Question

Breast Cancer

How do I choose between lumpectomy and mastectomy?

A Answers (2)

  • The main advantage of a lumpectomy is that it allows a woman to keep most of her breast. A disadvantage is the need for radiation therapy -- most often for 5 to 6 weeks -- after surgery. A small number of women having breast-conserving surgery may not need radiation while a small percentage of women who have a mastectomy will still need radiation therapy.

    When deciding between a lumpectomy and mastectomy, be sure to get all the facts. You may have an initial gut preference for mastectomy as a way to "take it all out as quickly as possible." Women tend to prefer mastectomy more often than their surgeons do because of this feeling. But the fact is that in most cases, mastectomy does not give you any better chance of long-term survival or a better outcome from treatment. Studies following thousands of women for more than 20 years show that when a lumpectomy can be done, mastectomy does not provide any better chance of survival than lumpectomy.

    Although most women and their doctors prefer lumpectomy and radiation therapy when it's a reasonable option, your choice will depend on a number of factors, such as:

    • how you feel about losing your breast
    • how you feel about getting radiation therapy
    • how far you would have to travel and how much time it would take to have radiation therapy
    • whether you think you will want to have more surgery to reconstruct your breast after having a mastectomy
    • your preference for mastectomy as a way to get rid of all your cancer as quickly as possible
    • your fear of the cancer coming back

    For some women, mastectomy may clearly be a better option. Lumpectomy or breast conservation therapy is usually not recommended for:

    • women who have already had radiation therapy to the affected breast
    • women with 2 or more areas of cancer in the same breast that are too far apart to be removed through 1 surgical incision, while keeping the appearance of the breast satisfactory
    • women whose initial lumpectomy along with re-excision(s) has not completely removed the cancer
    • women with certain serious connective tissue diseases such as scleroderma or lupus, which may make them especially sensitive to the side effects of radiation therapy
    • pregnant women who would require radiation while still pregnant (risking harm to the fetus)
    • women with a tumor larger than 5 cm (2 inches) across that doesn't shrink very much with neoadjuvant chemotherapy
    • women with inflammatory breast cancer
    • women with a cancer that is large relative to her breast size

  • The National Surgical Adjuvant Breast and Bowel Project (NSABP) B-04 and B-06 studies have established that radical surgery on the breast is not necessary for early breast cancer. The NSABP B-04 study found that the Halsted radical mastectomy did not provide any advantage to patients, either node positive or node negative, as compared to a simple mastectomy. The NSABP B-06 study proved that tumor excision (lumpectomy) followed by radiation is equal to mastectomy in local recurrence rate and over all survival. These studies confirm that radical surgery is not necessary in the treatment of early operable breast cancer. Women with early breast cancer can now be given a choice between breast conserving surgery and mastectomy.

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