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

British Columbia Specific Information

Breast cancer is the most common type of cancer in women in British Columbia. Breast cancer can occur in men as well, but it is not as common. Tests and treatments for breast cancer vary from person to person, and are based on individual circumstances. Certain factors such as your age, family history, or a previous breast cancer diagnosis may increase your risk of developing breast cancer. For information about your specific risk factors, speak with your health care provider.

A number of screening methods, including mammograms in women, can help find and diagnose breast cancer. The decision to have a mammogram or use any other screening method may be a difficult decision for some women. While screening for breast cancer is often recommended, it is not mandatory. Speak with your health care provider for information regarding how to get screened, the facts and myths about screening tests, how to maintain your breast health, and to get help making an informed decision.

For more information about breast cancer and breast cancer screening, visit:

If you have questions about breast cancer or medications, speak with your health care provider or call 8-1-1 to speak with a registered nurse or pharmacist. Our nurses are available anytime, every day of the year, and our pharmacists are available every night from 5:00 p.m. to 9:00 a.m.

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?

1

Get the
Facts

2

Compare
Options

3

Your
Feelings

4

Your
Decision

5

Quiz
Yourself

6

Your Summary

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 live just as long as women who have mastectomy.
Breast-conserving surgery has a slightly higher chance of cancer coming back in the same breast, because more breast tissue is left behind.
If you choose mastectomy, you may be able to have surgery to rebuild your breast. This is called reconstructive surgery.
Any surgery has a risk of problems. Mastectomy is a more involved surgery with a longer recovery time and a higher risk of problems than breast-conserving surgery. And if you have reconstruction, you will likely need more surgery, which will have risks, and more recovery time.
After breast-conserving surgery, you will need radiation treatments. Radiation often has side effects, including fatigue and a slight change in the colour of your skin.
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. Early-stage breast cancer means that the cancer cells haven't spread beyond the breast or the lymph nodes in the armpit.

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 (lumpectomy), along with radiation therapy. During this type of surgery, the doctor cuts out the tumour and some of the breast tissue around it. Sometimes all of the cancer isn't removed during the first surgery. If this happens, you will need to have another surgery to remove more breast tissue. This is called re-excision. After surgery, you may or may not need chemotherapy.
Mastectomy (removal of the breast). In most cases, you won't need radiation treatments after a mastectomy. And you may or may not need chemotherapy.
- The removal of the entire breast is called a total or simple mastectomy. Some women choose to have both breasts removed. This is called a bilateral or double mastectomy.
- The removal of the breast and the lymph nodes under the arm (axillary lymph nodes) is called a modified radical mastectomy.

With either breast-conserving surgery or mastectomy, you may need to have a few lymph nodes from under your arm sampled. This is called a sentinel node biopsy. Or you may need more lymph nodes removed. This is called an axillary lymph node dissection.

Your doctor will look at the type, size, and location of the tumour you have and the size of your breast to help learn which surgery may be right for you.

Your doctor may recommend that you have chemotherapy before surgery to shrink the tumour. This is called neoadjuvant therapy. It may make breast-conserving surgery an option, because less breast tissue has to be removed during surgery.

If you prefer breast-conserving surgery but are worried about radiation treatments, check with your doctor. Some women, such as those who are age 70 or older, may not need radiation.

Does one type of surgery work better than the other?

Experts now know that there is no guarantee that breast cancer won't come back (recur) in the same breast after breast-conserving surgery or won't come back in the same area where your breast used to be after a mastectomy.

When comparing mastectomy versus breast-conserving surgery followed by radiation treatments, studies show:^{footnote 1}

There's a very small difference in the chance of breast cancer coming back in the same breast or breast area. But breast-conserving surgery does have a slightly higher chance of cancer coming back in the same breast. That's because more breast tissue is left behind.
There is no difference in survival.

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).
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 had chemotherapy before surgery (called neoadjuvant therapy) to shrink the tumour, but it didn't reduce the size of the tumour enough to make breast-conserving surgery an option.
You have a health reason that keeps you from being able to have radiation. Those reasons may include a serious lung disease, a connective tissue disease, or a problem that was already treated with radiation to the breast or chest.

