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Lumpectomy vs Mastectomy

Breast-conserving surgery (lumpectomy) removes the cancer while preserving most of the breast; mastectomy removes the breast tissue.

For many people with early breast cancer both are accepted options. Suitability depends on the size and distribution of disease, the ability to achieve a clear margin, previous radiotherapy, inherited risk and personal preference — and is decided with the clinical team.

How the two approaches differ

 Breast-conserving surgery (lumpectomy)Mastectomy
What is removedThe cancer plus a margin, preserving most of the breastThe breast tissue; skin and nipple may sometimes be preserved
RadiotherapyUsually recommended afterwards to reduce local recurrenceMay still be recommended depending on tumour size, nodes and margins
Further surgeryPossible if a margin is positive on pathologyLess likely for margins; reconstruction may add stages
ReconstructionBreast largely preserved; oncoplastic reshaping may be usedOptional — implant or autologous reconstruction, or remaining flat
Main drivers of eligibilityTumour-to-breast size, single vs multiple lesions, margin, prior radiotherapyExtent of disease, multiple areas, margins unachievable, high inherited risk, preference

When breast-conserving surgery may be considered

  • The known disease can be removed with an acceptable margin while preserving a reasonable breast shape
  • Radiotherapy afterwards is medically suitable
  • The relationship between tumour and breast size allows a good cosmetic result

When mastectomy may be recommended

  • Disease involves a large area, or multiple areas cannot be removed in one operation
  • Clear margins cannot be achieved, or radiotherapy is not suitable
  • There is a high inherited risk of another breast cancer, or the patient chooses mastectomy after reviewing alternatives

Limitations

Common questions

Is one operation safer than the other?
For suitable patients with early breast cancer, breast-conserving surgery with radiotherapy and mastectomy are both established options. Which is appropriate depends on the individual case and is decided with the clinical team.
Does mastectomy avoid radiotherapy?
Not always. Post-mastectomy radiotherapy may still be recommended based on tumour size, lymph-node involvement and margins.
Can I still have reconstruction after lumpectomy?
Breast-conserving surgery preserves most of the breast; oncoplastic reshaping may be used. Reconstruction options are broader after mastectomy.

Related pages

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