A lumpectomy removes the tumor and a small portion of the breast. A mastectomy removes all of the breast tissue, and possibly the skin, nipple, and areola, on one or both breasts.
This article reviews each type of surgery, their use cases, their side effects, their advantages and disadvantages, and which of them may be right for you.
What to Know About a Lumpectomy
A lumpectomy is the surgical removal of a small mass in the breast. It’s also called breast-conserving surgery or a partial mastectomy.
How Does It Work?
Lumpectomies are a good option for those with single, early-stage tumors contained in a small area. They are not recommended for those who have later-stage cancers.
Depending on the type of cancer, you may need additional (adjuvant) treatments such as radiation, chemotherapy, or hormone therapy.
Most people who have a lumpectomy undergo radiation for six to eight weeks. This helps kill cancer cells that weren’t removed. Without radiation, there is a 39% chance of recurrence (cancer returning) compared to 14% with radiation. Radiation can affect the timing and options for reconstruction.
Lumpectomy Procedure
A surgical oncologist typically performs a lumpectomy by taking the following steps:
Anesthesia: Local (numbing) medicine or general anesthesia (sedation) is administered. Incision: A small incision (cut) is made to remove the tumor and a small margin (healthy tissue around the cancer). The surgeon may also take a lymph node sample or drain fluid. Pathology: A pathologist examines the tumor to confirm the type of cancer and if the margins are clear. This may take several days. Closure: The incision is closed with stitches, adhesive strips, or surgical glue and a sterile bandage.
Most people go home on the day of surgery. You may have a surgical drain that your provider needs to remove in their office within the first couple of weeks. Though this is a less invasive surgery, it can take a month or two to heal fully.
Side Effects
The side effects of a lumpectomy include:
Possible change in breast shape or appearanceSmall scar Possible indentation of breastPain or tendernessBruising and swelling
It also includes the risk of the following complications:
Hematoma (blood buildup under the skin around the incision) Seroma (fluid buildup under the skin around the incision) Infection and improper wound healing Lymphedema (fluid buildup causing swelling in the arm) Shoulder stiffness Loss of sensation in part of the breast
Prices and Where to Get It
A lumpectomy is performed in a hospital or surgery center. The average cost is about $38,000 before insurance. Contact your health insurance provider beforehand to ask about deductibles, out-of-pocket expenses, and the authorization process.
What to Know About a Mastectomy
A mastectomy removes all breast tissue on one (single) or both (double) breasts. Some, but not all, require skin, nipple, areola, lymph nodes, or muscle tissue removal.
How Does It Work?
There are different types of mastectomies, including:
Breast cancer on one side (and want to prevent it on the other) A genetic mutation that increases the risk of breast cancer, such as BRCA and non-BRCA mutations A strong family history of breast cancer
Total (simple): All breast tissue, skin, nipple, and areola are removed. Modified radical: Total mastectomy with the addition of lymph node removal. Radical: Total mastectomy with lymph node and chest muscle removal. Skin sparing: Removal of breast tissue, nipple, and areola, but not the skin. Skin and nipple-sparing: Removal of breast tissue but not the skin, nipple, or areola. This is typically reserved for tumors with no nipple involvement and at least 2 centimeters away from the skin, nipple, and areola.
Your surgical oncologist will base their recommendation on the cancer type, stage, grade, location, and the ability to leave clean margins.
Mastectomy Procedure
A surgical oncologist performs a mastectomy in the hospital as follows:
Anesthesia: General anesthesia (sedation that puts you to sleep) is administered. Incision: An incision (cut) is made to remove the tumor, tissue, margins, skin, lymph nodes, or muscle based on the mastectomy type. Pathology: A lab pathologist examines the tumor and lymph node sample to check for the type of cancer, clear margins, and lymph node involvement. Closure: The incision is closed with stitches, adhesive strips, or surgical glue. The plastic surgeon will take the first steps toward reconstruction (if applicable). Surgical drains: Surgical drains may be placed in your chest to prevent fluid buildup. They remove these in their office within a couple of weeks.
A mastectomy usually takes two to three hours (longer with lymph node removal or immediate reconstruction).
