Lumpectomy or mastectomy:
how to choose?

When facing a diagnosis of breast cancer, choosing between lumpectomy and mastectomy is one of the most important decisions to make with your surgical team. Both procedures offer equivalent overall survival — the right choice depends on your tumour profile, your anatomy, and your personal preferences.

For a full overview of surgical management, see our page on breast cancer surgery.

Understanding the two procedures

Lumpectomy: breast-conserving surgery

A lumpectomy removes only the tumour and a margin of healthy tissue, preserving most of the breast. The procedure takes between 30 minutes and 1h15 depending on tumour size and whether an oncoplastic technique is used. An intraoperative pathological analysis may verify clear margins.

• Breast conservation — natural shape preserved
• Fast recovery — return to activities in 1–2 weeks
• Radiotherapy required — 3–5 weeks in the vast majority of cases
• Lifelong surveillance — annual mammogram ± ultrasound ± MRI
• Risk of re-excision — 10–15% of cases if margins are involved

Mastectomy: complete removal of the breast gland

Mastectomy is always total — the entire breast gland is removed. What varies is the decision to reconstruct or not, and if so, how.

Option 1 — Flat closure (no reconstruction)

The breast gland is removed without volume reconstruction. Some patients deliberately choose this option for personal, medical or practical reasons. An external prosthesis can be worn if desired.

Option 2 — Immediate breast reconstruction (IBR)

Reconstruction is performed during the same procedure as the mastectomy. Two main strategies:

• NAC-preserving (nipple-areola complex) — possible when the tumour is far from the nipple. Inframammary or axillary incision.
• NAC-sacrificing — central oblique scar. Nipple reconstruction possible later.

Volume is restored by:

• Implant — definitive prosthesis or tissue expander (learn more)
• Fat grafting (lipofilling) — autologous fat injection (learn more)
• Autologous flaps — DIEP, latissimus dorsi (learn more)

Operating time: 2 to 5 hours depending on technique and reconstruction.

How to choose?

Factors favouring lumpectomy

• Single small tumour adapted to breast volume
• Favourable tumour-to-breast ratio for a good cosmetic result
• No contraindication to radiotherapy
• Clear margins achievable

Factors favouring mastectomy

• Large tumour compromising cosmetic outcome
• Multifocal or multicentric disease
• Extensive DCIS
• Contraindication to radiotherapy (e.g. previous thoracic irradiation)
• BRCA1/BRCA2 mutation — discussion of contralateral prophylactic mastectomy
• Local recurrence after prior lumpectomy and radiotherapy

Personal and psychological factors

Beyond medical criteria, your feelings matter. Some patients prefer to preserve their breast; others wish to minimise anxiety about recurrence. These preferences are legitimate and should be discussed at your consultation.

• Body image — importance placed on breast preservation
• Fear of recurrence — tolerance of residual risk
• Access to radiotherapy — geographical or professional constraints
• Reconstruction plans — desire, timing, feasibility

Special situations

• Young women (< 40) — systematic oncogenetic evaluation recommended
• Pregnancy — surgery possible, radiotherapy delayed until after delivery
• Inflammatory breast cancer — mastectomy after neoadjuvant chemotherapy; formal contraindication to immediate reconstruction
• Recurrence after lumpectomy — mastectomy indicated; re-irradiation is contraindicated
• BRCA1/BRCA2 mutations — bilateral prophylactic mastectomy to be discussed

Recovery after each procedure

After lumpectomy: return to activities in 1–2 weeks. After mastectomy: 3–6 weeks depending on technique and reconstruction. In both cases, you are accompanied at each post-operative follow-up visit.