Lumpectomy or Mastectomy? What You Need to Know

What Is a Lumpectomy?

A lumpectomy is a breast-conserving surgery. During this procedure, the surgeon removes only the cancerous tumor, a margin of healthy tissue surrounding the tumor, and, occasionally, some lymph nodes. Most of the breast is left intact.

Lumpectomy surgery is most often used to treat stage 1 and stage 2 breast cancer, which are early forms of the disease. It may also be an option for stage 3 breast cancer, depending on factors including the extent to which cancer has invaded nearby tissue. For patients with larger tumors, however, lumpectomy may not be a feasible option.

What Is a Mastectomy?

In a mastectomy, the surgeon removes the entire breast surrounding the tumor. Depending on the tumor size, location, and degree of spread, a mastectomy can be performed in several different ways:

• Total mastectomy: The surgeon removes the breast tissue, nipple, areola, and some skin.
• Modified radical mastectomy: The surgeon removes the breast tissue, nipple, areola, and some skin, as well as some lymph nodes located under the arm.
• Skin-sparing mastectomy: The surgeon removes the breast tissue, nipple, and areola, but leaves most of the breast skin intact.
• Nipple-sparing mastectomy: The surgeon removes the breast tissue while preserving the nipple, areola, and skin.

Mastectomy is an option for stage 1 through stage 3 breast cancer. Because it removes all of the breast, this treatment can be used for larger tumors than a lumpectomy can effectively treat.

Lumpectomy vs. Mastectomy: Advantages and Disadvantages

When deciding on the best surgical treatment for breast cancer, patients must weigh the pros and cons of each option. Lumpectomy and mastectomy surgeries both have benefits and downsides:

Lumpectomy

Because a lumpectomy is a less-extensive surgery, it takes less time to complete. Most patients can go home the same day and experience a shorter recovery period. In addition, the surgery preserves most of the breast’s original appearance and level of sensation. Breast reconstruction may not be required after a lumpectomy, but if reconstruction is desired, the procedure may be simpler to perform than reconstruction following a mastectomy.

The downside is that there is a higher risk of cancer returning after lumpectomy. For this reason, the surgery often is followed by a round of radiation therapy to destroy any remaining cancer cells. The additional treatment reduces the risk of cancer recurring. If a patient cannot undergo radiation therapy for some reason, lumpectomy may not be the best approach.

Mastectomy

By removing the entire breast, mastectomy removes any cancerous cells that may have spread from the cancer’s site of origin to other regions of the breast. Many patients do not need radiation therapy after mastectomy. This may make the procedure the preferred option for patients who are at high risk of recurrent cancer, who cannot receive radiation therapy, or who may derive greater peace of mind from having a more-extensive procedure.

Because mastectomy is a more-invasive procedure than lumpectomy, patients need a short hospital stay and have a longer recovery. Further, some patients can be quite uncomfortable with the thought of mastectomy and the impact it may have on their self-image. While breast reconstruction is an option, it may require additional surgeries.

Questions to Ask the Doctor

Neither lumpectomy nor mastectomy is preferable to the other in all patients and circumstances. Both surgeries are effective at eliminating cancer, and they have similar success rates and prognoses when used in appropriate patients and accompanied by any other indicated therapies, such as radiation in the case of many lumpectomies . As a result, the choice between lumpectomy and mastectomy is a personal one. The “right” answer for any patient depends on a variety of medical and other factors. The patient’s care team will help her decide, but it helps to be as informed as possible. Questions to ask include:

• What is my risk of recurrence, and does it change based on which surgery I receive?
• Will I need radiation therapy following either type of surgery? What side effects can I expect?
• How long will it take to recover from either surgery?
• How long will it take to recover if I also have reconstruction surgery?
• What changes to my breast can I expect after a lumpectomy?
• Will I be able to preserve the skin or nipple during my mastectomy?
• How will my surgery affect how I will be screened for cancer in the future?
• Is reconstruction surgery recommended during the initial breast cancer surgery?
• Will immediate breast reconstruction surgery interfere with chemotherapy, radiation therapy, or other treatment that also may be planned for me?
• Should I consider reconstruction surgery on both breasts to help them look more similar?
• Will reconstruction surgery make it more difficult to detect cancer if it recurs?
• What resources are available to connect me with other breast cancer patients?

Patients are encouraged to consider all these questions and weigh the information carefully before coming to a decision. By speaking with their care team, loved ones, and other patients who have undergone either surgery, patients can make the decision they will feel is best for them.

Contact RCCA for More Information on Breast Cancer Treatment

The decision between lumpectomy vs. mastectomy can be challenging, but it is not one that patients must make alone. The breast cancer specialists at Regional Cancer Care Associates work closely with patients to develop an optimal treatment plan. RCCA offers care at convenient locations across New Jersey, Connecticut, Massachusetts, and the Washington, D.C., area. For more information or to request an appointment, contact us today.

Frequently Asked Questions About Lumpectomy and Mastectomy

What are the survival rates for lumpectomy vs. mastectomy?

The survival rates for lumpectomy and mastectomy are similar when those procedures are performed in the patient populations for which each is best suited.

When is surgery recommended to treat breast cancer?

Surgery is the recommended approach for the earlier stages of breast cancer, when the tumor is still localized within the breast and has not spread to other parts of the body.

What are the early signs of breast cancer?

Common symptoms of breast cancer include:

• A lump in the breast or underarm area
• Dimpled, puckered, or thickened breast skin
• Warmth, swelling, or redness in the breast
• Changes in nipple shape
• Nipple discharge
• Persistent pain in the nipple or breast

Can breast cancer be asymptomatic?

Breast cancer often is asymptomatic in its early stages, meaning that it causes no noticeable symptoms. This is why routine breast cancer screening is essential. Annual mammograms can detect breast cancer before symptoms develop, giving patients a head start on treatment.

What treatments are recommended for late-stage breast cancer?

In stage 4 breast cancer, cancerous cells have spread beyond the breast to other parts of the body. At this point, the cancer is not curable. However, in recent years several drugs have shown the ability to control the cancer, enabling patients to live for many years with a good quality of life.