Lumpectomy vs. Mastectomy

If you’ve received a breast cancer diagnosis, your care team will likely present you with several treatment options, and those will vary based on the stage and type of disease. Most women will undergo some type of surgery as part of their treatment. The main types of surgery to remove breast cancer are lumpectomy and mastectomy.

What is the difference?
A lumpectomy, or breast-conserving surgery, is a procedure where only the portion of the breast containing the cancer and a margin of surrounding tissue is removed. A mastectomy is the surgical removal of the entire breast. There are several types of mastectomies:

• Total (or Simple) Mastectomy: Surgical removal of the breast tissue, nipple, areola and some skin. These can be either unilateral (removal of one breast) or bilateral (removal of both breasts).
• Skin-sparing Mastectomy: Surgical removal of the breast tissue, nipple and areola removing less skin to provide coverage for immediate breast reconstruction.
• Nipple-sparing Mastectomy: Surgical removal of the breast tissue preserving all skin, the nipple and areola; done in conjunction with immediate breast reconstruction.
• Modified Radical Mastectomy: Surgical removal of the breast tissue, nipple and areola combined with a procedure called axillary lymph node dissection where the majority of the lymph nodes in the underarm area are removed.

Risks and Benefits

Will I still need other treatment?
Although surgery is typically the first line of attack when it comes to treating breast cancer, additional therapies are often necessary and may be recommended before or after surgery, or sometimes both.

Additional therapies may include:

• Radiation therapy
• Chemotherapy
• Hormone therapy
• Targeted therapy
• Immunotherapy
• Some combination of the above

Dr. Susan Hoover, surgical oncologist

Treatment plans are based on the type and stage of breast cancer and take into consideration other factors such as a patient’s overall health and personal preferences.

“At Moffitt Cancer Center, treatment for patients with breast cancer is tailored in a multidisciplinary fashion,” said Dr. Susan Hoover, a surgical oncologist in the Breast Oncology Program. “This means the various doctors treating the patient work together to personalize their care plan. This approach optimizes the patient’s outcome.”

How does each procedure impact my appearance?
A lumpectomy conserves more of the breast but may still change the appearance. The breast may be smaller or have contour changes, and the procedure will leave a scar. If radiation therapy is given, it may further shrink the breast and change the shape and texture, sometimes making it feel firmer. The location or size of the cancer can also impact the resulting appearance following a lumpectomy. For this reason, many women may be better suited to undergo a mastectomy, with or without reconstruction.

Mastectomy scars vary based on the surgical approach. The location of the tumor and whether or not the individual will undergo reconstruction determine the type of incision. Breast reconstruction can be a potential option during a mastectomy or post-recovery. Reconstruction may be done using tissue from other areas of the body, breast implants or sometimes both. Some women may choose not to undergo reconstruction at all.

What about survival and recurrence?
The overall survival rate is the same for a lumpectomy with radiation therapy versus a mastectomy. Both procedures are equally as effective in treating early stage breast cancer. That said, with either surgery, a recurrence—or the likelihood of breast cancer returning—is possible.

The good news? “Overall recurrence rates are decreasing and survivals are holding strong, despite the type of surgery performed,” explained Hoover. She credits this to personalized treatments and the layering of very effective strategies like surgery, chemotherapy, radiation and hormonal therapy. “That’s why it’s important for a woman to choose the type of surgery she really wants,” she added. “It won’t negatively impact her overall outcome from her disease.”

Ultimately the decision between a lumpectomy or mastectomy is highly personal and each option presents different risks and benefits.

“Breast cancer is unique in that women are often given the option between a lumpectomy or mastectomy, with the final decision in their hands,” said Hoover. “This can create angst for some women who may prefer for the physician to choose for them. I always tell patients to go with their gut feeling—most of the time, deep down, they already know which procedure they would prefer after weighing carefully all that is involved with each surgical option. They should go with the type of surgery that would best suit their lifestyle and emotional and psychological needs.”