As part of early breast cancer treatment, you may be able to choose between a mastectomy or a lumpectomy with radiation. You may also wish that someone would just decide for you. Read on for the basics to help you decide whether to get a lumpectomy or mastectomy.
Are you worrying about making the wrong choice? Are you wondering if you’ll be second-guessing your decision should the cancer return in the future? Are your thoughts consumed with just getting the cancer out of your body by whatever means possible? These reactions and concerns are normal, but they still make the decision difficult.
Fortunately, there is no wrong decision.
Mastectomy vs. Lumpectomy Infographic
Let’s start with the basics. Here’s a visual overview. Below we’ll get into more detail. We also have a printable version here.
What is a Mastectomy?
A mastectomy is a surgical procedure that removes the entire breast. Several types of mastectomies are available, depending on your situation:
- Simple (total): This type of mastectomy removes the whole breast but does not remove any muscles from beneath the breast. Nor does it involve specific removal of underarm lymph nodes. It’s frequently used with women who are receiving a mastectomy to preventative mastectomy and women with large or multiple areas of DCIS (ductal carcinoma in situ).
- Radical: Most often used when has breast cancer spread to the muscles under the breast. Radical mastectomies remove the entire breast, the muscles along the chest wall under the breast, and levels I, II, and III underarm lymph nodes. The most extensive type, they are not commonly performed anymore.
- Modified radical: Involving the removal of the breast and levels I and II underarm lymph nodes, physicians use modified radical mastectomies for most women with invasive breast cancer. During these mastectomies, no muscles from beneath the breast are removed.
- Partial: A partial mastectomy removes only the breast tissue that contains the cancer cells, along with some of the healthy tissue surrounding the area. Technically, a lumpectomy is a type of partial mastectomy, but partial mastectomies typically remove more tissue than most lumpectomies.
- Nipple-sparing: This mastectomy is similar to a simple mastectomy in that the breast tissue is removed while the underlying muscle is left alone. However, in a nipple-sparing mastectomy, the nipple is also left alone, thus removing any need for nipple reconstruction. You may want to read more about nipple-sparing and skin-sparing mastectomies.
When is a Mastectomy an Option?
In the past, mastectomies were the typical surgical treatment for all types of breast cancer. Since the early 1990s, women choose lumpectomies more often for early stage breast cancer. However, roughly 20 percent of women will need a mastectomy due to the type of cancer or the size of their tumor (read more about breast cancer types and classification).
Among women whose breast cancer returned following a lumpectomy with radiation, a mastectomy is usually required to treat the recurring cancer. Mastectomies are still an option for women who have early stage breast cancer. They are also an option for ductal carcinoma in situ (DCIS), a form of non-invasive breast cancer, often called Stage 0.
Women with locally advanced breast cancer, which is cancer that has spread to the breast skin, chest wall, or lymph nodes, may require mastectomies. The same is true for women with inflammatory breast cancer.
Certain other factors such as your location, the training your surgeon has, and the hospital you go to affect the type of procedure recommended to you.
What are the Advantages and Disadvantages of Getting a Lumpectomy or Mastectomy?
Perhaps the biggest advantage of getting a mastectomy is peace of mind. The cancer is gone, and so is (most of) the tissue that the cancer affects. This is especially the case for women who have a bilateral mastectomy, a mastectomy that removes both breasts.
There are fewer opportunity for cancer cells left behind in the breast. While not common, occasionally a surgeon discovers that the cancer is more invasive than originally thought during a lumpectomy. In these cases, the surgeon may have to schedule a follow-up mastectomy.
In terms of disadvantages, mastectomies are much more extensive procedures than lumpectomies. This means longer hospital stays and general anesthesia. A mastectomy also does not automatically mean you will not need radiation either. Recovery time after a mastectomy is longer and side effects may be more difficult to handle. Furthermore, women receiving a mastectomy may be more at risk of suffering from various complications such as lymphedema.
Since a mastectomy removes the entire breast, you may also desire additional surgeries to reconstruct your breast.
Lumpectomy with Radiation
What is a Lumpectomy?
A lumpectomy is a type of breast conserving surgery, or BCS. Rather than removing the entire breast, your surgeon removes only the tumor and a small amount of clean tissue from around the tumor (also called a clean margin). In some cases, surgeons may also remove some underarm lymph nodes. The surgeon then closes the breast with stitches.
Most lumpectomies take between 15 and 40 minutes to complete. Sometimes surgeons can feel where the tumor is located. If not, mammography or other imaging technique determines the location. A pathologist tests the margin removed during the procedure to see if any cancer cells have spread away from the tumor. That’s how they determine whether or not the physician has successfully removed the entire tumor.
Radiation therapy usually follows a lumpectomy. This not only reduces the chances of cancer recurrence, it also kills any remaining cancer cells. In contrast, radiation therapy is not as frequently required following a mastectomy.
