How to Decide Between Mastectomy or Lumpectomy for Cancer Treatment

Weighing Your Options, Priorities, and Emotions

If you have found out you have breast cancer, you may be trying to choose between a mastectomy or a lumpectomy. Many women with early-stage breast cancer are given the option to choose which surgery to have for breast cancer. But it’s not an easy decision because it changes your life and your body forever. It is an intensely personal decision that only you can decide. Getting a handle on your feelings and priorities can help you make the decision.

Here are some good questions to consider when choosing between a mastectomy or lumpectomy. 

How Would You Feel About Losing Your Breast?

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For many women, regardless of breast size, breasts are an intrinsic part of their self-image and sexual identity. Having both breasts may be very important to your present intimate life or your future relationships.

For other women, losing a breast and then having breast reconstruction or wearing a breast prosthesis is a good solution.​

How Might a Mastectomy Affect Your Sex Life?

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For some women and their partners, the loss of a breast may not matter when your health concerns take center stage. But for other couples, losing one or both breasts may be a deal-breaker.

Have a frank private discussion about this, before you decide on surgery.

Are You Willing to Have Radiation Treatments If You Opt for a Lumpectomy?

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You may need to set aside six or more weeks for breast radiation after a lumpectomy. This will involve travel time, scheduling appointments and taking extra good care of your skin.

You will need time off from a job, have childcare arranged, and find dependable transportation.

Do You Have Local Access to a Radiation Clinic?

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If not, would you have to travel more than a reasonable distance for treatments?

Some women are willing to stay in another town during their six weeks of radiation and some are unwilling or not able to afford that. How would you handle it?

Have You Had Previous Chest Radiation Treatments?

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If you have, you may have already had the maximum lifetime dose of radiation for your chest.

Discuss this with your doctor to see if you would be a candidate for more radiation treatments. 

Are You Willing to Have More Surgery After a Mastectomy for Reconstruction?

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Most reconstruction methods will require more than one extra trip to the hospital to complete the new breast.

Check with your health insurance provider to see what procedures they will cover for you.

How High Is Your Anxiety About Having a Recurrence of Breast Cancer?

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You may be able to live with any fear of cancer recurrences if you opt for a lumpectomy and radiation.

However, if the thought of a recurrence frightens you, a mastectomy may help lower your fears.

Do You Have a Family History of Breast or Ovarian Cancer?

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If so, your risk of recurrence may be high and this would influence your decision. Consider having a genetic test, to see if you have a BRCA1 or BRCA2 gene mutation or one of the non-BRCA mutations that raise breast cancer risk.

It's very helpful to talk with a genetic counselor as well. The mutations that can now be tested account for less than half of hereditary breast cancers, and it's likely that more will be discovered in the future. A genetic counselor can look at cancer in your family (it's important to consider other types of cancer and not just breast cancer), and can help you determine if it's likely you have a genetic predisposition or not.

Some gene mutations carry a high risk of a second breast cancer developing, and may prompt you to lean towards a mastectomy instead of lumpectomy.

Are You Feeling Aggressive Toward Your Tumor?

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If so, you may want to get rid of all possible cancer as soon as possible and deal with other issues later.

Depending on the size of your tumor relative to the size of your breast, a mastectomy or a lumpectomy may work for you.

What Cosmetic Results Would You Be Content With After Breast Cancer Surgery?

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For some women, a lumpectomy is minimally invasive and only leaves a dimple in the breast. But for others, a lumpectomy may cause a change in size or a distortion of breast shape.

You can use a partial prosthesis to compensate for the difference or you may choose to go natural. You might also choose to have your other breast reshaped to restore your symmetry.

If you choose to have a mastectomy, you may also consider how to balance your appearance after surgery. Think about what options would appeal to you.

Take Time to Make Your Decision

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Research has shown that if you have these four things, early-stage breast cancer, only one tumor, a tumor less than four centimeters and clear surgical margins, then a lumpectomy and radiation will give you the same odds of survival as a mastectomy.

However, this is your breast, your body image, your life, and your feelings. If you are offered a choice between lumpectomy and mastectomy, make sure you take time to sort out your priorities and your emotions.

Discuss your decision with your family and your doctor. Make a choice that you will feel confident and comfortable with. 

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Article Sources

  • Hugh Scarth, Jacques Cantin, Mark Levine, for the Steering Committee on Clinical Practice Guidelines for the Care and Treatment of Breast Cancer. Clinical Practice Guidelines for the Care and Treatment of Breast Cancer: 3. Mastectomy or Lumpectomy? The Choice of Operation for Clinical Stages I and II Breast Cancer. Canadian Medical Association Journal, 2002 update. 

  • Surgery for Breast Cancer. American Cancer Society.