Mastectomy or Lumpectomy to Treat Breast Cancer

Is a lumpectomy or a mastectomy better for breast cancer?. Photo©dolgachov

If you have been diagnosed with early-stage breast cancer your first treatment decision is often about surgery. Before the 1970s, a mastectomy was the only surgery performed for any stage of breast cancer. Since then, less invasive techniques have been developed, and technology has greatly aided surgical accuracy. Patients have become more involved in treatment decisions and better informed of choices.

If you have early-stage breast cancer (DCIS or Stage I, IIA, IIB, or IIIA), you may have a choice between breast-conserving surgery (lumpectomy) and removing the breast (mastectomy). Still, deciding on a surgery for breast cancer is often difficult. Let’s look at your options and some statistics about lumpectomy and mastectomy.

Goal of Surgery

When discussing surgical options, it can be helpful to first keep in mind the ultimate goals of treatment.  These are to get good local control of the tumor (remove the cancer) and to reduce the risk of recurrence in the future.

Survival Comparison Between Lumpectomy and Mastectomy

It's normal to worry about how long you will live after surgery and treatment, or the chances of recurrence. These are practical questions to consider. For the majority of women with breast cancer, it appears that those who choose to have a lumpectomy followed by radiation will live as long as women who opt for a mastectomy -- whether or not they also choose to have reconstruction.

Your odds for recurrence of early-stage breast cancer in a distant region is the same with either procedure. Certainly, a mastectomy greatly reduces the chance that a cancer will recur in the same breast, but this likelihood is low with lumpectomy and radiation as well. It's thought that around 2 to 3% of women who have breast conserving surgery (a lumpectomy) will have a recurrence of the cancer in the same breast over the next 5 years.

With a lumpectomy, radiation is given after surgery to decrease this risk of recurrence. The choice to use chemotherapy or hormonal therapy will be the same regardless of the surgical procedure you choose. These treatments are designed to treat any cancer cells that have traveled beyond the breast, and therefore will be indicated (or not indicated) based on your type and stage of cancer and not the surgery you choose.

Both procedures carry some risks to consider. With a lumpectomy, you will need to go through radiation treatments which would not be required with a mastectomy. On the flip side, the risk of complications with a mastectomy (and reconstruction if you choose this) are significantly higher than with a lumpectomy.

Special Situations

There are some situations in which a mastectomy may be a better option than lumpectomy, but these are uncommon. These include:

  • If radiation cannot be given for some reason.
  • If the surgical margins during a lumpectomy are not clear
  • Perhaps for women with extensive ductal carcinoma in situ (DCIS,) especially those who are young, in which there is evidence of microcalcifications involving roughly a fourth of the breast tissue.
  • Possibly for very young women - for example, less than age 35.

Of course, there may be additional situations which would make a mastectomy (or in contrast a lumpectomy) a better choice for you based on your tumor and other medical conditions.  Ask your doctor what she would recommend and why, and what she would consider if it was her who was going through the decision-making process.

Male Breast Cancer

For early-stage male breast cancer, a mastectomy is recommended, because there usually is not enough breast tissue for a lumpectomy. Lymph nodes will be sampled to determine whether or not the cancer has spread beyond the breast. Radiation, chemotherapy, and hormonal therapy may also be needed, depending on the type, extent and location of the cancer.

Considering Your Surgery Choices

Get help for making your breast cancer surgery decision by talking to your oncologist and surgeon, family and friends, and learning as much as you can about your cancer. Try this list of 10 questions to help you sort out your feelings and options. The choice of type of surgery for your cancer will depend on many factors such as your location and preferences and is a very personal decision. Ask for input from your loved ones, but make the decision you alone feel most comfortable with. Consider getting a second opinion. Even if the opinions are the same, you will feel more confident in your care.

Ask about survival statistics based on your diagnosis, and about your surgeon's expertise in breast cancer surgery procedures. Sometimes your health insurance may limit your choices, but if you want more options, ask how you can work out a financial compromise. If you're favoring a mastectomy, you should also be discussing your choice of breast reconstruction methods. If breast reconstruction is not mentioned before you settle on a mastectomy, consult a plastic surgeon to see what your options may be. Make sure you feel as confident as possible when you choose your breast cancer surgery procedure.


Braunstein, L. et al. Long-term outcomes among breast cancer patients with extensive regional lymph node involvement: implications for locoregional management. Breast Cancer Research and Treatment. 2015. 154(3):633-9.
Cao, J. et al. Should women younger than 40 years of age with invasive breast cancer have a mastectomy? 15-year outcomes in a population-based cohort. International Journal of Radiation Oncology, Biology, and Physics. 2014. 90(3):509-17.
Lautner, M. et al. Disparities in the Use of Breast-Conserving Therapy Among Patients With Early-Stage Breast Cancer. JAMA Surgery. 2015. 150(8):778-86.
Litiere, S. et al. Breast conserving therapy versus mastectomy for stage I-II breast cancer: 20 year follow-up of the EORTC 10801 phase 3 randomized trial. Lancet Oncology. 2012. 13(4):412-9.

Nijenhuis, M., and E. Rutgers. Who should not undergo breast conservation?. Breast. 2013. 22 Suppl 2:S110-4.

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