Breast cancer

What type of surgery should you have?

Which type of surgery should you have?

The two surgical options for breast cancer are breast conserving surgery (otherwise known as lumpectomy, partial mastectomy, or wide local excision) followed by radiotherapy, or a mastectomy (which is less likely to require radiotherapy). Sometimes only one type of surgery is appropriate for an individual patient but some women are able to choose between the two. Your surgeon will advise you on which type of surgery will be best for you, or help you make a decision if both options are suitable.

Many patients believe that they will have a better chance of survival if they have the whole breast removed (with a mastectomy), even though their tumour is small and suitable for breast conservation. This is not true. Large studies have shown that the chances of surviving early breast cancer are similar, whether you have breast-conserving surgery with radiotherapy, or a mastectomy.

Although your choice of surgery won't impact your life expectancy after breast cancer, you may wish to weigh up which procedure is most suited to you if both are available options.

For example, some women opt for mastectomy because they don't wish to undergo a course of radiation therapy or perhaps feel unable to cope with the anxiety of ongoing surveillance of the affected breast.

On the other hand, many women choose breast conserving surgery and radiotherapy because it's important to them that their breast is preserved, and because the recovery time for this surgery is usually shorter.

The need for other treatments such as chemotherapy, hormone blocking therapy or Herceptin is not determined by the type of surgery performed but by the properties of the cancer.

What about the other breast?

Some women, on hearing a diagnosis of breast cancer, ask for both breasts to be removed, believing that this will increase their chances of long term survival. However, research has shown that removing the unaffected breast has no survival benefit, as it doesn't change the risk of spread from the already-diagnosed cancer.

With the exception of women with genetic mutations such as BRCA1 & 2, the risk of getting cancer in the other breast is generally much lower than people believe. However, some women may have valid reasons for wanting to have bilateral mastectomy. For example, large breasted women might find it intolerable to be left so imbalanced.

These issues are complex and should be thoroughly discussed with your surgeon and breastcare nurse so that you are confident that you are making an informed decision.

If you'd like to talk your decision over with our experienced breast nurses, call 0800 BC NURSE.

Breast conserving surgery vs. mastectomy

It may help to think about the possible advantages and disadvantages of breast conserving surgery versus mastectomy before making treatment decisions. This surgery decision chart outlines the main issues.

Breast conserving surgery Mastectomy
Amount of breast removed
The tumour and some healthy surrounding tissue is removed.
Entire breast removed but you may be able to have breast reconstruction.
Time in hospital
Usually overnight stay in hospital (or sometimes day-stay) and shorter recovery time.
1 – 2 nights in hospital and longer recovery time.
Breast drains
Usually no breast drains are placed.
Drain is placed under the chest wound, usually for a short period of time.
Axillary drains
Drain in underarm if axillary node dissection is performed. You may go home with this in place.
Drain in underarm if axillary node dissection is performed. You may go home with this in place.
Radiation therapy
Breast radiation therapy is required to reduce the risk of breast cancer recurrence in the affected breast.
Less likely to be required but chest wall radiation therapy may be necessary if the tumour has high risk features.
Further surgeries
More than one operation is sometimes needed to completely remove the tumour.
Further surgery not required unless breast reconstruction is desired.
Risk of cancer recurring
Slightly higher risk of cancer recurring in the remaining breast tissue.
Almost all breast tissue has been removed. Small risk of cancer recurring in the scar tissue.