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.
You may choose to have breast reconstruction. It may involve one or more surgeries.
In most cases, you won't need radiation treatments after a mastectomy.
You may or may not need chemotherapy.
You should be able to go back to work or your normal routine in 3 to 6 weeks.

Like breast-conserving surgery, mastectomy can help you live longer.
In most cases, you won't need radiation treatments after a mastectomy.

All surgery has some risks, including bleeding, infection, and risks from anesthesia. The risks are higher with mastectomy than they are with breast-conserving surgery. That's because it is a longer and more involved surgery.
The area where your breast used to be will not be as sensitive to touch as it was before surgery.
A reconstructed breast will not have the same natural sensitivity as your natural breast and will look different.
With breast reconstruction, there are risks from more 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.
You may or may not need chemotherapy.
Most women are able to get back to normal activity within a few days.

Like mastectomy, breast-conserving surgery can help you live longer.
You will keep more of your natural breast, with its natural look and sensitivity.
Surgery usually leaves only a small scar. You won't need breast reconstruction or an artificial breast.

All surgery has some risks, including bleeding, infection, and risks from anesthesia. The risks are lower with breast-conserving surgery than they are with mastectomy, because it is a less involved surgery.
There is a risk that all of the cancer may not have been removed during the first surgery. If this happens, you will need to have another surgery to remove more breast tissue. This is called re-excision.
Because more breast tissue remains, there is a slightly higher chance of cancer coming back in the same breast. If this happens, the chances of survival aren't affected, but you will then need to have a mastectomy.
The area where the tumour was taken out will not be as sensitive to touch as it was before surgery.
Radiation often has side effects, including fatigue and a slight change in the colour of your skin.

Personal stories about choosing breast-conserving surgery 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 centre. Travelling 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.

Ruby, 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 centre, so it will be easy for me to have my treatments.

Joan, age 52

I'm choosing to have a mastectomy because I want to put this part of my cancer journey behind me. I'm hopeful that only one surgery will be needed, because right now I just want to get on with my life. I know that I might need more treatments, but I'm okay with that.

Camila, 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 maybe having more surgeries if needed to remove all of the cancer.

More important

Equally important

More important

Keeping my breast is not that important to me.

I really want to keep most of my breast.

More important

Equally important

More important

I want to have a better chance of avoiding radiation treatments if I can.

I am worried about having problems after mastectomy, like getting an infection.

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 aren't a concern for me.

More important

Equally important

More important

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

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

Print Summary

Credits and References

Credits

Author	Healthwise Staff
Primary Medical Reviewer	Sarah Marshall MD - Family Medicine
Primary Medical Reviewer	E. Gregory Thompson MD - Internal Medicine
Primary Medical Reviewer	Adam Husney MD - Family Medicine
Primary Medical Reviewer	Kathleen Romito MD - Family Medicine
Primary Medical Reviewer	Wendy Y. Chen MD, MPH MD, MPH - Medical Oncology, Hematology

References

Citations

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.

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

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

Get the facts
Compare your options
What matters most to you?
Where are you leaning now?
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 live just as long as women who have mastectomy.
Breast-conserving surgery has a slightly higher chance of cancer coming back in the same breast, because more breast tissue is left behind.
If you choose mastectomy, you may be able to have surgery to rebuild your breast. This is called reconstructive surgery.
Any surgery has a risk of problems. Mastectomy is a more involved surgery with a longer recovery time and a higher risk of problems than breast-conserving surgery. And if you have reconstruction, you will likely need more surgery, which will have risks, and more recovery time.
After breast-conserving surgery, you will need radiation treatments. Radiation often has side effects, including fatigue and a slight change in the colour of your skin.
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. Early-stage breast cancer means that the cancer cells haven't spread beyond the breast or the lymph nodes in the armpit.

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 (lumpectomy) , along with radiation therapy. During this type of surgery, the doctor cuts out the tumour and some of the breast tissue around it. Sometimes all of the cancer isn't removed during the first surgery. If this happens, you will need to have another surgery to remove more breast tissue. This is called re-excision. After surgery, you may or may not need chemotherapy.
Mastectomy (removal of the breast). In most cases, you won't need radiation treatments after a mastectomy. And you may or may not need chemotherapy.
- The removal of the entire breast is called a total or simple mastectomy. Some women choose to have both breasts removed. This is called a bilateral or double mastectomy.
- The removal of the breast and the lymph nodes under the arm (axillary lymph nodes) is called a modified radical mastectomy.

