Breast-Conserving Surgery vs. Mastectomy

Deciding between breast-conserving surgery vs. mastectomy is an important decision after a breast cancer diagnosis.
While the world may feel like it has stopped turning after you receive a breast cancer diagnosis, the decisions you need to make won’t go away. It is usually best to tackle these choices head-on and take control of your treatment. Depending on the type and stage of your diagnosis, you may need to consider between breast-conserving surgery vs. mastectomy. This is the first of many important decisions you will make and can also affect your reconstruction options. Even though nothing will make this process easy, having the best information can help you feel more confident about your decisions and restore some sense of control.

What Is Breast Conserving Surgery?

When it comes to surgical options for treating breast cancer, the two main categories are breast-conserving surgery vs. mastectomy. To make an informed decision, you need to know the basics of each, how they compare in key areas like surgical candidates, and the pros and cons of each. We’ve included these details in the tables below for easy reference.

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

What Is a Mastectomy?

If breast-conserving surgery aims to leave as much of the breast tissue as possible, mastectomy is the opposite. There are different degrees of mastectomy procedures, but they all involve the complete removal of breast tissue to eliminate or prevent breast cancer.
Mastectomy

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

Breast-Conserving Surgery vs. Mastectomy

Knowing the basics of each procedure can help you decide if you are a better candidate for one surgery or another.

Breast-Conserving Surgery

Mastectomy

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

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

Choosing a Plastic Surgeon-Led Multidisciplinary Team When Considering Prophylactic Mastectomy

If you have a genetic predisposition to breast cancer, such as BRCA, and are considering surgical options, your first instinct might be to discuss all treatment planning options with an breast surgical oncologist first, but having those discussions with a plastic surgeon can help you plan your treatment with the final outcomes in mind, giving you better aesthetic results and a more satisfying life after cancer. The decision for breast-conserving surgery vs. mastectomy should be made in consultation with a multidisciplinary team, including breast surgeons, oncologists, and plastic surgeons before any surgery takes place. The team of experts will consider all the factors involved in your treatment, including tumor size, location, type, patient preferences, and post-surgery goals. If you are considering breast-conserving surgery, then a plastic surgeon trained in oncoplastic surgical techniques can step in immediately after the tumor is removed to use breast reduction techniques that will reshape the breast into its new form.

Are You Deciding Between Breast-Conserving Surgery vs. Plastic Surgery?

The experts at Harris Plastic Surgery are ready to help you evaluate all the options so you can make an informed decision about your treatment process. We believe all patients deserve to have the complete picture of what their breast cancer surgery and possible reconstruction will entail so they can feel confident in their choices and empowered for their future.

Bringing Patient Advocacy to Breast Reduction and Reconstruction

Contact us online or by phone/text message if you have questions or are ready to schedule your consultation.

Stephen U. Harris, MD FACS

Dr. Stephen U. Harris is a board-certified cosmetic surgeon and recognized expert in breast reduction and reconstruction surgeries, having performed thousands in his career. When it comes to patient care, his philosophy is that every surgery should improve his patient’s overall quality of life, not just their appearance. Dr. Harris stays up-to-date on all the latest advancements in breast augmentation, reconstruction, and reduction and is a recognized innovator in the field. In fact, he was the first surgeon at Good Samaritan Hospital to offer primary prepectoral implant breast reconstruction, as well as secondary prepectoral revision surgery.

Dr. Harris also serves as Chief of Plastic Surgery at Good Samaritan Hospital in West Islip, New York and is an active staff surgeon (and former Chief of Plastic Surgery) at South Shore University Hospital in Bay Shore, New York.

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