If you have hormone receptor-positive (HR+), HER2-negative (HER2-) breast cancer, you may be considering a lumpectomy or a mastectomy. They’re both surgical procedures to treat breast cancer. You may also hear doctors call a lumpectomy a “partial mastectomy” or “wide local excision.”
During a lumpectomy, the surgeon removes the cancer and some healthy tissue around it to have “clean margins.” That means making sure no cancer is left behind in that area. You might hear other names for lumpectomy, such as partial mastectomy, wide local incision, and breast-conserving surgery.
“The goal is to remove the cancer while leaving as much normal breast as possible,” says Shanthi Sivendran, MD, the senior vice president of cancer treatment support at the American Cancer Society.
How does a mastectomy differ from a lumpectomy?
With a mastectomy, the surgeon removes all of the breast tissue. They may or may not leave the skin and nipple. Some people choose to have breast reconstruction after a mastectomy, while some don’t.
Based on the exact type, location, and stage of cancer you have, your provider may recommend one of these procedures. They may let you know that you have a choice between them. Here’s what you need to know to make that choice.
How Are Lumpectomies and Mastectomies Performed?
Lumpectomies and mastectomies are both surgical procedures to treat breast cancer. But they differ in how they’re done, recovery time, and outcomes.
What to expect from a lumpectomy
A lumpectomy is usually done as an outpatient procedure, meaning you can go home on the same day. Usually, you’ll be put to sleep using general anesthesia. Sometimes, surgeons use local anesthesia and a sedative given to you through an IV line.
Preparation. Your health care team will give you instructions to prepare for the surgery. Instructions might include what medications you need to stop temporarily and when to stop drinking or eating before the procedure. They may also ask you to clean the area at home before surgery with a specific product to lower the chances of bacteria getting into your body during the procedure. You’ll need to bring someone with you or have someone scheduled to drive you home afterward.
Procedure. Your surgeon will make a small cut in your breast to remove the tumor and a bit of healthy tissue surrounding it. The goal is to keep the breast as intact as possible while making sure to take out all the cancer. Sometimes your surgeon will also remove nearby lymph nodes in your armpit in order to test them to see if the cancer has spread.
Recovery. You should be able to go home on the day of the procedure. You may feel sore where the tumor and any lymph nodes were removed. The scars you may get after the procedure may feel numb. Over-the-counter pain relievers or prescription pain medication can help you manage any pain after the procedure. If you had lymph nodes near your arm removed, you may not be able to move your arm like you usually would as you heal. Recovery time is usually about two weeks.
What to expect from a mastectomy
Here’s what you can expect if you’re getting a mastectomy.
Preparation. Preparing for a mastectomy is similar to preparing for a lumpectomy. If your provider tells you you’ll need (or may need) to stay overnight in the hospital, bring some comfortable clothes, including a robe and slippers, toiletries, and something to pass the time, such as a book.
Procedure. A mastectomy usually takes between one and three hours. If you get breast reconstruction during the same procedure, that can add one to five hours. You’ll most likely have general anesthesia, so you’ll be asleep for the entire procedure. The surgeon will make a larger cut around your breast to remove all of the breast tissue.
Depending on the type of procedure, they may also remove some skin and your nipple. Just like with a lumpectomy, your surgeon may remove some lymph nodes to see if the cancer has spread. If you’re having breast reconstruction at the same time, that procedure will follow the mastectomy.
Recovery. After the surgery, while you’re still asleep, your care team will take you to a recovery room. Here, they’ll check your vitals as you wake up from the anesthesia. Chances are you won’t feel any immediate pain when you wake up, thanks to the pain medicine used during the procedure. If you had breast reconstruction at the same time, you may feel tightness in your chest where they have put an implant or a tissue expander.
As the numbing medication wears off, you’ll need over-the-counter or prescription pain medicine to manage pain and soreness. You may or may not need to stay in the hospital. You’ll have a drain attached to the area where your breast or breasts were removed. The drain — small, pencil-thick tubes attached to your skin — takes any fluid your body makes and diverts it into a small sack attached to the tubes. This helps prevent infection and encourages healing. You’ll get instructions on how to care for your drains, which are left in until the fluid is gone (usually two to three weeks).
Recovery time from a mastectomy is usually three to four weeks.
