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Breast Cancer: Should I Have Breast-Conserving Surgery or a Mastectomy for Early-Stage Cancer


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Decision Point

Breast Cancer: Should I Have Breast-Conserving Surgery or a Mastectomy for Early-Stage Cancer?

You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.

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Breast Cancer: Should I Have Breast-Conserving Surgery or a Mastectomy for Early-Stage Cancer?

Get the facts

Your options

  • Have surgery to remove the breast (mastectomy).
  • Have surgery to remove just the cancer from the breast (breast-conserving surgery) followed by radiation treatments.

Key points to remember

  • For early-stage breast cancer, studies show that women who have breast-conserving surgery followed by radiation treatments have the same survival rates as women who have mastectomy.
  • The stage of your cancer—how far it has spread—is very important in deciding which treatment is best.
  • Breast-conserving surgery may be a better choice if the tumor is small or if it is at the edge of the breast.
  • Mastectomy may be a better choice if you have two or more areas of cancer in the same breast that would need more than one cut, or incision.
  • If you choose mastectomy, you may have surgery to rebuild your breast. This is called reconstructive surgery. It can often be done at the same time as the mastectomy.
  • Breast-conserving surgery has a slightly higher chance of the cancer returning.
  • The radiation used after breast-conserving surgery can cause side effects such as fatigue.
  • This is a very personal decision. Your feelings about keeping your breast are just as important as anything else in choosing what feels right for you.
FAQs

What is breast cancer?

Breast cancer occurs when abnormal cells grow out of control in the breast. It is highly curable if found early.1

What types of surgery are used to treat breast cancer?

The two different types of surgery used to treat early-stage breast cancer are:

  • Breast-conserving surgery, along with radiation therapy and an exam (biopsy) of some of the lymph nodes under the arm.
    • In a lumpectomy, the doctor cuts out the tumor and some of the breast tissue around it. You may also hear this called an "excisional biopsy" or "wide excision."
    • In a partial or segmental mastectomy, the doctor cuts out the tumor and a larger section of breast tissue around it. He or she also cuts out the lining over the chest muscles below the tumor. But most of your breast remains.
  • Removal of the breast (mastectomy).
    • The removal of the entire breast is called a total or simple mastectomy.
    • The removal of the breast, the lymph nodes under the arm (axillary lymph nodes), the lining over the chest muscles, and sometimes part of the chest wall muscles is called a modified radical mastectomy.

What will help you decide which type of surgery to choose?

How far the cancer has spread within your breast and whether it has spread to nearby tissues or other organs is called the stage. Your doctor will find out the stage of your breast cancer by gathering information from other tests such as lymph node biopsies, blood tests, bone scans, and X-rays. The stage of your cancer is one of the most important things to think about when you choose the treatment option that is right for you.

Does one type of surgery work better than the other?

For many years, experts thought that having a mastectomy would help you live longer and reduce the chance that your breast cancer would come back (recur). Breast-conserving surgery does have a slightly higher chance of the cancer returning. But studies now show that women who have breast-conserving surgery followed by radiation treatments have the same survival rates as women who have mastectomy.2

Why might your doctor recommend a mastectomy instead of breast-conserving surgery?

Your surgeon may recommend a mastectomy if:

  • You have two or more areas of breast cancer in the same breast that are too far apart to be removed with a single cut (incision).
  • You have precancerous changes in more than one-quarter of your breast (one breast quadrant) or throughout one or both breasts.
  • Your breast cancer is large or is large relative to the size of your breast, and removing it will require removing a lot of breast tissue. You may not be satisfied with the way your breast looks after surgery.
  • You have a serious lung disease, such as COPD or emphysema. The radiation therapy needed after a lumpectomy may make your lung problems worse.
  • You have already had radiation treatment to your breast or your chest to treat another condition, such as Hodgkin's lymphoma.
  • You have a connective tissue disease, such as scleroderma, that makes you especially sensitive to the effects of radiation.
  • You are pregnant. Radiation treatment should not be used during pregnancy.

Compare your options

Compare

What is usually involved?









What are the benefits?









What are the risks and side effects?