Your doctor will look at the type, size, and location of the tumour you have and the size of your breast to help learn which surgery may be right for you.

If you prefer breast-conserving surgery but are worried about radiation treatments, check with your doctor. Some women, such as those who are age 70 or older, may not need radiation.

Does one type of surgery work better than the other?

When comparing mastectomy versus breast-conserving surgery followed by radiation treatments, studies show:¹

There's a very small difference in the chance of breast cancer coming back in the same breast or breast area. But breast-conserving surgery does have a slightly higher chance of cancer coming back in the same breast. That's because more breast tissue is left behind.
There is no difference in survival.

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).
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 had chemotherapy before surgery (called neoadjuvant therapy) to shrink the tumour, but it didn't reduce the size of the tumour enough to make breast-conserving surgery an option.
You have a health reason that keeps you from being able to have radiation. Those reasons may include a serious lung disease, a connective tissue disease, or a problem that was already treated with radiation to the breast or chest.

2. Compare your options

	Have a mastectomy	Have breast-conserving surgery
What is usually involved?	You will stay overnight in the hospital. You may choose to have breast reconstruction. It may involve one or more surgeries. In most cases, you won't need radiation treatments after a mastectomy. You may or may not need chemotherapy. You should be able to go back to work or your normal routine in 3 to 6 weeks.	There's no need to stay in the hospital overnight. You will probably have daily radiation treatments for 3 to 6 weeks. You may or may not need chemotherapy. Most women are able to get back to normal activity within a few days.
What are the benefits?	Like breast-conserving surgery, mastectomy can help you live longer. In most cases, you won't need radiation treatments after a mastectomy.	Like mastectomy, breast-conserving surgery can help you live longer. You will keep more of your natural breast, with its natural look and sensitivity. Surgery usually leaves only a small scar. You won't need breast reconstruction or an artificial breast.
What are the risks and side effects?	All surgery has some risks, including bleeding, infection, and risks from anesthesia. The risks are higher with mastectomy than they are with breast-conserving surgery. That's because it is a longer and more involved surgery. The area where your breast used to be will not be as sensitive to touch as it was before surgery. A reconstructed breast will not have the same natural sensitivity as your natural breast and will look different. With breast reconstruction, there are risks from more surgeries.	All surgery has some risks, including bleeding, infection, and risks from anesthesia. The risks are lower with breast-conserving surgery than they are with mastectomy, because it is a less involved surgery. There is a risk that all of the cancer may not have been removed during the first surgery. If this happens, you will need to have another surgery to remove more breast tissue. This is called re-excision. Because more breast tissue remains, there is a slightly higher chance of cancer coming back in the same breast. If this happens, the chances of survival aren't affected, but you will then need to have a mastectomy. The area where the tumour was taken out will not be as sensitive to touch as it was before surgery. Radiation often has side effects, including fatigue and a slight change in the colour of your skin.

Personal stories

Personal stories about choosing breast-conserving surgery 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 centre. Travelling 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."

— Ruby, 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 centre, so it will be easy for me to have my treatments."

— Joan, age 52

"I'm choosing to have a mastectomy because I want to put this part of my cancer journey behind me. I'm hopeful that only one surgery will be needed, because right now I just want to get on with my life. I know that I might need more treatments, but I'm okay with that."

— Camila, 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 maybe having more surgeries if needed to remove all of the cancer.

More important

Equally important

More important

Keeping my breast is not that important to me.

I really want to keep most of my breast.

More important

Equally important

More important

I want to have a better chance of avoiding radiation treatments if I can.

I am worried about having problems after mastectomy, like getting an infection.

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 aren't a concern for me.

More important

Equally important

More important

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

Credits

By	Healthwise Staff
Primary Medical Reviewer	Sarah Marshall MD - Family Medicine
Primary Medical Reviewer	E. Gregory Thompson MD - Internal Medicine
Primary Medical Reviewer	Adam Husney MD - Family Medicine
Primary Medical Reviewer	Kathleen Romito MD - Family Medicine
Primary Medical Reviewer	Wendy Y. Chen MD, MPH MD, MPH - Medical Oncology, Hematology

References

Citations

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.

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