• If you need to undergo surgery for breast cancer, your doctor may recommend a lumpectomy (removing part of the breast) or a mastectomy (removing the entire breast).
• Both procedures are equally effective for treating most types of breast cancer.
• Mastectomies may allow you to avoid radiation treatments but can lead to more extensive side effects.

Breast cancer treatment usually begins with surgery. Most people with a breast cancer diagnosis will need to undergo a procedure to remove some or all of the breast tissue. In some cases, a doctor may recommend having radiation or chemotherapy first to shrink the tumor before surgery.

It can be overwhelming to understand recommendations and make decisions about which type of surgery option is best. There are risks and benefits for each. The procedure that is right for you is based on the details of your breast cancer as well as your values and preferences.

This article will look at the similarities and differences between mastectomies and lumpectomies. Ultimately, you should work with your doctor to determine which option is best for your particular diagnosis.

Terms and Types

Lumpectomies and a mastectomies are the two main types of breast cancer surgery.

A lumpectomy, also known as breast-conserving surgery, involves removing the breast tumor and a small amount of the healthy tissue that surrounds it. During a lumpectomy, a breast surgeon may also remove some lymph nodes to check whether cancer cells are spreading.

A mastectomy is the removal of all of the breast tissue. People with various stages of breast cancer may have the option of a mastectomy. There are different types of mastectomies, including:

• Total or simple mastectomy — Surgery to remove one breast
• Double or bilateral mastectomy — Surgery to remove both breasts
• Skin-sparing mastectomy — Surgery that leaves as much skin intact as possible to later reconstruct the breast
• Nipple-sparing mastectomy — A breast removal procedure that leaves the nipple in place
• Modified radical mastectomy — Elimination of the breast and the lymph nodes in the armpit
• Radical mastectomy — Surgery that removes the breast tissue, lymph nodes, and some chest muscles (this is rarely done today)

Your doctor may recommend either a lumpectomy or mastectomy based on factors like the size and location of your tumor, how many tumors you have, the status of the lymph nodes, and your overall health. However, your personal preferences matter, too.

Effectiveness

Some people prefer the idea of a mastectomy because they feel like removing the breast tissue will protect them from cancer in the future. However, this is generally not the case.

Research has found that breast cancer recurrence (having the cancer return after being treated) is slightly more likely for people getting lumpectomies, compared to those who have mastectomies. If you undergo a lumpectomy, your risk of cancer coming back in the same breast is about 5 percent to 10 percent when combined with radiation treatment as needed. In contrast, for a mastectomy, your risk is about 5 percent.

However, you have the same life expectancy if you have a lumpectomy compared to a mastectomy, regardless of whether your cancer returns. A 20-year study found that women had the same survival rates regardless of which surgery they initially underwent.

Health experts generally agree that lumpectomies and mastectomies are equally effective.

Next Steps After Surgery

You will likely need other types of breast cancer treatments after surgery.

Additional surgeries may be necessary after your first procedure. If you get a lumpectomy and your doctor was unable to remove all of the cancer, they may need to go back and cut out additional tissue or perform a mastectomy. About 10 percent to 40 percent of people need additional surgery after a lumpectomy.

If you choose reconstruction after breast cancer surgery, mastectomy is more likely to require multiple surgeries to rebuild tissue compared to a lumpectomy. If you get a breast implant, it may need to be replaced after about 10 years, so this could mean additional surgeries in the future.

Radiation therapy is almost always needed after a lumpectomy. If any cancer cells are left behind after surgery, radiation treatments can help kill them. This usually involves going into the clinic five days per week for five to seven weeks.

You may also need additional treatments like chemotherapy or hormone therapy after either type of breast cancer surgery. Your doctor will know more about your cancer after a lumpectomy or mastectomy, so you may not know your full treatment plan until after surgery.

Outpatient vs. Inpatient Procedures

A lumpectomy is usually an outpatient procedure — you can often leave the hospital on the day of surgery and recover at home. Lumpectomies usually take less than an hour, and in some cases may take only 15 minutes.