Have a mastectomy Have a mastectomy
  • You will stay overnight in the hospital.
  • Breast reconstruction is possible. It may involve one or more surgeries.
  • You may or may not need radiation treatment afterward.
  • Like breast-conserving surgery, mastectomy can help you live longer.
  • You may not need to have daily radiation treatment after surgery.
  • Removing a breast without doing reconstructive surgery can cause a weight shift, leading to neck and back pain. This is more common if you have large breasts.
  • Some women are disappointed with the way they look after mastectomy, even with reconstruction.
  • A reconstructed breast does not have the sensitivity of your natural breast.
  • With breast reconstruction, there are risks from additional surgeries.
Have breast-conserving surgery Have breast-conserving surgery
  • There's no need to stay in the hospital overnight.
  • You will probably have daily radiation treatments for 3 to 6 weeks.
  • Like mastectomy, breast-conserving surgery can help you live longer.
  • You will keep more of your natural breast, which will have more sensitivity than a reconstructed breast.
  • Surgery usually leaves only a small scar, so you won't need breast reconstruction or an artificial breast.
  • Because more breast tissue remains, there is a slightly higher chance of the cancer coming back in that breast. If this happens, the chances of survival are not affected, but you will then need to have a mastectomy.
  • Radiation often has side effects, including fatigue and a slight change in the color of your skin.

Personal stories

Are you interested in what others decided to do? Many people have faced this decision. These personal stories may help you decide.

Read More
close

Personal stories about choosing breast-conserving therapy or mastectomy

These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.

I don't want to lose my breast. It is a part of me, and I don't believe that I would feel the same way about myself if it were gone. Wearing a prosthesis seems like a hassle, and I don't want to have more surgery to reconstruct my breast, so the lumpectomy feels like the right choice for me. I don't mind going for the radiation treatments.

Maggie, age 61

I live about 60 miles from the nearest cancer center. Traveling to and from there each day will just be too much for me. I would rather have a mastectomy and not have to go through 6 more weeks of treatment. At some point, I may decide to have reconstructive surgery to restore my breast, but I can't take that much time off from my job right now.

Ellen, age 49

I don't want to have a daily reminder, a flat spot on my chest wall, about this cancer. I want the doctor to take out only what is necessary. I think if I had a mastectomy, my scar would be a constant reminder of my cancer, even if I chose to have reconstruction. Also, I work really close to the cancer center, so it will be easy for me to have my treatments.

Joan, age 52

I don't want to have radiation treatments. I know that it is not the same today as it was years ago, but I still am concerned about the side effects and the weeks and weeks of treatments. I'm glad that I have the choice. I am certain that I do not want to have radiation, so mastectomy seems like the right choice for me. Maybe some day I will have reconstructive surgery, but right now I just want to get on with my life.

Beth, age 65

What matters most to you?

Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.

Reasons to choose mastectomy

Reasons to choose breast-conserving surgery

I am worried that breast-conserving surgery will not remove all of the cancer.

I don't mind trying breast-conserving surgery first and having a mastectomy if it's needed to remove all of the cancer.

More important
Equally important
More important

Keeping my breast is not as important as getting rid of all the cancer.

I really want to keep most of my breast.

More important
Equally important
More important

I am worried about having radiation treatment or side effects such as fatigue and skin changes.

I am worried about problems after mastectomy, such as neck and back pain.

More important
Equally important
More important

I'm worried about the inconvenience of radiation treatment, such as extra time and daily travel.

Time and travel for radiation treatment isn't a concern.

More important
Equally important
More important

My other important reasons:

My other important reasons:

More important
Equally important
More important

Where are you leaning now?

Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.

Mastectomy

Breast-conserving surgery

Leaning toward
Undecided
Leaning toward

What else do you need to make your decision?

Check the facts

1.

Which option has a slightly higher chance that the cancer will return in the same breast?

  • MastectomyNo, that's wrong. The right answer is breast-conserving surgery. It leaves behind more breast tissue, so there is a slightly higher chance of the cancer coming back in that breast.
  • Breast-conserving surgeryYou are right. Breast-conserving surgery leaves behind more breast tissue, so there is a slightly higher chance of the cancer coming back in that breast.
  • Both are equalNo, that's wrong. The right answer is breast-conserving surgery. It leaves behind more breast tissue, so there is a slightly higher chance of the cancer coming back in that breast.
  • I'm not sureIt may help to go back and read "Compare your options." Breast-conserving surgery leaves behind more breast tissue, so there is a slightly higher chance of the cancer coming back in that breast.
2.

