A breast cancer diagnosis usually brings up many feelings at once. Getting the facts you need to choose the best treatment plan can help you feel more in control. If surgery is an option for you, one of your first big decisions is likely to be which type of surgery to have. Here's what you need to know about the most common types of breast cancer surgery. Your doctor will help you decide which one is best for you.
What Are the Different Types of Surgery?
There are two main types of surgery used to treat breast cancer:
Mastectomy: With a simple mastectomy, the surgeon removes the entire breast and possibly a few lymph nodes under your arm. If you get a modified radical mastectomy, your entire breast is removed along with the lymph nodes under your arm.
Lumpectomy: With this operation, the surgeon removes the part of the breast where the cancer is located. A border of normal tissue surrounding the cancer and some lymph nodes also may be removed. Because lumpectomy leaves as much breast tissue as possible, it is known as breast-conserving surgery or partial mastectomy. Lumpectomy is sometimes followed by radiation to help prevent the cancer from returning to the breast.
How Do I Decide Which Surgery to Get?
If you have early invasive or locally advanced breast cancer, your doctor will usually recommend surgery right away. Sometimes chemotherapy is given before surgery to shrink the tumor. For early cancers there is the option of lumpectomy. In the case of locally advanced breast cancer, which is higher risk, a mastectomy is usually recommended. Studies show that when radiation therapy to the breast is combined with lumpectomy, survival is better than with a mastectomy alone.
For women with breast cancer that has spread beyond the breast to distant organs, chemotherapy is the main treatment. Women with advanced cancer may get surgery to help relieve their symptoms, but it is not part of the primary treatment plan.
Mastectomy may be preferable if you:
- Have a large breast cancer mass
- Have small breasts and cancer in more than one area of your breast
- Have cancer under your nipple
- Cannot receive radiation therapy
- Are at increased risk for radiation side effects because you have a connective tissue disorder such as lupus or scleroderma
- Have received radiation therapy to the breast in the past
- Are pregnant and would need radiation therapy during your pregnancy. This could harm the baby.
If you get a mastectomy, you may want to consider breast reconstruction surgery to help rebuild the shape of your breast. It can be done at the same time as your mastectomy or at a later date.
In some cases, women who get a lumpectomy can have fat tissue grafted from other parts of the body to help conceal any dimples created by the surgery.
On the rare occasions when a man has breast cancer, about 98% of them receive a mastectomy.
Does the Type of Surgery I Get Affect How Long I Will Live?
If you have early-stage breast cancer, recent studies show you may live longer if you are treated with lumpectomy followed by radiation than if you have a mastectomy.
With both types of surgery, there is a small risk that cancer will come back. Within 12 years, 5% to 10% of women who have breast-sparing surgery followed by radiation develop cancer in the same breast. If this occurs, you can get a mastectomy.
Women who get a mastectomy have a slightly smaller risk. About 5% will develop cancer on the same side of the chest within 12 years. Breast reconstruction does not increase your risk of developing cancer in the breast that was operated on. It also does not affect how long you will live.
What Should I Expect After Surgery?
You’re likely to have some pain. Before surgery, talk to your doctor about options to treat your pain. If you have a lumpectomy, you should be back to your everyday activities within 5 to 10 days. After mastectomy, it could take 3 to 4 weeks for you to start to feel back to normal. If you also received breast reconstruction, count on 6 to 8 weeks of recovery time.
If you received a lumpectomy or some other type of breast-sparing surgery, your breast should look much the way it did before the operation. Your breast, nipple, and areola (the dark circle around your nipple) should still have feeling. If you had a large cancer removed, your breast may look smaller or different. You’ll also have a small scar where an incision was made to remove the cancer.
After a simple mastectomy or modified radical mastectomy, your breast and nipple will be gone, and your chest will be flat on the side that was operated on. If you have a nipple-sparing mastectomy, the nipple and areola are left in place. If your breast was large, the scar will be longer than it would be in a small-breasted woman. You may have no feeling in the skin where your breast was removed and possibly the area under your arm. Within a year or two, the feeling may somewhat improve, but it won’t feel the way it did before the surgery. If you get breast reconstruction, you won’t have feeling in most of the area around your breast.
What Are the Risks of Complications?
With any type of surgery, there is a risk of complications. For both lumpectomy and mastectomy, the most common ones are similar and include:
- Pain
- Infection
- Bleeding
- Swelling
Because mastectomy is a more invasive procedure, your risks for these complications are greater.
Will I Need More Treatment?
After surgery, you’ll probably need more treatment. If you get a lumpectomy or some other type of breast-conserving surgery, you’ll likely need radiation therapy 5 days a week for 1 to 6 weeks. If you choose a mastectomy, you also may need radiation therapy.
With both types of surgery, your treatment also may include chemotherapy, hormone therapy, or targeted therapy.
If you get a lumpectomy, it’s possible you’ll need more surgery to remove any remaining cancer cells. With mastectomy, additional surgery also may be necessary. More than one surgery after breast reconstruction also is common.
What Else Could Affect My Choice of Breast Cancer Surgery?
When choosing between a lumpectomy and mastectomy, you’ll want to think about possible complications, recovery time, and your personal feelings about your breast’s appearance. Cost also may be a factor in your decision. Many things will affect the long-term costs of breast cancer treatment, including hospitalization and the need for follow-up treatment.
Research shows that only 22% of women talk to their medical team about the cost of their surgery. About one-third of women studied said that their care cost more than they had expected. Even if you have insurance, you may want to discuss costs upfront so you can factor that into your decision making. Ask your doctor if your treatment center has a “financial navigator” or some other person who can talk to you about costs.
When choosing between a mastectomy or lumpectomy, a woman’s choice also may be influenced by her race or ethnicity. In a study published in Annals of Surgical Oncology, 41% of American Indian and Alaska Native women with early-stage breast cancer got a mastectomy compared with 34% of white women. With lumpectomy, a higher percentage of white women got the operation (65.6% versus 59% of the Indigenous women.)
Remember: If lumpectomy is an option, choosing to have a mastectomy won’t help you live longer. Research also shows that a mastectomy may be more expensive and lead to more complications.