Side Effects
The side effects of a mastectomy include:
Chest sorenessLoss of sensation in the breast and nippleInability to breastfeedSwelling (short term and temporary)Scarring
Possible complications of a mastectomy include:
HematomaSeromaLymphedemaUndesirable resultsUneven breastsInfection or improper wound healingPulling feeling under your armDepression, changes in self-imageLoss of sexual identity
Prices and Where to Get It
A mastectomy averages $25,231 without reconstruction and $66,620 with reconstruction. U.S. federal law requires insurance to cover the cost of a mastectomy and reconstruction. Deductibles and maximum out-of-pocket expenses still apply. Medicare covers breast reconstruction, but Medicaid coverage varies from state to state.
Ask your insurance provider about final costs, pre-certification, and authorization. Some require a second opinion before agreeing to pay for surgery. Ensure the price includes the facility, diagnostic tests, surgeon, and anesthesia provider.
Which Treatment Is Best for You?
Surgical oncologists often consult with a team of specialists from imaging, radiation, general oncology, and plastic surgery before providing a recommendation. They base their recommendations on the following:
Age and overall health Grade, stage, type, size, and location of the cancer Breast size Risk of recurrence Lymph node involvement Future treatment plan (such as radiation) Personal preferences
Reasons you might choose a lumpectomy include:
Small (less than 5 centimeters), early-stage cancer confined to one areaPreservation of some breast tissue for appearance, sensation, and ability to breastfeedDecreased recovery time and cost
Reasons you might choose a mastectomy include:
Large (more than 5 centimeters or large in proportion to the breast), late-stage cancer Two areas of cancer, far apart Inflammatory breast cancer A lumpectomy won’t remove the entire tumor with good margins Inability to receive radiation because of pregnancy, previous radiation, or medical history Remaining cancer after a lumpectomy A genetic mutation or family history of breast cancer Personal preference
Can a Lumpectomy and a Mastectomy Happen Together?
A lumpectomy and mastectomy do not usually happen together. However, a mastectomy may be required after a lumpectomy if the surgeon couldn’t get clear margins or if recurrence or second cancer occurs and a lumpectomy with radiation isn’t an option.
Coping With the Side Effects
Not everyone experiences the same side effects, but the following address those commonly associated with breast surgery.
Pain Management
Pain medications can initially manage chest soreness. It may also help to stay upright and sleep in a recliner or bed lounger.
Mastectomy pillows protect your incisions and keep pressure off the chest. These can work for lumpectomies as well.
Breast Reconstruction
Though lower self-esteem may not be an issue for everyone, breast reconstruction can help reduce the risk for some. Learn about the different options before researching plastic surgeons because they usually specialize in different types.
When reconstruction is not an option, a prosthesis and special mastectomy bras are available.
Support System
Emotional support can come from friends, family, support groups, and mental health professionals. It can be beneficial to take a loved one to appointments; they often catch information you may have missed.
Breast cancer and surgery can be difficult in a sexual relationship even long after surgery. Some reasons for this adjustment include:
Fatigue or treatment side effectsPoor self-imageDecreased libido Lack of breast sensationVaginal discomfort (due to some treatments)Depression
When possible, include your partner in as many decisions as possible to keep them informed and help them feel included.
Loved ones often focus on getting you through the surgery and survival. Their grief can be delayed. They and you may not always process all of this until it happens, so be patient with them and yourself.
Summary
A lumpectomy and mastectomy are surgeries for treating breast cancer. A lumpectomy is more conservative because it only removes the tumor and a small portion of the breast. It’s reserved for small, contained, early-stage cancers.
A mastectomy removes all of the breast tissue, and possibly the skin, nipple, and areola on one or both breasts. It’s for treating later-stage cancers or when a lumpectomy is not a good option.
Each has side effects that can be managed in various ways. Some people need additional treatments, such as radiation, chemotherapy, or hormone therapy. Most people who have a lumpectomy will get radiation for six to eight weeks.
A Word From Verywell
Choosing between a lumpectomy and a mastectomy can be a hard decision. Contemplating losing all or some of your breasts can be a difficult emotional struggle and a type of grief. Gather information and a second opinion (or two), so you can weigh your options and make the best choice for you and your loved ones.
