Choosing between breast conserving surgery (lumpectomy) or mastectomy

There are advantages and disadvantages of different types of surgery for early breast cancer. 

Your doctor or breast care nurse will discuss the options with you. They take into account:

• the size of your cancer
• where the cancer is in your breast
• whether there is more than one area of cancer
• the size of your breasts
• your general health

Depending on your situation, your surgeon might recommend that you have a particular operation. Or you might have a choice of operations to consider.

Why you might have a choice

The treatments work equally well in curing the cancer but they each have different benefits and disadvantages.

Your doctor might offer you a choice between:

• removing the cancer with a surrounding border of normal breast tissue (breast conserving surgery) followed by radiotherapy
• removing the whole breast (mastectomy) and then possibly having a new breast made (breast reconstruction)

Things to consider

There are no right or wrong answers when you are making a decision between treatments. Women each feel very differently. You can decide what feels best for you.

Some women want to keep their breast if at all possible, so they choose breast conserving surgery and radiotherapy.

Other women feel that once they have breast cancer, they would rather have the whole breast removed because it makes them feel it is more likely to remove all of the cancer. They can then choose to have a new breast made (breast reconstruction).

To help you decide, you might want to think about:

• how you feel about having the whole breast removed
• how you feel about having only part of the breast removed
• how quickly you want the treatment to be finished
• whether you would want to have a breast reconstruction after mastectomy
• whether you would want reconstruction straight away or some months after surgery

The most important thing is to take time to find out how you feel and make the right decision for you. You can say to your specialist that you need some time to think over your options.

You can discuss the issues with family or friends or reflect on your own about how you feel. Before making a decision you can ask your specialist nurse questions about the different treatments if you need to.

Advantages of breast conserving surgery

Breast conserving surgery is also called a wide local excision or lumpectomy.

Removal of just the area of cancer:

• aims to keep most of the breast tissue
• is less of a change to your body than a mastectomy
• has a recovery time of 2 to 3 weeks

Disadvantages of breast conserving surgery

After this operation:

• you may have more surgery if the margins are not clear
• your breast might be mis-shapen or dimpled or unequal to the other one
• you are likely to need radiotherapy to the breast, depending on your situation you might have it for between 1 to 3 weeks (some people may also need radiotherapy after a mastectomy)
• radiotherapy can make you tired for a few months
• you will need regular mammograms
• if the cancer comes back some time later, you won't be able to have radiotherapy again and would need a mastectomy

Advantages of mastectomy

Removal of the whole breast means:

• you might feel more confident your cancer won't come back
• you usually won't need radiotherapy after the surgery
• you won’t need mammograms
• you can have radiotherapy to the area if your cancer comes back in the future

Disadvantages of mastectomy

After a mastectomy:

• you have permanent removal of your breast
• recovery time after simple (flat chest) mastectomy is about 3 to 6 weeks
• if you have breast reconstruction the surgery takes longer and it can take some months to recover
• you usually have 1or 2 smaller operations after a reconstruction (to match the reconstruction to your other breast as much as possible)
• if you don't have reconstruction you might need to wear an external breast shape (prosthesis)

There are many things to consider and it can be difficult to make a decision about your treatment. Your surgeon and specialist nurse will help and support you throughout. Do speak to them if you have any questions.