Lumpectomy vs. Mastectomy Decision Guide

This page is for people weighing lumpectomy against mastectomy for early breast cancer. It covers the facts that matter and the themes people often describe when they decide.

Some people have DCIS (ductal carcinoma in situ, abnormal cells that have not spread beyond the milk duct) or early breast cancer that surgery can remove. For them, breast-conserving surgery followed by radiation gives the same survival as mastectomy. NCI states it plainly: women who have breast-conserving surgery live as long as women who have a mastectomy.

Once that is settled, the decision is no longer about which option is safer. It becomes about which set of trade-offs you would rather live with. That is a genuinely different question. And it is one where your own priorities decide.

Mastectomy is the medical recommendation in specific situations. One is when the cancer is large next to the size of the breast. Another is when it involves several separate areas of the breast, or when it sits under the nipple. If cancer is found in the healthy tissue removed, you may need more surgery or a mastectomy. And it may be preferred when radiation cannot be given, for example during pregnancy. If your team is recommending mastectomy, ask which of these applies to you. Then you will know whether you are choosing or being advised.

NCI says about 5 to 10 percent of women get cancer in the same breast within 12 years after lumpectomy. After mastectomy, about 1 out of every 20 women get cancer on the same side of the chest in that time. The gap is small.

Some people find that gap reassuring. Others find it intolerable. Both reactions are reasonable. Knowing the actual figures beats reasoning from a vague sense that more surgery must be safer.

Radiation. Lumpectomy usually commits you to radiation. The traditional schedule is five days a week for up to six weeks. NCI says partial-breast radiation can take 2 to 4 weeks, and some schedules use larger doses to cut the number of treatments. Ask which one you would be offered. Daily travel, work absence, childcare and distance from the center all matter here. They are not trivial logistics.

Recovery. NCI says most women are ready for most usual activities within 2 weeks after lumpectomy. After mastectomy it may take 3 to 4 weeks to feel mostly normal. With reconstruction, full recovery can take 6 to 8 weeks or longer.

Appearance and sensation. After lumpectomy the breast keeps more of its shape. After mastectomy the chest is flat unless rebuilt, and the skin around the cut will be numb. With reconstruction, most of the area around the breast will not have feeling.

NCI also says women who have breast-conserving surgery have a better long-term quality of life than those who have a mastectomy. Group averages describe populations, though, not individuals.

People describing this choice tend to return to a few themes. Fear of recurrence pushes toward more surgery, even when the survival numbers are equal. A strong wish to be done with treatment quickly cuts against six weeks of radiation. Some worry about symmetry. Caring duties can make a longer recovery hard. And often there is pressure, from inside or outside, to decide faster than needed.

Ask your team how much time you have to decide, and whether a second opinion fits. Asking for the specific numbers that apply to your tumor is normal.

If you are eligible for both, there is no medically better answer here. There is the option that fits your body, your logistics and your tolerance for different kinds of risk. Understand the survival equivalence clearly before you decide. Take the time your team says is safe.

• NCI — Breast Cancer Treatment (PDQ) patient version
• NCI — Choosing Between Lumpectomy and Mastectomy
• NCI — Lumpectomy
• NCI — Radiation Therapy for Breast Cancer