Which option has the highest chance of survival?

  • MastectomyNo, that's not right. Experts used to think that mastectomy was better. But studies now show that breast-conserving surgery followed by radiation treatments is as good as mastectomy in treating early-stage breast cancer.
  • Breast-conserving surgeryNo, that's not right. Actually, mastectomy and breast-conserving surgery followed by radiation treatments are equally good at treating early-stage breast cancer.
  • Both are equalYou are right. Studies show that breast-conserving surgery followed by radiation treatments is as good as mastectomy in treating early-stage breast cancer.
  • I'm not sureIt may help to go back and read "Get the Facts." Breast-conserving surgery followed by radiation treatments is as good as mastectomy in treating early-stage breast cancer.
3.

Which option has the highest chance of side effects from radiation, such as fatigue?

  • MastectomyNo, that's wrong. The right answer is breast-conserving surgery. Radiation isn't usually used after a mastectomy for early-stage breast cancer. It is normally used after breast-conserving surgery.
  • Breast-conserving surgeryYou are right. After you have this surgery, you will need radiation treatments. Radiation often has side effects, including fatigue and a slight change in the color of your skin.
  • Both are equalNo, that's wrong. The right answer is breast-conserving surgery. Radiation isn't usually used after a mastectomy for early-stage breast cancer. It is normally used after breast-conserving surgery.
  • I'm not sureIt may help to go back and read "Compare your options." Radiation isn't usually used after a mastectomy for early-stage breast cancer. It is normally used after breast-conserving surgery.

Decide what's next

1.

Do you understand the options available to you?

2.

Are you clear about which benefits and side effects matter most to you?

3.

Do you have enough support and advice from others to make a choice?

Certainty

1.

How sure do you feel right now about your decision?

Not sure at all
Somewhat sure
Very sure
3.

Use the following space to list questions, concerns, and next steps.

Your Summary

Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision.

Your decision

Next steps

Which way you're leaning

How sure you are

Your comments

Your knowledge of the facts

Key concepts that you understood

Key concepts that may need review

Getting ready to act

Patient choices

What matters to you

Credits and References

Credits
CreditsHealthwise Staff
Primary Medical ReviewerSarah Marshall, MD - Family Medicine
Specialist Medical ReviewerDouglas A. Stewart, MD - Medical Oncology
References
Citations
  1. Paley PJ (2001). Screening for the major malignancies affecting women: Current guidelines. American Journal of Obstetrics and Gynecology, 184(5): 1021–1030.
  2. Fisher B, et al. (2002). Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer. New England Journal of Medicine, 347(16): 1233–1241.
You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.

Breast Cancer: Should I Have Breast-Conserving Surgery or a Mastectomy for Early-Stage Cancer?

Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision.
  1. Get the facts
  2. Compare your options
  3. What matters most to you?
  4. Where are you leaning now?
  5. What else do you need to make your decision?

1. Get the facts

Your options

  • Have surgery to remove the breast (mastectomy).
  • Have surgery to remove just the cancer from the breast (breast-conserving surgery) followed by radiation treatments.

Key points to remember

  • For early-stage breast cancer, studies show that women who have breast-conserving surgery followed by radiation treatments have the same survival rates as women who have mastectomy.
  • The stage of your cancer—how far it has spread—is very important in deciding which treatment is best.
  • Breast-conserving surgery may be a better choice if the tumor is small or if it is at the edge of the breast.
  • Mastectomy may be a better choice if you have two or more areas of cancer in the same breast that would need more than one cut, or incision.
  • If you choose mastectomy, you may have surgery to rebuild your breast. This is called reconstructive surgery. It can often be done at the same time as the mastectomy.
  • Breast-conserving surgery has a slightly higher chance of the cancer returning.
  • The radiation used after breast-conserving surgery can cause side effects such as fatigue.
  • This is a very personal decision. Your feelings about keeping your breast are just as important as anything else in choosing what feels right for you.
FAQs

What is breast cancer?

Breast cancer occurs when abnormal cells grow out of control in the breast. It is highly curable if found early.1

What types of surgery are used to treat breast cancer?