Surgeons attempt to maintain the original appearance of the breast during a lumpectomy. They often used curved incisions when cutting into the breast to match the natural shape. However, some women will still opt for breast reconstruction following a lumpectomy.
When is a Lumpectomy an Option?
A lumpectomy with radiation treats fairly small tumors or those in the early stages of breast cancer. Ideally, tumors should be smaller than four centimeters in diameter. Women with inflammatory breast cancer or multiple tumors are usually not good candidates for this type of procedure. Tumors that are large relative to a woman’s breast size are also a common disqualifying factor, as are tumors that have spread throughout the breast.
Sometimes a woman would be eligible for a lumpectomy, but not for radiation, thus requiring a mastectomy. For example, pregnant women cannot receive radiation therapy, nor can women who have already have radiation therapy on the same breast. In addition, women with systemic lupus or scleroderma are not good candidates for radiation treatment.
What are the Advantages and Disadvantages?
Since lumpectomies with radiation are less invasive, women have shorter, and often easier, recovery times than women who have had a mastectomy.
However, the primary advantage of a lumpectomy is preserving the sensation and appearance of your breast. While breast reconstruction can recreate the appearance of the lost breast, it will probably lose sensation and the process is more intensive. A lumpectomy with radiation preserves your original breast.
Unfortunately, despite the cosmetic advantages, lumpectomies have plenty of disadvantages.
Radiation therapy may take up to seven weeks following the initial surgery, meaning treatment continues for a while. If you still want to have breast reconstruction after a lumpectomy, radiation therapy may also affect the timing and types of reconstruction options available to you.
Ultimately, you may need additional follow-up surgeries after your lumpectomy. If the margin that was removed is discovered to have cancer cells (not “clean”), the surgeon will need to take more tissue out. Surgeons try to have pathologists examine the tissue during the procedure, but this is not always possible. In such cases, the margin may not be fully analyzed up to a week after surgery. Similarly, once you receive radiation therapy in one breast, it cannot receive it again. If your cancer returns in that same breast, a mastectomy may be the only option left.
Overall Survival and Recurrence Rates
Numerous studies compare survival and recurrence rates between women who have had a mastectomy versus a lumpectomy with radiation. Local recurrence, which is cancer returning in the breast, occurs at only a slightly higher rate among women who had a lumpectomy with radiation. Meanwhile, the risk of metastasis or distant recurrence, which occurs when cancer spreads to other organs, is the same for both procedures.
Survival rates are also largely the same among women with early breast cancer who received either treatment. This suggests that lumpectomy with radiation is at least as good as a mastectomy. However, a few studies that suggest that lumpectomies with radiation have a slightly higher survival rate.
Questions to Ask Yourself When Deciding Between a Lumpectomy or Mastectomy
If a lumpectomy and a mastectomy are both options for you, the decision relies on what you feel is the best course of action for you. We’ve included just a few questions you can ask yourself to help you decide.
- How worried are you about recurrence? For some women, the fear of breast cancer recurrence is a strong deciding factor. If you know that having a mastectomy would help you worry less, then that may be a legitimate factor in your decision. However, the survival rate is about the same.
- Do you want to avoid painful recoveries? A lumpectomy does not guarantee your recovery will be less painful, but it’s associated with shorter and easier recovery times. Many women find that recovery following a mastectomy is longer and involves more pain due to the more extensive nature.
- Do you want to preserve your natural breast? Your breasts are a part of you and it is completely normal to want to preserve them as much as possible. Lumpectomies with radiation allow you to preserve your natural breast as much as possible.
- Are you concerned about radiation? The length and nature of radiation therapy may worry you. Radiation therapy can cause a wide range of side effects, including skin redness, breast swelling and fatigue. Additionally, in rare cases radiation can scatter to other areas of the body and damage the heart, bones or lungs.
- Is having symmetry and the final cosmetic look very important to you? For some reason, the idea of a hole or dent in one breast is unacceptable. She is willing to go through multiple surgeries to make sure she comes out with two identical and “perfect” breasts. She may need to meet with a plastic surgeon to discuss whether a double mastectomy is worth the risk and pain in her case.
- How old are you? The younger you are when you are diagnosed with breast cancer, the greater risk you have of developing cancer again later in life. Younger women may prefer a mastectomy because it limits the risk of recurrence.
It’s Your Decision
The chances of survival and recurrence are the same for both lumpectomy or mastectomy. It’s important that you evaluate the pros and cons carefully before making your final decision. Each woman has her own reasons for choosing between a lumpectomy or mastectomy.
Even though their personal reasons may not always relate to you, it is helpful to discuss the decision with other women who have been through the same situation. As always, you should also thoroughly discuss your options with your physicians.
Note: We have several other FANTASTIC resources on this subject. First, check out infographic. Consider printing it out and discussing with your physician. Then listen to our podcasts on the topic. You may also be interested in our Breast Cancer Basics page, which is a great starting point for any woman beginning her breast cancer journey. Don’t forget to sign up for our newsletter and Navigating Your New Diagnosis e-course below.