What 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 breast radiotherapy, or a mastectomy (which is less likely to require radiotherapy). Sometimes only one type of surgery is appropriate for an individual patient, usually due to tumour size, 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 when 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 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 and the risk of it recurring in the future.

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 an 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 and 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 breast care 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.

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.