The two different types of surgery used to treat early-stage breast cancer are:

  • Breast-conserving surgery , along with radiation therapy and an exam (biopsy) of some of the lymph nodes under the arm.
    • In a lumpectomy, the doctor cuts out the tumor and some of the breast tissue around it. You may also hear this called an "excisional biopsy" or "wide excision."
    • In a partial or segmental mastectomy, the doctor cuts out the tumor and a larger section of breast tissue around it. He or she also cuts out the lining over the chest muscles below the tumor. But most of your breast remains.
  • Removal of the breast (mastectomy ).
    • The removal of the entire breast is called a total or simple mastectomy.
    • The removal of the breast, the lymph nodes under the arm (axillary lymph nodes), the lining over the chest muscles, and sometimes part of the chest wall muscles is called a modified radical mastectomy.

What will help you decide which type of surgery to choose?

How far the cancer has spread within your breast and whether it has spread to nearby tissues or other organs is called the stage. Your doctor will find out the stage of your breast cancer by gathering information from other tests such as lymph node biopsies, blood tests, bone scans, and X-rays. The stage of your cancer is one of the most important things to think about when you choose the treatment option that is right for you.

Does one type of surgery work better than the other?

For many years, experts thought that having a mastectomy would help you live longer and reduce the chance that your breast cancer would come back (recur). Breast-conserving surgery does have a slightly higher chance of the cancer returning. But studies now show that women who have breast-conserving surgery followed by radiation treatments have the same survival rates as women who have mastectomy.2

Why might your doctor recommend a mastectomy instead of breast-conserving surgery?

Your surgeon may recommend a mastectomy if:

  • You have two or more areas of breast cancer in the same breast that are too far apart to be removed with a single cut (incision).
  • You have precancerous changes in more than one-quarter of your breast (one breast quadrant) or throughout one or both breasts.
  • Your breast cancer is large or is large relative to the size of your breast, and removing it will require removing a lot of breast tissue. You may not be satisfied with the way your breast looks after surgery.
  • You have a serious lung disease, such as COPD or emphysema. The radiation therapy needed after a lumpectomy may make your lung problems worse.
  • You have already had radiation treatment to your breast or your chest to treat another condition, such as Hodgkin's lymphoma.
  • You have a connective tissue disease, such as scleroderma, that makes you especially sensitive to the effects of radiation.
  • You are pregnant. Radiation treatment should not be used during pregnancy.

2. Compare your options

Have a mastectomy Have breast-conserving surgery
What is usually involved?
  • You will stay overnight in the hospital.
  • Breast reconstruction is possible. It may involve one or more surgeries.
  • You may or may not need radiation treatment afterward.
  • There's no need to stay in the hospital overnight.
  • You will probably have daily radiation treatments for 3 to 6 weeks.
What are the benefits?
  • Like breast-conserving surgery, mastectomy can help you live longer.
  • You may not need to have daily radiation treatment after surgery.
  • Like mastectomy, breast-conserving surgery can help you live longer.
  • You will keep more of your natural breast, which will have more sensitivity than a reconstructed breast.
  • Surgery usually leaves only a small scar, so you won't need breast reconstruction or an artificial breast.
What are the risks and side effects?
  • Removing a breast without doing reconstructive surgery can cause a weight shift, leading to neck and back pain. This is more common if you have large breasts.
  • Some women are disappointed with the way they look after mastectomy, even with reconstruction.
  • A reconstructed breast does not have the sensitivity of your natural breast.
  • With breast reconstruction, there are risks from additional surgeries.
  • Because more breast tissue remains, there is a slightly higher chance of the cancer coming back in that breast. If this happens, the chances of survival are not affected, but you will then need to have a mastectomy.
  • Radiation often has side effects, including fatigue and a slight change in the color of your skin.

Personal stories

Are you interested in what others decided to do? Many people have faced this decision. These personal stories may help you decide.

Personal stories about choosing breast-conserving therapy or mastectomy

These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.

"I don't want to lose my breast. It is a part of me, and I don't believe that I would feel the same way about myself if it were gone. Wearing a prosthesis seems like a hassle, and I don't want to have more surgery to reconstruct my breast, so the lumpectomy feels like the right choice for me. I don't mind going for the radiation treatments."