Mastectomies, on the other hand, take longer. You may be on the operating table for up to three hours if your surgeon is also removing lymph nodes or doing breast reconstruction. In some cases, you may be able to go home the same day. If you have other health issues or need more extensive surgery, your mastectomy may be an inpatient procedure that requires you to stay overnight or for a couple of days.

Recovery

Lumpectomies are less invasive procedures with shorter recovery times. You will probably be able to go back to your daily routine within five to 10 days.

Recovery from a mastectomy may take up to one month. If you have undergone breast reconstruction at the same time as your mastectomy, healing may take eight weeks or more.

After either surgery, you will have some pain. You may be able to manage a lumpectomy with over-the-counter pain medications, or without any drugs. Your doctor is likely to give you stronger painkillers for a mastectomy.

If you undergo a lumpectomy, you are less likely to have a surgical drain (a tube that allows fluid to leak out of your breast area). In the case of either procedure, your cancer care team should tell you how to take care of wounds or drains and give you arm exercises.

Risks

A mastectomy is more likely to lead to ongoing problems like scarring, pain, and numbness. You will also be unable to lactate (produce milk) after a mastectomy, although this may be possible after a lumpectomy.

Although a lumpectomy may lead to fewer surgery-related side effects, it is usually paired with radiation, which can cause other problems. Radiation therapy to the breast can cause these side effects:

• Skin changes (such as dryness, redness, or itching)
• Breast swelling or tenderness
• Hair loss
• Tiredness

Undergoing a mastectomy may allow you to avoid radiation-related side effects. However, there is a chance you will still need radiation therapy if your tumor has grown large or has spread. Ask your doctor whether you will need radiation therapy.

Lymphedema (swelling of your arm, breast, chest, or abdomen) can be an uncomfortable side effect of a lumpectomy or mastectomy. The more lymph nodes that are removed, the greater your chances of lymphedema will be.

Appearance and Reconstruction

Many people want their breasts to look and feel as normal as possible after surgery, while others may not mind an altered appearance. If you don’t like the way your breasts look, you may experience lower self-esteem or poor mental health.

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A lumpectomy will usually allow you to keep some of your normal breast tissue and appearance. These procedures also tend to not affect the size of the breast, which means your breasts will likely appear the same size. However, the radiation that follows a lumpectomy may lead to changes in your skin’s appearance.

A mastectomy will change the appearance and size of your breast more drastically. Your chest will be flat on one side and your nipple will likely be removed.

Breast reconstruction surgery helps your breasts look more balanced in size and allows your clothes to fit better. It may also make you feel more confident about your appearance. However, as with any surgery, you could experience blood clots or infections. Other risks of reconstruction include necrosis (having some of your skin or breast tissue die), dimpled skin, weaker muscles, and scarring. Additionally, some people lose feeling in their breast after reconstruction.

Some people don’t feel strongly about having different-looking breasts. They may choose not to undergo breast reconstruction to avoid the possible risks. Some people who go with this option use prosthetics or breast forms under their clothes to help their breasts look even.

Emotional Toll

It’s essential to carefully consider how either surgical treatment might make you feel over time.

Because a mastectomy tends to change your breast’s appearance more, it may affect your self-image or feelings about your sexuality. Mastectomies may also lead to a worse sense of well-being in the long term.

You may also want to consider how you may feel after your cancer has been successfully treated. If you have a lumpectomy and leave much of your original breast tissue in place, you may have increased anxiety about whether your cancer will come back. A mastectomy may provide more peace of mind, although it’s still possible for cancer to return. It may help to keep in mind that lumpectomies and mastectomies are considered to be equally effective.

Talk With Others Who Understand

MyBCTeam is the social network for people with breast cancer and their loved ones. On MyBCTeam, more than 58,000 members come together to ask questions, give advice, and share their stories with others who understand life with breast cancer.

Have you undergone breast cancer surgery? How do you feel about your surgery if you’ve had a lumpectomy or mastectomy? Share your experiences in the comments below, or start a conversation by posting on your Activities page.