Breast-Conserving Surgery vs. Mastectomy

Breast-conserving surgery is also called a lumpectomy or partial mastectomy.

The goal of breast-conserving surgery is exactly what it sounds like: the complete removal of cancerous tissue while preserving as much of the healthy breast tissue as possible.

Process

• Tumor Removal The breast surgeon removes the tumor along with a margin of surrounding healthy tissue to ensure complete elimination of cancerous cells.

• Preservation of Breast Tissue Breast-conserving surgery aims to preserve as much healthy breast tissue as possible.

• Lymph Node Evaluation The breast surgeon may perform a sentinel lymph node biopsy or axillary lymph node dissection to evaluate whether cancer has spread to nearby lymph nodes (metastasis).

• Radiation Therapy After surgery, many patients undergo whole-breast or partial-breast radiation therapy to reduce the risk of cancer recurrence in the treated breast.

Reconstruction Options

• Depending on the size and area of tumor removal, some women may choose to undergo breast reconstruction to restore breast shape and symmetry. 

• Consulting with a plastic surgeon before breast-conserving surgery can give you the best reconstruction outcomes.

• Reconstruction can be performed using oncoplastic techniques (tissue rearrangement to reshape the breast so that there is no contour deformity after lumpectomy), or rarely, volume replacement with local tissue transfer from the lateral chest wall or back to fill the larger lumpectomy defect.

Mastectomy is a surgical procedure that completely removes the breast tissue as treatment for breast cancer or as a preventative measure for individuals at high risk of developing breast cancer. Forms of mastectomy include:

• Aesthetic flat closure, which removes all breast tissue, overlying skin, nipples, and areolas. This procedure removes any skin excess after the breast is removed and is typically done when no reconstruction is chosen.

• Skin-sparing, which removes all breast tissue, nipples, and areolas, but the overlying skin is preserved for improved aesthetic outcomes.

• Nipple-sparing, which removes all breast tissue, but skin, nipples, and areolas are left in place to improve aesthetic outcomes. This procedure is better for women at low risk of recurrence or undergoing a prophylactic mastectomy.

• Contralateral, which is a mastectomy in which one breast has been removed due to cancer diagnosis, and the other is also removed – either due to a high risk of recurrence or for more symmetrical reconstruction options.

Process

• Removal of all breast tissue, including fat, glandular tissues, ducts, blood vessels, and in some cases, the overlying skin, nipple, and areola.

• Mastectomy is often part of a comprehensive breast cancer treatment plan, which may include additional therapies like radiation, chemotherapy, hormone therapy, and targeted therapy, depending on the cancer’s specific characteristics.

Reconstruction Options

• Consulting with a plastic surgeon (especially a plastic surgeon-first consult for prophylactic mastectomy) can give you the best aesthetic outcomes for reconstruction.

• You can either have an immediate reconstruction or wait for tissue healing and have a delayed reconstruction.

• Reconstruction of the breast mound can be done with implants or natural tissue transfer.

• To finalize the process, you can also have areola and nipple reconstructions. 

Breast-Conserving Surgery

Mastectomy

Good Candidates

• Early-stage breast cancer

• Smaller tumor

• No evidence of cancer spread (metastasis)

• Clear surgical margins

• Tumor location allows adequate surgical removal while preserving aesthetics

• Larger, more advanced tumors

• BRCA1/2 positive

  • Or positive for other genetic factors that increase breast cancer risk

• High risk of recurrence

  • Family history

  • Previous diagnosis

Pros

• As effective as mastectomy in treating early-stage breast cancer when combined with shole-breast radiation

  • Similar long-term survival rates 

• Oncoplastic surgery

  • Leaves breasts intact but reshaped and often reduced and lifted

• Improved body image and self-esteem

• Shorter recovery time

• Potentially less pain + quicker return to normal activities

• Less extensive surgery = reduced surgical risks

• Less invasive

• Preserves sensation

• May avoid breast reconstruction 

• Complete breast removal with larger margins around any cancerous area

• Risk reduction for prophylactic mastectomy

• Reduced risk of recurrence:

  • Eliminates residual breast tissue

• May eliminate the need for radiation therapy

• Psychological benefits

  • Emotional & psychological relief

  • Provides a sense of control 

  • Reduces anxiety 

• Option for breast reconstruction

• Reduces follow-up monitoring

  • No breast tissue to monitor for recurrence

Cons

• Required follow-up care 

  • Mammograms 

  • Ultrasounds

  • Monitor for signs of recurrence

• May deform the breast

• Risk of local recurrence

• Need for radiation therapy

• Potential changes in breast shape

• Possible asymmetry

• Potential for additional surgeries

  • Re-excision if initial surgical margins are unclear 

  • Can impact overall cosmetic outcome

• Psychological impact

  • Stress and anxiety of possible recurrence

• Loss of breast tissue

  • Emotional distress 

• Impact on self-esteem and body image

• Psychological effects

  • Potential feelings of grief or loss

• Longer recovery with period of reduced work and daily activity

• Limited breast sensation which can be restored with re-sensation procedures

• Potential for lymphedema if lymph nodes are removed

  • Swelling in the arm or hand from impaired lymphatic drainage