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Medically Reviewed By:

Dr. Amanda Olson, DPT, PRPC
President & Chief Clinical Officer

Mastectomy vs Lumpectomy

A mastectomy and a lumpectomy are both procedures to remove breast cancer, however, they differ according to how much of the breast is removed. In some circumstances, women are given the choice to remove the entire breast via a mastectomy, or the less invasive lumpectomy, which leaves most of the breast intact. 

In this article, we discuss the differences between a mastectomy and lumpectomy, the pros and cons of each, and what to take into consideration before deciding. 

What is a Lumpectomy?

A lumpectomy is a surgical procedure to remove breast cancer when a tumor is relatively small, leaving most of the breast intact. It is usually suggested for patients whose tumor is smaller than four centimeters or for those with one site of cancer in the breast.

Surgeons typically make an incision over the site of the tumor and remove it along with a small amount of surrounding healthy tissue.    

After a lumpectomy, most patients will also undergo radiation therapy to eliminate any possible remaining cancer cells and prevent cancer from recurring. Doctors will also check that all cancer has been removed, but if it has spread, a mastectomy would more than likely be the next step. 

What is a Mastectomy?

A mastectomy is a surgical procedure to remove the entire breast, mainly due to a large tumor, or cancer spreading to more than one site in the breast. Not all mastectomies are the same, however. 

The following are the five different types of mastectomies:

Partial Mastectomy

This type of surgery removes only a portion of the breast as well as some of the surrounding breast tissue. Although a lumpectomy could be considered similar to a partial mastectomy, the difference is that the tumor may be larger and require more healthy surrounding breast tissue to be removed with it.    

Nipple-Sparing Mastectomy

Also referred to as a subcutaneous mastectomy, this procedure aims to remove any cancerous breast tissue through a small incision while preserving the nipple. 

Simple (total) Mastectomy

During this type of mastectomy, surgeons remove the entire breast, leaving the lymph nodes in the underarm and the pectoral muscles beneath the breasts intact. 

Modified Radical Mastectomy

This mastectomy removes the entire breast as well as some of the lymph nodes (usually level 1 or 2) to carry out a biopsy and investigate if any cancer has spread from the breast.  

Radical Mastectomy

This type of mastectomy is the most extensive and is recommended for patients whose cancer has spread beyond the breast and into the chest muscles. The procedure involves removing the entire breast, as well as all lymph nodes under the arm, and the chest muscles beneath the breast. 

Mastectomy or Lumpectomy – How to Decide?

When given the choice of a mastectomy or a lumpectomy, many women might not be sure which one to choose. Doctors will usually advise patients to consider the following before making the choice. 

Keeping Your Breasts

When given the choice, some women might feel that keeping their breasts is important for their identity, mental health, and self-confidence. In this case, they decide to have a lumpectomy followed by radiation treatment in the hope that all cancer will be eliminated. 

Recurring Cancer

Some women can suffer from severe anxiety about cancer returning after undergoing surgery to have it removed. If you feel like this could be true for you, it might be better for your overall mental and physical health to opt for the type of mastectomy recommended by your doctor over a lumpectomy.

Although the entire breast is removed, a mastectomy also removes any breast tissue that could accommodate recurring cancer. In this case, you can also speak with your doctor about the possibilities for breast reconstructive surgery.   

Lumpectomy Pros and Cons

For a lot of women, the biggest advantage to undergoing a lumpectomy is the fact that their breast is left intact afterward. In comparison to a mastectomy, surgery is far less invasive for a lumpectomy. And thirdly, recovery time after the procedure is easier and shorter than with a mastectomy. 

The cons to a lumpectomy include patients undergoing 5-7 weeks of radiation therapy following surgery to ensure all cancer has been destroyed. However, even after receiving radiation therapy 5 days per week for up to 7 weeks, there is no guarantee that breast cancer will not return. 

Additionally, during a lumpectomy, surgeons usually remove a small amount of healthy tissue around the tumor to ensure that cancer has not spread. It can, however, take up to a week to complete this type of test, and should it reveal more cancer cells, further surgery will be needed. 

Lastly, radiation therapy can somewhat restrict the options for reconstructive breast surgery if needed at a later date.

Mastectomy Pros and Cons

The biggest advantage of a mastectomy is that it removes the possibility of cancer recurring. And although a lumpectomy leaves the breast cosmetically intact, a lot of women find more peace of mind when the entire breast is removed and there is no chance of cancer recurring. It is important to note that in some cases, radiation therapy is also recommended after a mastectomy, but it is rare. 

The disadvantages to a mastectomy start with the removal and permanent loss of the breast. This physical change can take getting used to, however women who have trouble accepting their new appearance can seek counseling to help them adjust and move forward. 

Mastectomies are also more extensive surgeries than lumpectomies and recovery time is longer, more painful, and more uncomfortable. Additional surgery must also be faced should patients opt for breast reconstruction. 

Conclusion 

When it comes to choosing a mastectomy or a lumpectomy, it is important to decide on the best option for you. It is perfectly acceptable to preserve your breasts with a lumpectomy, for example. Just as it is perfectly acceptable to remove the breast entirely and move forward in life, with or without reconstructive surgery.

The most important factors to consider are your overall mental and physical health, as well as your full recovery. Should you have any doubts or questions, don’t be afraid to consult with your doctor as many times as it takes for you to make the right decision for you and your body. 

References

Breast Cancer.Org – What is a Mastectomy - https://www.breastcancer.org/treatment/surgery/mastectomy/what_is

Breast Cancer.Org – What is a Lumpectomy - https://www.breastcancer.org/treatment/surgery/lumpectomy/what_is

Komen.Org - Mastectomy vs Lumpectomy Plus Radiation - https://www.komen.org/breast-cancer/facts-statistics/research-studies/topics/mastectomy-vs-lumpectomy-plus-radiation-and-overall-survival-in-early-breast-cancer/