Most people diagnosed with breast cancer will need at least one surgery to remove some or all breast tissue. Two of the most common surgical options for treating breast cancer are lumpectomy and mastectomy. Each comes with its own risks and benefits.

The best procedure for you depends on many factors, including your specific breast cancer diagnosis, risk of recurrence (cancer returning), lifestyle, and personal preferences.

This article will walk you through the main similarities and differences between mastectomies and lumpectomies to help you understand your options. Be sure to discuss these choices with your oncologist or healthcare team, and consider a second opinion if you’re still unsure.

Is It Better To Have a Mastectomy or Lumpectomy?

Your oncology care team will help you decide which type of surgery is best for you. Reading this section before your appointment can help you understand the terms and surgical options your doctor may talk about.

There are two main types of breast cancer surgery: lumpectomy and mastectomy.

A lumpectomy, also known as breast-conserving surgery, removes the tumor and a small amount of healthy tissue around it. During a lumpectomy, a breast surgeon may also remove some lymph nodes to see whether cancer cells are spreading. Lymph nodes are small, bean-shaped structures that filter lymph fluid and play a key role in helping your body fight infection.

Mastectomy removes all of the breast tissue. People with different stages of breast cancer may consider a mastectomy. Types of mastectomies include:

• Total (or simple) mastectomy — Removes one breast
• Double or bilateral mastectomy — Removes both breasts
• Skin-sparing mastectomy — Keeps as much skin as possible, often to support later breast reconstruction
• Nipple-sparing mastectomy — Leaves the nipple while removing other breast tissue
• Modified radical mastectomy — Removes the entire breast and lymph nodes under the arm
• Radical mastectomy — Removes the breast tissue, lymph nodes, and some muscles from the chest wall (rarely performed)

Your doctor’s recommendation for lumpectomy or mastectomy will depend on factors such as:

• Tumor size and location
• Breast size
• Number of tumors
• Lymph node status
• Tumor cell type
• Your overall health

Your personal preferences are important, too. It’s a personal choice, and your doctor can guide you through it.

Does a Lumpectomy Remove All Cancer?

Research shows that breast cancer recurrence is slightly more likely after a lumpectomy than after a mastectomy. If you have a lumpectomy followed by radiation, the chance of cancer returning in the same breast is about 5 percent to 10 percent. After a mastectomy, the risk is around 5 percent.

Even with this difference, life expectancy is the same whether you choose a lumpectomy or mastectomy. A 20-year study in The New England Journal of Medicine found no difference in survival rates between women who chose one surgery over the other.

Some people choose a total mastectomy because they feel that removing all breast tissue gives extra protection against future cancer. However, scientists agree that lumpectomy and mastectomy are equally effective treatment options.

What Stage of Breast Cancer Requires a Mastectomy?

Mastectomy can be be used to treat several stages of breast cancer, including:

• Stage 0 — Noninvasive breast cancer, like ductal carcinoma in situ
• Stages 1 and 2 — Early-stage breast cancer (invasive)
• Stage 3 — Locally advanced breast cancer

Mastectomies are rarely used to treat stage 4 breast cancer. Once breast cancer cells have metastasized (spread) to other parts of the body, removing the breast won’t prevent cancer from developing and typically does not affect survival rates.

Some people at higher risk of breast cancer, due to family history, genetic mutation (variation), or other risk factors, may choose to have a mastectomy even before developing breast cancer. This is called a prophylactic (preventive) mastectomy.

Will You Need Additional Treatment?

Most people will need other types of breast cancer treatments after surgery. Sometimes, additional surgeries may be needed. For example, if a lumpectomy does not remove all of the cancer, the surgeon may need to remove more tissue or perform a mastectomy after the lumpectomy. Today, thanks to advances in surgical techniques, only around 20 percent of people need additional surgery after a lumpectomy.

If you choose reconstruction after breast cancer surgery, you may need multiple surgeries, particularly after a mastectomy. For instance, breast implants may need to be replaced after about 10 years, which could require additional surgeries later.

Radiation therapy is often needed after a lumpectomy. If any cancer cells are left behind after surgery, radiation treatments can help kill them. Radiation therapy usually involves going to the clinic five days a week for four to six weeks. Some people see this as a drawback of choosing lumpectomy.

