Most people diagnosed with breast cancer will undergo at least one procedure to remove some or all of the breast tissue. Two common surgical options for treating breast cancer are lumpectomy and mastectomy. Both have risks and benefits. The best procedure for you will depend on your specific breast cancer diagnosis, personal risk factors for recurrence (cancer returning), individual preferences, lifestyle, and other considerations.

This article will share some similarities and differences between mastectomies and lumpectomies to help you evaluate which may be the right option for you. Ultimately, you should work with your oncologist or other health care provider when making this decision. Be sure you understand their recommendations and all the options before moving forward, and consider getting a second opinion if you’re still unsure.

Is It Better To Have a Mastectomy or Lumpectomy?

Your oncology care team will work with you to determine which type of surgery is best suited to your needs. Reviewing this section before your next appointment can help you become familiar with important terms and the surgical options your doctor may discuss.

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

A lumpectomy, also known as breast-conserving surgery, involves removing the tumor and a small amount of surrounding healthy tissue. During a lumpectomy, a breast surgeon may also remove some lymph nodes to check whether cancer cells are spreading. Lymph nodes are small, bean-shaped structures that filter lymph fluid and play a key role in the body’s immune response.

A mastectomy is the removal of all of the breast tissue. People with various stages of breast cancer may have the option of a mastectomy. Types of mastectomies include:

• Total (or simple) mastectomy — Removal of one breast
• Double or bilateral mastectomy — Removal of both breasts
• Skin-sparing mastectomy — Preserves as much skin as possible, often to support later breast reconstruction.
• Nipple-sparing mastectomy — Leaves the nipple intact while removing other breast tissue
• Modified radical mastectomy — Removes the entire breast and lymph nodes under the arm

• Radical mastectomy — A rarely performed procedure that removes the breast tissue, lymph nodes, and some muscles from the chest wall

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

• Size and location of the tumor
• Size of the breast
• Number of tumors
• Status of the lymph nodes
• Tumor cell type
• Your overall health

However, your personal preferences matter, too.

Does a Lumpectomy Remove All Cancer?

Research has shown that breast cancer recurrence is slightly more likely after a lumpectomy compared to a mastectomy. If you undergo a lumpectomy, the risk of cancer returning in the same breast is about 5 percent to 10 percent when followed by radiation as needed. In comparison, the risk after a mastectomy is around 5 percent.

However, life expectancy remains the same whether you choose a lumpectomy or mastectomy, regardless of the possibility of cancer recurrence. A 20-year study, published in The New England Journal of Medicine, found no difference in survival rates between women who initially chose one surgery over the other.

Some people prefer a total mastectomy, feeling that removing all breast tissue offers greater protection against future cancer. However, this isn’t always the case. Health experts generally agree that both lumpectomy and mastectomy are equally effective treatment options.

What Stage of Breast Cancer Requires a Mastectomy?

A mastectomy can be an option for treating several stages of breast cancer, including:

• Stage 0 — Ductal carcinoma in situ and other noninvasive breast cancer
• 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 elsewhere and typically does not affect survival rates.

People with a higher risk of breast cancer, due to a family history, genetic mutation (variation), or other risk factors, sometimes choose to have a mastectomy before developing breast cancer. This is called a prophylactic (preventive) mastectomy.

Will You Need Additional Treatment?

You’ll likely need other types of breast cancer treatments after surgery. Additional surgeries may be necessary after your first procedure. If you get a lumpectomy and your doctor is unable to remove all of the cancer, they may need to go back and cut out additional tissue or perform a mastectomy after the lumpectomy. Thanks to advances in surgical guidelines and techniques, only around 20 percent of people now need additional surgery after a lumpectomy.

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

Radiation therapy is often required 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 per week for four to six weeks. Some people may see this as a potential drawback of lumpectomy.

Additional treatments such as chemotherapy or hormone therapy may also be recommended after either type of surgery. Your doctor will understand 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, meaning you can often leave the hospital the same day and recover at home. Lumpectomies typically 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 may be able to go home the same day, but if you have other health considerations or need a more extensive procedure, a mastectomy may require an overnight or multi-day hospital stay.

What Is the Recovery Process?

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

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

After either surgery, some pain is expected. Many people can manage discomfort from a lumpectomy with over-the-counter pain medications or without any medications. For a mastectomy, your doctor may prescribe stronger pain relief.

Unlike mastectomies, lumpectomies generally don’t require a surgical drain (a tube that allows fluid to drain from the breast area). After either procedure, your care team will guide you on wound or drain care, as well as arm exercises to aid recovery. They may also schedule follow-up appointments to monitor your healing.

What Are the Risks?

A mastectomy is more likely to lead to ongoing problems like scarring, pain, and numbness. After a mastectomy, milk production won’t be possible, but with a lumpectomy, you may still be able to produce milk.

Although lumpectomy often has fewer surgery-related side effects, it is generally paired with radiation therapy, which can introduce other challenges. Radiation therapy to the breast may cause some common side effects, such as:

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

Undergoing a mastectomy may help you avoid radiation-related side effects, though some cases still require radiation, especially if the tumor is large or has spread. Talk with your doctor to determine whether radiation therapy may be necessary.

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

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What Does the Breast Look Like After a Lumpectomy or Mastectomy?

Many people want their breasts to look and feel as close to their natural appearance as possible after surgery, while others may be comfortable with an altered look. If you’re dissatisfied with how your breasts look after surgery, you may experience lower self-esteem or mental health challenges.

A lumpectomy generally allows you to retain some of your natural breast tissue and shape. Lumpectomies also tend not to affect breast size, so your breasts will likely appear similar in size. However, radiation therapy following a lumpectomy may lead to changes in the appearance of your skin.

A mastectomy, on the other hand, will significantly alter the appearance and size of your breast. Your chest will be flat on one side, and the nipple is typically removed.

Breast reconstruction surgery helps your breasts look more balanced in size and allows your clothes to fit better. It may also make you feel more confident about your appearance. However, as with any surgery, you could experience side effects including:

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

If you are interested in getting breast implants, talk to a plastic surgeon or other specialist to ensure you understand all your reconstruction options.

Some people are comfortable with a different appearance and choose not to have breast reconstruction to avoid these risks. Those who opt out of reconstruction may use breast prosthetics or forms under clothing to create an even look.

What Other Factors Should You Consider?

It’s essential to think carefully about how each surgical option might affect you over time.

Because a mastectomy tends to change your breast’s appearance more, it may be likely to affect your self-image or feelings about sexuality. Some people also report a lower sense of well-being in the long term after a mastectomy.

Consider how you may feel after treatment is complete. With a lumpectomy, keeping most of your original breast tissue may lead to anxiety about cancer recurrence. A mastectomy might offer more peace of mind, though recurrence is still possible. Remember that both lumpectomies and mastectomies are generally considered equally effective treatments.

Talk With Others Who Understand

MyBCTeam is the social network for people with breast cancer and their loved ones. On MyBCTeam, more than 74,000 members come together to ask questions, give advice, and share their stories with others who understand life with breast cancer.

Have you undergone breast cancer surgery? Did you have a lumpectomy or mastectomy? Why did you choose one over the other? Share your experiences in the comments below, or start a conversation by posting on your Activities page.