Lumpectomy vs. Mastectomy: How to Choose a Breast Cancer Surgery

A diagnosis of breast cancer throws you into a new reality filled with new terms to understand, doctors to meet, and decisions to make. Among the first, and most important, decisions women are asked to make is whether they’ll have a lumpectomy or a mastectomy.

According to Dr. Jesse Casaubon, a breast surgeon at Baystate Surgical Oncology & Breast Specialists, “Treatment for breast cancer almost always involves surgery. It’s the most trusted and enduring method for removing breast cancer.”

But while having surgery is usually a given, the type of surgery to have, says Casaubon, “depends on a number of factors, including the patient’s personal preference.”

Lumpectomy vs. Mastectomy: Understanding Your Surgical Options for Breast Cancer

The surgical choice for breast cancer comes down to a lumpectomy or a mastectomy. While the survival rates for both surgeries are the same, the procedures are dramatically different as are the recoveries. But more importantly, notes Casaubon, “Not every patient is a candidate for both procedures.”

Here’s a look at each procedure, including the advantages, disadvantages, and the deciding factors that should be considered when weighing your options.

Lumpectomy

A lumpectomy involves removing just the portion of the breast affected by cancer, thus preserving more of the breast tissue. In addition to removing the cancer, the surgeon will also remove a small portion, or rim, of healthy tissue from around the cancer. This tissue will then be examined to check for any spread of the cancer. If cancer is detected, a second surgery will be recommended. Casaubon notes that a second procedure, or re-excision, is only necessary in 10-15% of cases. “As frustrating and emotionally hard as a re-excision can be, it’s the best option for getting all the cancer. In fact, radiation cuts the chance of getting breast cancer again by 50%.”

Because patients who have a lumpectomy versus a mastectomy have a slightly higher risk of the cancer returning, lumpectomies are frequently followed by a course of radiation beginning a month after surgery.

“Receiving radiation is usually painless,” says Casaubon. “Each treatment takes just a few minutes but is administered 5 days a week up to three and a half weeks depending upon the findings for the individual patient. Most patients experience a bit of fatigue and in some cases the treated area may become a bit angry and red like a sunburn.”

In addition, patients who undergo a lumpectomy should continue to get regular mammograms post-surgery.

It’s important to note that not every breast cancer patient is a candidate for a lumpectomy.

“A lumpectomy only works if all the cancer can be removed and meaningful amount of breast tissue can be left behind,” says Casaubon. “In cases where the tumor is very large or the cancer has spread to multiple areas of the breast, a lumpectomy would not be considered.”

Mastectomy

Unlike a lumpectomy, which targets a small area of the breast for removal, a mastectomy involves removing all the breast tissue. “A mastectomy is a major surgery,” says Casaubon, “with more post-surgery side effects and a longer recovery time. Some women lose sensation in their chest following the procedure. However, a mastectomy does lower the risk of needing a second surgery and eliminates the need for radiation therapy.”

Depending upon a patient’s preference, a mastectomy can be performed in a manner that allows for breast reconstruction or to leave the chest flat.

“It’s really a matter of personal preference,” says Casaubon, “but it’s choice that should be discussed with the breast surgeon well in advance of the procedure.”

This is especially important for those choosing to have breast reconstruction.

“If we know a patient wants to pursue reconstruction, we can consult with the plastic surgeon to discuss how to approach the mastectomy,” explains Casaubon. “Very often we’ll approach the surgery in a manner that preserves the most skin as possible and, when possible, allows the plastic surgeon to use the same incision to insert the implant, minimizing scarring for the patient.”

In some cases, the plastic surgeon may be present during the mastectomy so that they can insert a tissue expander. Very similar to an implant, the expander holds the space in the breast until the implant surgery can be performed (usually about a month after the mastectomy). But unlike an implant, an expander has a valve the plastic surgeon can access to either add or remove fluid, depending upon the patient’s wishes.

Should I get a lumpectomy or mastectomy?

Assuming you’re a candidate for either a mastectomy or a lumpectomy, here are some questions to ask yourself when making your surgical decision.

• How important is to you to keep your breast?
• How anxious are you likely to be about breast cancer coming back? 
• Do you have a personal or family history of cancer?
• Are you prepared to undergo multiple surgeries?

Be sure to share your responses with your surgeon so that they can work with you to determine the best option for you.

The choice of which surgery to have is up to you and your surgeon, and will depend on your individual health condition, personal preference, and the spread of the cancer.