Deciding Between a Mastectomy or a Lumpectomy
It may be hard to decide whether to have a mastectomy or a lumpectomy (also called breast-conserving surgery).
First, talk with your surgeon to see if you have a choice between a mastectomy or a lumpectomy.
If you have a choice, study your options. Weigh the risks and benefits of each surgery and choose the one that’s right for you. Survival is the same for a lumpectomy plus radiation therapy and a mastectomy [1-2]. This means both treatments lower the risk of dying (from breast cancer or other cause) by the same amount.
If you want reconstruction, find out if there’s a plastic surgeon available who specializes in breast reconstruction. This may be important when making a decision about surgery. Discuss your reconstruction options with your plastic surgeon before your breast surgery.
Neoadjuvant (preoperative) therapy
Neoadjuvant therapy is chemotherapy, hormone therapy, HER2-targeted therapy and/or immunotherapy given before surgery. In some cases, neoadjuvant therapy can change a person’s surgical options.
Neoadjuvant therapy may shrink a tumor enough so a lumpectomy becomes an option to a mastectomy.
Sometimes, breast cancer has spread to the lymph nodes in the underarm area and these lymph nodes are enlarged. Neoadjuvant therapy can shrink the tumors in the lymph nodes. This makes it easier to surgically remove these lymph nodes. In some cases, fewer lymph nodes will need to be removed.
Survival and breast cancer recurrence
Survival
Survival is the same for a lumpectomy plus radiation therapy and a mastectomy [1-2]. They both lower the risk of dying from breast cancer (as well as dying from any cause) by the same amount [1-2].
| For a summary of research studies on a mastectomy versus a lumpectomy plus radiation therapy and overall survival, visit the Breast Cancer Research Studies section. |
Breast cancer recurrence
The risk of breast cancer recurrence (return of breast cancer) varies greatly from person to person. For example, the risk of recurrence varies by the stage of the breast cancer at diagnosis and the biology of the tumor.
Most people diagnosed with breast cancer will never have a recurrence. However, everyone who has had breast cancer is at risk of the cancer returning.
Compared to a mastectomy, there’s a slightly higher risk of a local breast cancer recurrence (a return of the cancer to the breast or chest area) following a lumpectomy and radiation therapy [1]. A local recurrence is treated with some combination of surgery (with or without radiation therapy), chemotherapy, hormone therapy, HER2-targeted therapy and/or other drug therapies.
The risk of metastasis (when breast cancer spreads to other parts of the body is the same for a lumpectomy plus radiation therapy and a mastectomy [1]. Metastasis may also be called distant recurrence.
Learn more about treatment for local breast cancer recurrence and treatment for metastasis.
Risks and benefits of mastectomy and lumpectomy plus radiation therapy
The table below outlines some things to consider when choosing between a mastectomy and a lumpectomy plus radiation therapy.
The main benefit of a lumpectomy plus radiation therapy is the breast is preserved as much as possible.
A potential benefit of a mastectomy is radiation therapy may be avoided. Although some women will need radiation therapy after a mastectomy, many will not. Ask your health care team if you are likely to avoid radiation therapy if you have a mastectomy.
Radiation therapy has some side effects and most often requires daily trips to a treatment center for 1-6 weeks. If you can’t get to a radiation treatment center, or if you can’t have radiation therapy, a mastectomy is usually a better option than a lumpectomy.
Total mastectomy versus lumpectomy plus radiation therapy |
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Total mastectomy |
Lumpectomy plus radiation therapy |
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Treatment for early breast cancer |
Very effective |
Very effective |
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Amount of tissue removed |
Entire breast |
Part of the breast (tries to keep the original look of the breast) |
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Extent of surgery |
Major surgery with general anesthesia |
Less extensive surgery with general or regional anesthesia, or local anesthesia with sedation |
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Hospital stay |
At least one overnight hospital stay is needed |
Most people go home the same day as surgery |
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Radiation therapy |
Sometimes done |
Almost always done |
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Temporary soreness of chest, underarm and shoulder |
Yes |
Yes |
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Chance of local recurrence (recurrence within the breast) |
Very low for early-stage breast cancer |
Low for early-stage breast cancer (but slightly higher than with a mastectomy) |
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Chance of metastasis (spread beyond the breast and nearby lymph nodes, also called distant recurrence) |
Same as with a lumpectomy plus radiation therapy |
Same as with a mastectomy |
|
Chance of lymphedema if you have a sentinel node biopsy or an axillary dissection |
Yes |
Yes |
What to expect after surgery
With both a mastectomy and a lumpectomy, you will have some soreness in your chest, underarm and shoulder. If axillary lymph nodes (lymph nodes in the underarm area) are removed during surgery, you may also have some numbness and a burning feeling under and behind your arm.
Learn about what to expect after a lumpectomy.
Learn about what to expect after a mastectomy.
Learn more about the management of surgery-related pain.
Emotional health
After either surgery, you may feel a buildup of emotions. You may have been anxious leading up to surgery. And, after surgery, you may feel a sense of relief or may be worried about what happens next. This is normal.
Make sure you take time to recover both emotionally and physically. You may want to have family and friends available for support.
Chemotherapy, hormone therapy, HER2-targeted therapy or other drug therapy
The type of surgery you have doesn’t affect whether you’ll have chemotherapy, hormone therapy, HER2-targeted therapy or other drug therapy.
Drug therapies are given based on the characteristics of the tumor, not the type of surgery you have. For example, whether or not you’ll need hormone therapy and/or HER2-targeted therapy depend on the biomarkers, hormone receptor status and HER2 status.
Learn about other factors that affect treatment options.
Differences in lumpectomy rates
Personal preference matters a lot when deciding between a lumpectomy or a mastectomy. For example, some people very much wish to keep their breasts, while for others, a mastectomy offers peace of mind.
Where you live may affect your surgery choice. Compared to women who live in urban areas, those who live in rural areas are more likely to have a mastectomy [9]. Women who live far from a center that offers radiation therapy (needed for a lumpectomy) may prefer to have a mastectomy.
Talk with your health care provider about your surgery options
Not everyone can have a lumpectomy plus radiation therapy. Talk with your health care provider about whether a lumpectomy is an option for you.
Learn about the risks and benefits of each surgery. Talk with your health care provider about which treatments are best for you. This can help you feel you’re getting the best care possible.
You may want to have a family member or friend with you at your appointments to help you take notes and ask questions. They may also be able to help you think through information after your appointments.
Second opinions
It’s always OK to get a second opinion from a medical oncologist and/or breast surgeon at a different hospital or practice. Getting a second opinion can:
- Instill confidence in the first health care provider by confirming a treatment plan
- Give a different insight into your treatment
- Increase your options for care
- Give you more information about your breast cancer
- Make you feel more comfortable with your treatment choices
- Give you a chance to meet with another health care provider who may be better suited to treat your cancer
Learn more about getting high-quality care.
Susan G. Komen® Support Resources |
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Updated 04/11/24
