much as possible in size? For most women,
lumpectomy has a good cosmetic result. In rare cases when a larger area of tissue needs to
be removed, lumpectomy can cause the breast to look smaller or distorted. There are
reconstruction options available for both lumpectomy (if there is significant distortion) and
mastectomy. If you need to have a large area of tissue removed and two breasts of
matching size are very important to you, you and your doctor will need to decide which
surgery is best for your situation.
How anxious will you be about breast cancer coming back? If removing the entire breast
would help you worry less about the possibility of the breast cancer coming back
(recurrence), you might consider mastectomy.
There are also other, less personal factors that can affect which type of surgery you
have:
Where you live: Research has shown that women who live in the United States are more
likely to have mastectomies than women in other countries. In the Midwestern and
southern parts of the U.S., mastectomies are very common. We don't know why this is, but
it probably has something to do with the attitudes of women and their doctors.
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Mastectomy vs. Lumpectomy
Where you go for treatment: Lumpectomies are more commonly performed in universitybased hospitals than in community hospitals.
When the surgeon was trained: Older surgeons in some parts of the United States may be
more old-fashioned and less likely to offer lumpectomy with radiation as an option for their
patients, particularly their older patients. Until the mid-1980s, mastectomy was the
standard of care for any stage of breast cancer, and research has shown that surgeons
trained before 1981 recommend mastectomy more often than lumpectomy. If you feel
strongly about one option over the other, ask your surgeon how many mastectomies and
lumpectomies he or she performs and why. Seek a second opinion to get a more complete
and balanced understanding of your options. Don't let hidden biases or unchanging
attitudes keep you from getting the best care.
Lumpectomy: Advantages and disadvantages
The main advantage of lumpectomy is that it can preserve much of the appearance and
sensation of your breast. It is a less invasive surgery, so your recovery time is shorter and
easier than with mastectomy.
Lumpectomy has a few potential disadvantages:
You are likely to have 5 to 7 weeks of radiation therapy, 5 days per week, after lumpectomy
surgery to make sure the cancer is gone.
Radiation therapy may affect the timing of reconstruction and possibly your reconstruction
options after surgery. Radiation therapy also may affect your options for later surgery to
lift or balance your breasts.
There is a somewhat higher risk of developing a local recurrence of the cancer after
lumpectomy than after mastectomy. However, local recurrence can be treated successfully
with mastectomy.
The breast cannot safely tolerate additional radiation if there is a recurrence in the same
breast after lumpectomy. This is true for either a recurrence of the same cancer, or for a
new cancer. If you have a second cancer in the same breast, your doctor will usually
recommend that you have a mastectomy.
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Mastectomy vs. Lumpectomy
You may need to have one or more additional surgeries after your initial lumpectomy.
During lumpectomy, the surgeon removes the cancer tumor and some of the normal tissue
around it (called the margins). A pathologist looks to see if cancer cells are in the margins.
If there are cancer cells, more tissue needs to be removed until the margins are free of
cancer. Ideally, this is all done during the lumpectomy, but analyzing the margins can take
about a week. So sometimes after the pathology report is done, the margins are found to
contain cancer cells and more surgery (called a re-excision) is needed.
Mastectomy: Advantages and disadvantages
For some women, removing the entire breast provides greater peace of mind ("just get the
whole thing out of there!"). Radiation therapy may still be needed, depending on the results
of the pathology.
Mastectomy has some possible disadvantages:
Mastectomy takes longer and is more extensive than lumpectomy, with more post-surgery
side effects and a longer recuperation time.
Mastectomy means a permanent loss of your breast.
You are likely to have additional surgeries to reconstruct your breast after mastectomy.
Making your own decision
Your breasts may be such an important part of your identity — your sense of who you are
— that you'll go to great lengths to preserve them. That's a completely acceptable approach
to take, no matter what your age or figure — AS LONG AS it doesn't endanger your overall
health and chances for a full recovery.
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