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Choosing Between Lumpectomy vs. Mastectomy: What’s Best for Me?

| January 28, 2022 August 2, 2023 | |

lumpectomy vs. mastectomy

Every woman diagnosed with early-stage breast cancer faces an important decision about what type of surgery to have. A mastectomy, the removal of one or both breasts, used to be the routine surgical treatment for breast cancer because it could reduce the risk of recurrence.

However, a breast tumor does not leave patients with only one choice – complete removal of the breasts. A less extreme option, called lumpectomy, which removes only the cancerous tumor and surrounding tissue, has the option of leaving the rest of the breast intact. Many cases of breast cancer, especially early detection, have been saved by this innovation.

When breast cancer is diagnosed at an early stage, surgeons should discuss their findings with their patients and make recommendations on how to proceed. Lumpectomy and mastectomy each have their advantages, but the choice comes with several considerations:

  • The removal of cancer and the surrounding border of normal breast tissue (breast-conserving surgery) to be followed by radiotherapy; or
  • The removal of the whole breast (mastectomy) and then possibly having a new breast made through breast reconstruction.

Candidates for Lumpectomy

The risk of cancer spreading to other parts of the body is about the same with either mastectomy or lumpectomy. Anyone can opt for a mastectomy as there are no restrictions on it. On the other hand, a lumpectomy requires a few qualifications.

For the early stage of breast cancer, a patient can undergo a lumpectomy followed by radiation therapy if the tumor is relatively small. Most of the time, radiation therapy is the next necessary procedure after a lumpectomy as radiotherapy destroys the remaining cancer cells.

The combination of the two has similar overall survival rates, however, it has a slightly higher chance of recurrence. If the patient is pregnant or has other existing medical conditions that may be liable to the side effects of radiation therapy, doctors should therefore advise the patient against undergoing a lumpectomy.

There is a correlation between the size of the patient’s breast and the size of the tumor whether or not a lumpectomy is still a viable option. The size of the tumor alone is a bit tricky. Even in a small tumor whose location makes it hard to conserve much breast tissue, lumpectomy is no longer doable.

The ideal candidate for lumpectomy is someone who has:

  • Stage I or II breast cancer
  • DCIS or ductal carcinoma in situ
  • A tumor that is relatively small to the breast size
  • A tumor in only one breast
  • Physical capability to receive radiation treatments after lumpectomy

Candidates for Mastectomy

Quite understandably, many cancer patients and their families may perceive this procedure as too invasive. But technology has caught up with the times, offering various types of mastectomy that can save as much part of the breast as possible.

  • Simple mastectomy – removes the whole breast including the nipple, the areola, and most of the underlying skin
  • Skin-sparing mastectomy – keeps the overlying skin but removes the breast tissue, the nipple, and the areola.
  • Nipple-sparing mastectomy and areola-sparing mastectomy – remove the breast tissue but keep the nipple and the areola.

Having cancer is such a painful experience that involves not only the patients but also their loved ones. The intense emotional rollercoaster is something that everyone suffering has wanted to get out of as soon as possible. A mastectomy hastens the flight from this physical and also emotional ordeal. Yet, the struggle continues as the survivor deals with a removed body part.

Thankfully, modern technology has addressed this struggle with the option of breast reconstruction. The decision all boils down to how you feel—about having the whole breast removed and how quickly you want your treatment to be finished. The length of time that you are willing to wait since your mastectomy for breast reconstruction can also matter.

While reconstruction is an option, it is also a perfectly valid choice to forgo breast reconstruction and go for a flat closure. A flat closure removes the excess skin that is left by mastectomy. In fact, “going flat” has gained popularity in recent years and echoed the body positivity movement—that flat-chested women can be beautiful and confident. Being braless, reestablishing their posture, decreasing their back pain, and having more freedom to do their daily activities without the breasts getting in the way are among the benefits that women get from going flat.

Many other factors can play a role in this decision such as the lack of suitability of the patient for multiple surgeries, the need to recover as quickly as possible to go back to responsibilities, and concerns about the financial costs of breast reconstruction.

Advantages and Risks of Lumpectomy and Mastectomy

When making a decision, it’s important to consult with your doctor who will help you weigh between these advantages and risks, especially if you are eligible for either surgery.

  • Higher risk of recurrence; though it varies from person to person
  • 5-7 weeks of Radiation therapy may affect the possibility and timing of reconstruction
  • Possible more surgeries after your first lumpectomy
  • Provides cancer survivors greater peace of mind
  • Very low risk of recurrence for early stages
  • Permanent loss of breast
  • Longer recovery period
  • Surgeries to reconstruct the lost breast

What Factors to Consider When Making Your Decision

Breast cancer is a complex experience as each patient encounters it in their daily lives very differently. Some women want to save their breasts if given the option, so they go for a lumpectomy followed by radiation therapy. Others, on the other hand, would rather go for a mastectomy as this makes them more likely to feel secure that all of the cancer is gone.

While you are the one who is making the decision whether you opt for mastectomy or lumpectomy, you are not alone. Seek the support of your loved ones and consult with a board-certified plastic surgeon in your area.

Throughout the years, Dr. Kocak and I have been helping women conquer breast cancer through a range of surgical treatments. Schedule a consultation today to learn your options.

About the Author

Dr. Pankaj Tiwari, is a board-certified plastic surgeon who focuses on breast reconstruction with advanced microsurgical techniques (DIEP and GAP flaps) and the treatment of lymphedema.
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*Our blog entries are written in order to further educate our patients and raise awareness towards topics related to plastic surgery. Any solutions offered on this blog are intended to help possible patients develop educated decisions before undergoing a consultation with our doctors.

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