— Maggie, age 61

"I live about 60 miles from the nearest cancer center. Traveling to and from there each day will just be too much for me. I would rather have a mastectomy and not have to go through 6 more weeks of treatment. At some point, I may decide to have reconstructive surgery to restore my breast, but I can't take that much time off from my job right now."

— Ellen, age 49

"I don't want to have a daily reminder, a flat spot on my chest wall, about this cancer. I want the doctor to take out only what is necessary. I think if I had a mastectomy, my scar would be a constant reminder of my cancer, even if I chose to have reconstruction. Also, I work really close to the cancer center, so it will be easy for me to have my treatments."

— Joan, age 52

"I don't want to have radiation treatments. I know that it is not the same today as it was years ago, but I still am concerned about the side effects and the weeks and weeks of treatments. I'm glad that I have the choice. I am certain that I do not want to have radiation, so mastectomy seems like the right choice for me. Maybe some day I will have reconstructive surgery, but right now I just want to get on with my life."

— Beth, age 65

3. What matters most to you?

Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.

Reasons to choose mastectomy

Reasons to choose breast-conserving surgery

I am worried that breast-conserving surgery will not remove all of the cancer.

I don't mind trying breast-conserving surgery first and having a mastectomy if it's needed to remove all of the cancer.

More important
Equally important
More important

Keeping my breast is not as important as getting rid of all the cancer.

I really want to keep most of my breast.

More important
Equally important
More important

I am worried about having radiation treatment or side effects such as fatigue and skin changes.

I am worried about problems after mastectomy, such as neck and back pain.

More important
Equally important
More important

I'm worried about the inconvenience of radiation treatment, such as extra time and daily travel.

Time and travel for radiation treatment isn't a concern.

More important
Equally important
More important

My other important reasons:

My other important reasons:

More important
Equally important
More important

4. Where are you leaning now?

Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.

Mastectomy

Breast-conserving surgery

Leaning toward
Undecided
Leaning toward

5. What else do you need to make your decision?

Check the facts

1. Which option has a slightly higher chance that the cancer will return in the same breast?

  • Mastectomy
  • Breast-conserving surgery
  • Both are equal
  • I'm not sure
You are right. Breast-conserving surgery leaves behind more breast tissue, so there is a slightly higher chance of the cancer coming back in that breast.

2. Which option has the highest chance of survival?

  • Mastectomy
  • Breast-conserving surgery
  • Both are equal
  • I'm not sure
You are right. Studies show that breast-conserving surgery followed by radiation treatments is as good as mastectomy in treating early-stage breast cancer.

3. Which option has the highest chance of side effects from radiation, such as fatigue?

  • Mastectomy
  • Breast-conserving surgery
  • Both are equal
  • I'm not sure
You are right. After you have this surgery, you will need radiation treatments. Radiation often has side effects, including fatigue and a slight change in the color of your skin.

Decide what's next

1. Do you understand the options available to you?

2. Are you clear about which benefits and side effects matter most to you?

3. Do you have enough support and advice from others to make a choice?

Certainty

1. How sure do you feel right now about your decision?

Not sure at all
Somewhat sure
Very sure

2. Check what you need to do before you make this decision.

  • I'm ready to take action.
  • I want to discuss the options with others.
  • I want to learn more about my options.

3. Use the following space to list questions, concerns, and next steps.

Credits
ByHealthwise Staff
Primary Medical ReviewerSarah Marshall, MD - Family Medicine
Specialist Medical ReviewerDouglas A. Stewart, MD - Medical Oncology
References
Citations
  1. Paley PJ (2001). Screening for the major malignancies affecting women: Current guidelines. American Journal of Obstetrics and Gynecology, 184(5): 1021–1030.
  2. Fisher B, et al. (2002). Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer. New England Journal of Medicine, 347(16): 1233–1241.
Note: The "printer friendly" document will not contain all the information available in the online document some Information (e.g. cross-references to other topics, definitions or medical illustrations) is only available in the online version.

Last Revised: June 28, 2011

Author: Healthwise Staff

Medical Review: Sarah Marshall, MD - Family Medicine & Douglas A. Stewart, MD - Medical Oncology


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This information does not replace the advice of a doctor. Healthwise disclaims any warranty or liability for your use of this information. Your use of this information means that you agree to the Terms of Use. How this information was developed to help you make better health decisions.

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