No matter which procedure you have, a pathologist will test any tissue removed from your body. They’ll put their findings in a pathology report. This report gives your doctor a lot of detailed information about the tumor, including the size, grade, and type of cancer, among other things.
When Is a Lumpectomy Preferred Over a Mastectomy?
Your provider will talk to you about whether a lumpectomy is possible based on the cancer’s type, stage, and location. If either treatment is an option?
“A lumpectomy is preferred when a patient wants to conserve as much of their own breast as possible,” says Sivendran.
If you have early to locally advanced breast cancer, getting a lumpectomy may be an option for you.
“A lumpectomy is an option for most people who have early breast cancer or ductal carcinoma in situ [a noninvasive breast cancer],” says Erica Kuhn, MPH, director of health information and publications at the Susan G. Komen Breast Cancer Foundation. “A lumpectomy may also be an option for some people with locally advanced breast cancer after treatment with neoadjuvant therapy [a drug therapy given before surgery]. In some cases, neoadjuvant therapy can shrink a tumor enough so a lumpectomy becomes an option instead of a mastectomy.”
Almost all lumpectomies are followed by radiation treatment to destroy any cancer cells that may have been left behind. If radiation therapy isn’t an option for someone — for example, if they’re more likely to have severe side effects from radiation — then a lumpectomy isn’t an option, either.
When is a mastectomy preferred over a lumpectomy?
In some cases, a mastectomy may be preferred over a lumpectomy.
“A mastectomy may be the best surgical option when there are two or more [tumors in different areas of the same breast], and when multiple lumpectomies can’t be done with a good enough cosmetic result,” Kuhn says.
Other reasons you may get a mastectomy over a lumpectomy include:
- The tumor is large relative to your breast size, making it difficult to keep your breast’s shape after surgery
- A mammogram shows large areas of calcifications in the breast (a buildup of calcium), which means there may be more areas of cancer
- A breast MRI before surgery shows lots of abnormal tissue in your breast that a lumpectomy can’t remove
- The tumor is just below the nipple, which can affect the cosmetic look after a lumpectomy
- The surgeon can’t remove all the tumor after multiple attempts by a lumpectomy
- Radiation or hormone therapy following a lumpectomy isn’t an option
- You have a genetic risk factor (such as the BRCA gene) that may increase the risk of a second breast cancer
- You have inflammatory breast cancer, which means it’s spread throughout your breast
Pros and Cons of Getting a Lumpectomy
Your provider should go over any pros and cons of a lumpectomy specific to you and your particular cancer. But there are some general advantages and disadvantages of getting a lumpectomy with radiation therapy.
Pros of getting a lumpectomy
People most often choose lumpectomies when they want to keep their breast and avoid a more intense surgery. The recovery time is usually shorter, too.
“The main benefit of a lumpectomy is that the breast is preserved as much as possible,” Kuhn says. “It’s also a less extensive surgery than a mastectomy and a person will likely be able to go home the same day.”
Disadvantages of lumpectomies
There are a few reasons a lumpectomy may not be the right choice for you.
The need for radiation therapy. Radiation therapy usually accompanies a lumpectomy, most often after the surgery. Sometimes, radiation comes before the surgery to shrink the tumor and make it easier to remove.
“Radiation therapy often requires daily trips to the radiation center for many weeks,” Kuhn says.
That can be a big disadvantage if you don’t live near a radiation center. It can be extra difficult if you have work or childcare responsibilities that would make it difficult to travel back and forth.
Some people can’t do radiation therapy because they’re more at risk of serious side effects or have had radiation in that breast before.
Potential for additional surgery. If the pathology report shows positive margins (meaning some cancer is still there after surgery), you may need a another lumpectomy or a mastectomy.
Chance of recurrence. While the likelihood of cancer coming back is low in general, the risk is slightly higher with a lumpectomy than with a mastectomy.
Pros and Cons of Getting a Mastectomy
A mastectomy may be the best choice based on your cancer. Your provider should walk you through the good and the difficult parts of getting a mastectomy.
Pros of getting a mastectomy
One of the main reasons people choose a mastectomy when a lumpectomy is an option is peace of mind, Kuhn says. Other people might choose a mastectomy if they have a higher risk of breast cancer recurrence or cannot have radiation therapy.
Cons of getting a mastectomy
A mastectomy is a more serious surgery, which is usually done under general anesthesia and often requires a short hospital stay. If someone opts to do breast reconstruction at the same time, the stay may be even longer.
