Lumpectomy vs mastectomy: choosing between breast cancer operations

The NHS says the main treatment for breast cancer is usually surgery, and the type depends on how big the cancer is and whether it has spread. Surgery can include removing only the area of the breast with the cancer in it (breast-conserving surgery, also called lumpectomy or wide local excision), removing the whole breast (mastectomy) and removing lymph nodes in the armpit.

Cancer Research UK explains that in breast conserving surgery the surgeon removes the area of cancer and some surrounding breast tissue, leaving as much normal tissue as possible. A pathologist checks the border around the tumour, and a clear margin means you are unlikely to need more surgery and the risk of the cancer coming back is lower. A mastectomy is surgery to remove all of the breast, and a breast reconstruction may be done at the same time or later.

Cancer Research UK says your doctor or breast care nurse will discuss the options and take into account the size of the cancer, where it is in the breast, whether there is more than one area of cancer, the type of breast cancer, the size of your breasts and your general health and fitness. Depending on the situation, a surgeon might recommend a particular operation, or you may have a choice.

Lumpectomy may be recommended if the cancer is small compared with the breast size, in a suitable position, and only in one area of the breast. It may not be suitable if you are unable to have radiotherapy afterwards. Mastectomy may be recommended when those conditions are not met, or may be chosen by the person where a choice is offered. Some people choose a mastectomy to prevent breast cancer if at high risk, according to the NHS.

For breast conserving surgery, the advantages are keeping most of the breast tissue, less of a change to the body and a shorter recovery of 2 to 3 weeks. The disadvantages are possible further surgery, feeling more worried that the cancer will come back, possible shape change, the need for breast radiotherapy that can cause tiredness for a few months, and, if the cancer returns, being unable to have radiotherapy again and needing a mastectomy.

For mastectomy, the advantages are that some people feel more confident that the cancer will not come back, radiotherapy is usually not needed, and radiotherapy remains possible if the cancer returns. The disadvantages are permanent removal of the breast, a longer recovery of about 3 to 6 weeks, a longer operation and recovery with reconstruction, usually 1 or 2 smaller operations to match the breasts, and possibly an external prosthesis if there is no reconstruction.

The NHS says after a mastectomy you may have drains in the wounds for a few days or weeks, may be able to go home the same day or after 1 or 2 days, and can usually return to most usual activities in around 3 weeks, though wounds take around 6 weeks to heal. Complications can include bleeding, fluid build-up (seroma), infection, painful scarring, blood clots, numbness or loss of feeling in the arm, shoulder problems and lymphoedema. Call NHS 111 for sudden pain or swelling, bleeding from wounds or sudden loss of feeling in the arm, and call 999 for chest pain, severe breathlessness or a very fast heartbeat.

Whatever operation you have, lymph nodes in the armpit are usually checked, and further treatment such as chemotherapy, hormone therapy or targeted treatment may follow, depending on the type of cancer.

Cancer Research UK suggests thinking about how you feel about having the whole breast removed, how you feel about having only part removed, how quickly you want treatment to be finished, and whether you would want reconstruction, and if so straight away or some months later. It says to take time to find out how you feel, to discuss with family or friends, and to ask your specialist nurse questions. You are entitled to ask for time to think over your options.