Breast Conservation vs Mastectomy

These two operations remove the cancer from the breast.  For most early breast cancers there is no difference in survival between the two approaches.  Breast conserving surgery (or “lumpectomy”) involves removing the cancer from the breast through a small incision but leaving the rest of the breast tissue undisturbed.  In most cases it will be combined with radiotherapy to the remaining breast tissue.  It is the addition of radiation to the lumpectomy that makes it just as effective as a mastectomy.  There is usually no need for a drain after breast conservation surgery.  

Wire or imaged localised excisions are types of breast conserving surgery used when the cancer cannot be felt and has only been detected by mammogram or ultrasound.  The radiologists place a wire or other marker in the cancer so your surgeon can more easily find the correct piece of breast tissue to remove.  

Most breast cancers can be treated with breast conservation surgery. If this can't be done, your surgeon may recommend a mastectomy. Potential reasons for this include the relative size of the cancer, the presence of multiple cancers within the breast or the use of radiotherapy to treat a breast cancer on that side previously.

Mastectomy involves the removal all of the breast tissue so usually there is no need for radiotherapy to that side in early breast cancer.  If there is not going to be an immediate reconstruction then the usual operation is what is called a simple mastectomy.  In this operation the breast tissue including the nipple and areolus is removed with some of the surrounding skin so that at the end of the operation the chest on that side is flat with a simple straight scar across the chest.  Your surgeon will often leave a drain tube in the wound to help decrease swelling for a few days after the operation.

Nipple and skin sparing mastectomies are used when there is going to be an immediate reconstruction of the breast after mastectomy.  Keeping as much of the skin of the breast (ideally all of it) can give you the best long term cosmetic result.

Some ladies suitable for breast conservation surgery will choose to have a mastectomy rather than a lumpectomy, and this is a perfectly safe choice to make. We encourage all ladies choosing to have a mastectomy instead of a lumpectomy to spend time discussing with their surgeon the reasons for their choice.