If you have been recently diagnosed with breast cancer, making decisions about your treatment can be an overwhelming part of an already difficult time. Although your options will vary depending on the stage and type of cancer you have and your overall health, many people with breast cancer will have some form of surgery as a part of their treatment plan. Some patients with early-stage breast cancer may have a choice between the two main types of surgery: lumpectomy or mastectomy.

Your cancer care team at Missouri Cancer Associates will help develop a plan that best fits your breast cancer diagnosis and your treatment goals. Understanding your options can help give you peace of mind as you move forward through your cancer journey.

What is the difference between a lumpectomy and a mastectomy?

Lumpectomy and mastectomy procedures are both performed to remove breast cancer. Although both are effective, they have different benefits and risks.

A lumpectomy preserves the breast, while a mastectomy removes it. Your oncologist will help you decide which is best for you. The location and stage of your cancer are significant factors when deciding between the two, as well as patient characteristics such as the size of your breasts.

A lumpectomy, also called breast-conserving surgery, removes the tumor and some surrounding healthy tissue. Some lymph nodes may also be removed. This is usually followed by radiation therapy to treat any remaining cancer cells. Patients given a lumpectomy can generally keep most of the breast tissue.

A mastectomy removes the tumor by removing the entire breast. While some patients may need radiation therapy following mastectomy, many do not. There are several types of mastectomies:

  • Total mastectomies remove the breast tissue, nipple, areola and some skin.
  • Modified radical mastectomies remove the breast tissue, nipple and areola, in addition to some lymph nodes under the arm.
  • Skin-sparing mastectomies remove the breast tissue, nipple and areola while removing less skin.
  • Nipple-sparing mastectomies remove the breast tissue while preserving the nipple, areola and skin.

What are the advantages and disadvantages of each surgery?

A lumpectomy is a less extensive surgery, and most patients are able to go home the same day. Because only part of the breast is removed, this surgery might not change much of the original appearance of the breast. The patient may also keep most of the sensation in the area.

The risk of cancer returning to the breast after a lumpectomy is low, but it is a higher risk than with a mastectomy. Lumpectomies are almost always followed by radiation therapy to destroy any remaining cancer cells. If you cannot have radiation therapy or do not want to undergo radiation therapy, a lumpectomy may not be the best surgical option.

Because mastectomy removes the entire breast, some patients might feel more at ease. Recurrence in the breast after mastectomy in early-stage breast cancer is extremely low. While some patients might need radiation therapy following surgery, many will not.

A mastectomy is a more extensive surgery and results in permanent loss of a breast. If you opt for breast reconstruction, this could result in additional surgeries. At least one overnight hospital stay will be needed following mastectomy.

Lumpectomy and mastectomy procedures are both effective treatments for breast cancer. It’s important to note that for early-stage breast cancer, research shows mastectomy and lumpectomy have similar overall survival rates. The main differences between the two surgeries involve peace of mind and potential side effects.

Can a lumpectomy and a mastectomy happen together?

A lumpectomy and mastectomy do not usually happen together. However, a mastectomy may be required after a lumpectomy if the surgeon couldn’t get clear margins or if recurrence or second cancer occurs and a lumpectomy with radiation isn’t an option.

What should I ask my doctor as I consider my options?

Although both surgeries are effective treatments for early-stage breast cancer, the choice between lumpectomy and mastectomy can be very personal. The “right” choice for you can depend on a variety of lifestyle factors and personal preferences. Although your physician will help you make the most informed choice possible, here are a few things you might want to ask:

  • What is the risk of recurrence? Is there a significant difference in recurrence for my type of cancer with either type of surgery?
  • If I need radiation therapy, what side effects can I expect?
  • How long will it take to recover? How long will it take to recover if I also have reconstruction surgery?
  • What kind of changes to my breast can I expect after a lumpectomy? Will I be able to preserve the skin or nipple during my mastectomy?

Our oncologists at Missouri Cancer Associates work together with radiologists, genetic counselors, breast surgeons and plastic surgeons to provide each patient with the best possible personalized care. We are dedicated to diagnosing and treating diseases and disorders of the breast — both cancerous and benign.

Mung Chin, MSN, NP-C, OCN is certified in cancer genetics. Your initial genetic evaluation session will focus on questions and concerns about your or your family’s risk for cancer.

Dr. Anne Petersen is a general surgeon with Boone Health with nearly 15 years of experience treating breast cancer and performing breast cancer surgeries including mastectomies (complete and skin- or nipple-sparing) and breast conservation procedures utilizing oncoplastic techniques.

Dr. Leslie Shock is a plastic surgeon with a passion for and specialized training in breast reconstruction following mastectomy as well as large-volume oncoplastic procedures for improved cosmesis and symmetry following breast-conserving surgeries.