Mastectomy recovery is also longer.
“Patients who undergo a mastectomy may have a recovery period of about four weeks before getting back to regular activities,” says Sivendran.
There may be more side effects after getting a mastectomy than after getting a lumpectomy. Even if you get a mastectomy, there’s a chance you may still need radiation.
Recovering: What to Expect From a Lumpectomy vs. a Mastectomy
When it comes to pain and length of recovery, lumpectomies and mastectomies aren’t that different. But how things look afterward can be very different depending on which procedure you get. Here are some things to keep in mind about recovery and post-procedure life.
Breast appearance
Because appearance is often a big reason people choose one procedure over another, it’s important to know what each can look like in recovery and beyond. Even though a lumpectomy is sometimes done to save your breast, there may still be some changes in appearance and how it feels. For example, because your surgeon may take out some breast tissue, your breast may look smaller than it used to post-surgery.
Radiation therapy can also change how your breast looks or feels to touch. For example, it may look tanned or red, depending on your skin color.
If you have a total mastectomy without reconstruction, your chest will be flat after surgery. You may have a horizontal scar that stretches across to your armpit if any lymph nodes were removed.
When you’re having a mastectomy, you’ll have a choice whether you want to have reconstructive surgery done. Breast reconstructive surgery can rebuild your breast. This may look similar to what your breast looked like before the mastectomy.
But when it comes to having breast reconstruction after a mastectomy, there’s no wrong answer. Some people want breast reconstruction and some don’t. Either choice is OK.
“Sometimes, this is done at the time of mastectomy and sometimes, at a later time point,” Sivendran says. “If you are interested in having breast reconstructive surgery, it is important to meet with both your breast surgeon and your plastic surgeon to understand what is best for you.”
If you choose to have breast reconstruction immediately following a mastectomy, your surgeon may do a skin-sparing or nipple-sparing mastectomy. That means they’ll try to save as much breast skin as possible to cover the reconstructed breast so your nipple can be reattached.
Post-surgery side effects
After a lumpectomy, you might have:
- Some soreness in your chest, underarm, and shoulder
- A healing ridge (a firm ridge below the scar while it heals)
- Numbness along the scar
- Some swelling that goes away after some time
After a mastectomy (with or without breast reconstruction), you might feel some soreness in your chest, underarm, and shoulder areas. You may also feel numb across your chest, from your collarbone to the top of your rib cage. Even though some feeling may come back over time, chances are it may not feel the same as before surgery, Kuhn says.
There’s a chance you may feel phantom breast pain or other sensations. That’s when you feel discomfort in the place where your breast used to be, even though it’s not there anymore. Medication or massage can help.
You’ll also leave the hospital with a drain. Usually, you’ll have it for two to three weeks.
How Effective Are Lumpectomies vs. Mastectomies?
Both lumpectomies and mastectomies can be effective treatments for people with breast cancer. If you have cancer in one place in one of your breasts and the mass is less than 4 centimeters, getting a lumpectomy and radiation is often just as effective as a mastectomy.
There may be a slightly higher risk of cancer returning to the breast or chest area when treated with lumpectomy plus radiation.
But everyone who’s had breast cancer has a risk of recurrence. The risk of cancer spreading to another part of your body is the same for both procedures.
“The good thing is that most people diagnosed with breast cancer will never have a recurrence,” Kuhn says.
Regardless of which procedure you choose, that decision won’t affect whether you’ll need chemotherapy, hormone therapy, HER2-targeted therapy, or other drug therapies.
“Drug therapies are given based on the characteristics of the tumor, such as hormone receptor status and HER2 status — not the type of surgery a person has,” Kuhn says.
Choosing between a lumpectomy and a mastectomy
Give yourself the information and time you need to make a decision. Start by asking your provider if you have a choice, given your specific cancer. If the answer is yes, talk to them about things such as:
- The risks and benefits of each surgery
- Your medical history and risk factors
- Your own goals for recovery and life after treatment
- Your values and lifestyle
“You have time to make a thoughtful, informed decision,” Kuhn says. “It’s always OK to get a second opinion to confirm the recommendation or get a different insight into your care. Remember, survival is the same for people who have a lumpectomy plus radiation therapy and those who have a mastectomy.”
The right choice for you will depend on your needs, goals, and health. Your doctor can explain each procedure and help you decide which might be best for you.