Other treatments, like chemotherapy or hormone therapy, may also be recommended after either type of surgery. Your doctor will know more about your cancer after surgery, so your full treatment plan may not be confirmed until then.

Can You Go Home After Surgery?

Recovery time is one of the key differences between a lumpectomy and a mastectomy. A lumpectomy is usually an outpatient procedure. Most people go home the same day. Lumpectomies usually take less than an hour.

Mastectomies, however, are longer procedures. If your surgeon is also removing lymph nodes or performing breast reconstruction, the surgery can take up to three hours. Some people go home the same day, but if you have other health issues or need a more extensive procedure, you may need to stay at the hospital overnight or even for several days after your mastectomy.

What Is the Recovery Process?

Lumpectomies are less invasive procedures with shorter recovery times. Most people can resume their daily activities within 5 to 10 days.

Recovery after a mastectomy may take up to four weeks. If you undergo breast reconstruction at the same time, healing can take 8 weeks or longer.

After either surgery, some pain is expected. A 2021 study found that people who had a mastectomy had less long-term pain and fewer side effects after surgery than those who had a lumpectomy. However, people who had a mastectomy were often less happy with how they looked afterward. People who had a lumpectomy were more likely to report long-term pain than those who had a mastectomy.

What Are the Risks?

Both surgeries have risks. A mastectomy is more likely to cause ongoing problems such as scarring, pain, and numbness. After a mastectomy, you won’t be able to produce milk.

Lumpectomy often has fewer surgery-related side effects, and you may still be able to produce milk. Lumpectomy is usually followed by radiation therapy, which can bring its own challenges. Radiation therapy to the breast may cause some side effects, including:

• Skin changes (such as dryness, discoloration, or itching)
• Breast swelling or tenderness
• Hair loss (rare)
• Fatigue

Having a mastectomy may help you avoid radiation and its side effects. But sometimes, radiation is still needed, especially if the tumor is large or has spread to other areas. Talk with your doctor to find out whether radiation therapy will be part of your treatment.

Lymphedema (swelling in the arm, breast, chest, or abdomen) can be an uncomfortable side effect of a lumpectomy or mastectomy. The more lymph nodes are removed, the higher the risk of developing lymphedema.

How Will Your Breasts Look After a Lumpectomy or Mastectomy?

Everyone has different feelings about how their breasts look after cancer surgery. Some people want their breasts to look and feel as natural as possible, while others may feel comfortable with changes. If you’re unhappy with how your breasts look after surgery, it can affect your self-esteem or mental health.

A lumpectomy usually lets you keep most of your natural breast tissue and shape. Lumpectomies tend not to affect breast size, so your breasts probably won’t change much in terms of size. However, radiation therapy after a lumpectomy can lead to changes in the color or texture of your skin.

A mastectomy, on the other hand, will significantly change the appearance and size of your breast. Your chest will be flat on the side or sides where the surgery is performed, and the nipple is usually removed.

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Breast reconstruction surgery helps your breasts look more even and makes clothes fit better. It may also make you feel more confident about your appearance. Like any surgery, though, it comes with a risk of side effects, including:

• Blood clots
• Infections
• Loss of sensation
• Necrosis (tissue death)
• Dimpled skin
• Weaker muscles
• Scarring

If you are interested in breast implants or other reconstruction methods, talk to a plastic surgeon or other specialist. They can explain all your reconstruction options.

Some people are comfortable with a different appearance and choose not to have breast reconstruction to avoid these risks. Instead, they may use breast prosthetics or forms under clothing to create a more even look.

What Other Factors Should You Consider?

It’s essential to consider how each surgical option may affect you in the long run.

Because a mastectomy tends to change your breast’s appearance more than a lumpectomy, it may affect how you feel about your body or sexuality. Some people also report lower well-being in the long term after a mastectomy.

Consider how you may feel after treatment is complete. With a lumpectomy, you keep most of your original breast tissue. This can cause worry about cancer coming back. A mastectomy might offer more peace of mind, though recurrence is still possible.

Both lumpectomies and mastectomies are considered equally effective treatments.

Talk With Others Who Understand

On MyBCTeam, people share their experiences with breast cancer, get advice, and find support from others who understand.

Have you undergone breast cancer surgery? Did you have a lumpectomy or mastectomy? Why did you choose one over the other? Let others know in the comments below.