Many people with early stage breast cancer can choose between breast-conserving surgery, called a lumpectomy, or total removal of the breast, a mastectomy. They may also require radiation therapy.
The choice between the two procedures involves many personal and medical factors, including the person’s previous medical history and their concerns regarding recurrence and cosmetic issues.
In this article, we explain lumpectomies and mastectomies in more detail, including what they involve 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 subsequent treatments and recovery times.
In a mastectomy, a surgeon will remove the entire breast.
There are different types of mastectomies. According to the American Cancer Society, these include:
- Simple or total mastectomy: The surgeon removes the entire breast, including the skin, areola, and nipple. They may also remove some lymph nodes under the arms. Most people can go home the day after the surgery.
- Skin-sparing mastectomy: The surgeon will keep most of the skin over the breast intact and only remove the breast tissue, nipple, and areola. They will remove the same amount of tissue as with a simple or total mastectomy. The surgeon can then use tissue from other parts of the body or implants to reconstruct the breast.
- Nipple-sparing mastectomy: The surgeon removes the breast tissue but keeps the skin and nipple intact. They may check for cancer cells in the breast tissue from under the nipple. If they find cancer cells, they will also remove the nipple.
- Modified radical mastectomy: This procedure involves the removal of the entire breast, as with a simple or total mastectomy. The surgeon will also remove the lymph nodes under the arms.
- Radical mastectomy: During this surgery, the surgeon removes the entire breast, the lymph nodes under the arm, and the pectoral muscles under the breast. Surgeons tend to recommend less extensive surgeries that have fewer side effects but are equally effective. However, they may still perform this surgery on people with large tumors growing into the pectoral muscles.
- Double mastectomy: Surgeons may perform this surgery, in which they remove both breasts, as a risk-reducing measure for people at very high risk of getting breast cancer. Most double mastectomies are simple or total mastectomies, but some may be nipple-sparing.
In a lumpectomy, a surgeon will remove the breast tumor and some of the healthy tissue surrounding it. A lumpectomy is technically a partial mastectomy, as it removes part of the breast.
The amount of breast tissue that the surgeon removes depends on the size and location of the tumor and the size of the breast, among other factors.
For example, a person may undergo a type of lumpectomy called a quadrantectomy, in which the surgeon will remove about one-quarter of the breast.
A person will likely need radiation therapy following a lumpectomy, and they may also need other treatments, such as chemotherapy or hormone therapy.
A lumpectomy might result in scarring or dimpling in the area where the tumor was before its removal. It may also lead to pain and, sometimes, a type of swelling in the arm area called lymphedema. Some people opt to have reconstructive surgery following the procedure.
Among people with breast cancer who have a choice of treatment, many prefer the less invasive lumpectomy over a mastectomy. Anyone who needs to make a decision should consider various factors.
- Keeping the breast: A person who wishes to keep their breast might choose a lumpectomy with radiation.
- Lower risk of recurrence: A person who is very anxious about breast cancer returning may opt for a mastectomy. There is a higher risk of local recurrence with a lumpectomy than with a mastectomy.
- Lower cost: If a person is concerned about the cost of their treatment, they may choose a lumpectomy. A
2016 studyfound that a mastectomy with reconstruction was substantially more expensive than other options.
- Cosmetic factors: For people who wish for their breasts to match as much as possible, a lumpectomy might be preferable, as this surgery usually has a good cosmetic result. However, reconstructive surgeries are usually possible following both lumpectomies and mastectomies.
Some people with breast cancer are not candidates for a lumpectomy. A person will need to talk with their doctor to determine whether a lumpectomy is a possibility for them.
A surgeon may suggest a lumpectomy to treat early, localized, or operable breast cancer.
A person may also require other treatments, such as radiation therapy, chemotherapy, and hormonal therapy.
The pros and cons of lumpectomy include:
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 stop them from growing.
There are two types of radiation therapy:
External beam radiation therapy
Doctors use this therapy to treat breast cancer. A machine outside the body directs radiation toward the cancerous area.
Internal beam radiation therapy
Doctors use this therapy, which is 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 it travels to the surface of the bones. The substance releases radiation, which kills cancer cells in the bones.
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.
This treatment removes hormones or prevents their actions, stopping cancer cells from growing.
Doctors can test a sample of breast tissue to check for hormone receptors on the cancer cells. If these receptors are present, doctors can use surgery, radiation therapy, or drugs to reduce the production of hormones or stop them from working.
Doctors can use a treatment called ovarian ablation to stop the ovaries from producing estrogen, which is the hormone that makes breast cancer grow.
Doctors use targeted therapy to identify and attack specific cancer cells.
Targeted therapies can 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 can administer this treatment in the form of drugs.
Immunotherapy uses the person’s 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 boost the body’s natural defenses against cancer.
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 choose a lumpectomy to preserve the appearance of the breast, save money, or avoid more extensive surgery.
Others may choose a mastectomy to get peace of mind, lower the likelihood of needing radiation therapy, or decrease the risk of recurrence.
Other treatment options are available, which a person may receive before, after, or without surgery. These options include radiation therapy, chemotherapy, hormonal therapy, targeted therapy, and immunotherapy.