Breast-Conserving Surgery or Mastectomy? How Do We Choose?

For many women diagnosed with breast cancer, the hardest decision is the type of operation. The good news is that in early stage disease, in suitable patients, breast-conserving surgery and mastectomy give similar long-term survival. So the decision should be made by considering the features of the tumour, the structure of the breast and your own preferences together.

Breast-conserving surgery (lumpectomy)

The tumour is removed with a margin of healthy tissue; the breast is largely preserved. A clear surgical margin is essential. After surgery, radiotherapy to the remaining breast tissue is standard. With oncoplastic techniques the shape of the breast can be preserved even when removing larger tumours.

Mastectomy

All breast tissue is removed. It is often recommended when:

• There is more than one focus in the breast, far from each other
• The tumour is very large relative to the breast and does not shrink enough with pre-operative treatment
• Radiotherapy cannot be given (for example, previous radiotherapy to the same area)
• There is high genetic risk (e.g. a BRCA change) and the patient prefers risk-reducing surgery
• It is the patient’s informed choice

Reconstruction: in the same operation, or later?

After mastectomy the breast can be rebuilt immediately (in the same operation) or later. Options include implants/expanders and reconstruction with your own tissue. Skin- and nipple-sparing mastectomy markedly improves the aesthetic result in suitable patients. The radiotherapy plan affects the method and timing of reconstruction, so joint planning before surgery is essential.

Ask yourself

• How important is keeping my breast to me?
• Am I suited to the radiotherapy schedule (daily sessions over weeks)?
• Do I want reconstruction, and when?
• What will follow-up be like in the future?

The right decision is made with the specialist team, using data specific to you. Getting a second opinion is a natural part of this process.