Introduction

Breast cancer is a disease caused by an abnormal growth in breast cells leading to the formation of tumours. If left undiagnosed, these tumours can spread through the body and become fatal. According to the World Health Organization (WHO), breast cancer was the most common cancer in people assigned female at birth (AFAB) in 157 countries out of 185 in 2022. Surgical treatment is most often the first step in treatment for early-stage breast cancer.

Lumpectomy and mastectomy are two types of surgery commonly used for treatment in breast cancer patients. Lumpectomy involves the removal of the tumour as well as the surrounding breast tissue; only part of the breast is removed. Mastectomy on the other hand involves the removal of the entire breast, including all of the breast tissue. This article will explore these two types of surgical treatments to help you understand both procedures better.

Understanding lumpectomy and mastectomy

When treating breast cancer, doctors often combine the use of surgery to remove the breast tumour, radiation therapy to reduce recurrence risk and medications to kill cancer cells, such as hormonal therapies, chemotherapy or targeted biological therapies. The two types of surgery commonly performed in breast cancer patients are lumpectomy and mastectomy.

Lumpectomy

Lumpectomy, also known as breast-conserving surgery, is a procedure focused on the removal of tumours and the surrounding healthy tissue. The procedure aims to conserve as much tissue as possible, only removing the tumourous part of the breast.

On the day of a lumpectomy procedure, you will receive either general anaesthesia or local anaesthesia to numb the site. The surgeon will then remove the breast tumour and the surrounding breast tissue, followed by using sutures to sew the skin together.

The expected duration for full recovery from this procedure is roughly 2 weeks after surgery. Symptoms such as pain, swelling and bruising are expected to improve daily. Although lumpectomy involves the removal of the tumour, radiation therapy is often used as post-operative care to minimise recurrences, but this may not always be the case. For instance, if you have a type of breast cancer with a very low risk of recurrence.

There are also different types of lumpectomy procedures, this includes:

• Excisional biopsy: This involves removing the tumour as part of a biopsy
• Wide local excision: This involves removing the tumour plus a small margin of nearby healthy tissue
• Quadrantectomy: This involves removing roughly a quarter of your breast
• Re-excision of margins: This is a follow-up procedure to a local excision, where your surgeon will reopen the surgical site to remove more tissue and ensure all cancer cells are gone

Mastectomy

Mastectomy is a procedure focused on removing all of your breast tissue and nearby tissue in one or both breasts (double mastectomy). It is the treatment for most breast cancer stages.

Before performing a mastectomy, general anaesthesia is given and a mildly radioactive substance (tracer) or blue dye is injected into your breast to highlight lymph nodes. The surgeon will then remove your breast tissue, including or sparing your skin and/or nipple. All lymph nodes may be removed from the underarms. Finally, you may decide to have breast reconstruction surgery, if not the surgeon will close the opening. Your surgical wound will take around three weeks to heal with a possibility of feeling sore and stiff for up to six weeks post-surgery. Overall, The surgical process of a mastectomy tends to be more extensive than a lumpectomy, requiring a longer recovery period.

There are many different types of mastectomy including:

• Partial mastectomy (lumpectomy): This involves the removal of a tumour and some healthy tissue around it from your breast
• Simple mastectomy: This involves removing all breast tissue, leaving pectoral muscles below
• Double mastectomy (bilateral mastectomy): This involves the total mastectomy of both breasts
• Skin-sparing mastectomy: This involves removing your breast tissue but sparing the skin/nipple
• Mastectomy with breast reconstruction
• Modified radical mastectomy: This involves removing all of your breast tissue as well as underarm lymph nodes on the same side
• Radical mastectomy: This involves removing all of your breast tissue, underarm lymph nodes, and pectoral muscles

Indications for lumpectomy and mastectomy

Different factors can influence the decision when choosing between lumpectomy plus radiation therapy or mastectomy, these factors include:

• The size and location of the tumour: Lumpectomy is more suited for small and isolated tumours. Whereas, larger tumours and tumours in multiple sites are more suitable for mastectomy
• Stage of cancer: Lumpectomy is usually performed on patients with early-stage breast cancer. Later stages of breast cancer at a more advanced stage would require a mastectomy to remove a larger area of breast tissue
• The extent of surgery: Patients who want to keep their breasts often decide to undergo a lumpectomy with radiation rather than a mastectomy. A lumpectomy usually offers a better cosmetic result, as parts of the breast are retained
• Genetic factors: If you carry a genetic mutation, including BRCA1 and BRCA2, p53 and PTEN, this will mean you have an increased chance of developing breast cancer in your lifetime. In this case, undergoing a preventative mastectomy will reduce your breast cancer risk by 90%

Deciding between a lumpectomy and mastectomy can be difficult when different guidelines suggest different approaches. A lumpectomy is often preferred when you are willing to have radiation therapy alongside lumpectomy treatment, as if you undergo a mastectomy you are less likely to need radiation therapy as well. Lumpectomy is also preferred for those who have early stages of breast cancer with small and isolated tumours, whereas a mastectomy will be more necessary for larger tumours or if the tumour is in multiple regions of the breast.

Lumpectomy and mastectomy advantages and disadvantages

Lumpectomy

Advantages

• Less intensive surgery with a shorter recovery time
• Cosmetic reasons: To preserve most of the appearance

Disadvantages

• Radiotherapy is required after lumpectomy surgery
• The breast cannot safely tolerate additional radiation if there is a recurrence in the same breast after the lumpectomy; your surgeon will usually suggest a mastectomy in this case

Mastectomy

Advantages

• Removing the entire breast, provides greater peace of mind as the chance of recurrence decreases
• More appropriate for aggressive tumours

Disadvantages

• More extensive than lumpectomy with more post-surgery side effects and a longer recovery time
• A mastectomy means a permanent loss of breasts

Psychological and emotional considerations

It is normal for you to feel a range of psychological and emotional feelings when diagnosed with breast cancer, from the initial diagnosis through to treatment and post-surgery. Surgery is often the first step in the treatment of breast cancer, emotions like fear of death and distress are common feelings felt during this period. Fear of recurrence is another common feeling felt through breast cancer treatment. Some reflect on their experience and feel their diagnosis has enhanced relationships and increased their sense of resilience. Many are often shocked that many months after they finish treatment they continue to experience fatigue, regular rest periods and listening to your body are vital in managing this ongoing fatigue. 

Moreover, many report that their perception of their body image has changed. They may feel disfigured as a result of surgery, identifying their breasts as part of their womanhood and sexuality. This can lead to anxiety about sexual performance and fear of abandonment from their partner if they express a lack of sexual desire.

Coping strategies

People cope with treatment differently and experience a variety of emotions throughout their journeys. For this reason, it is important to bring awareness to different coping strategies with breast cancer to find what is right for you. These strategies include:

• Talking to a friend, counsellor or psychologist
• Attending online or local support groups to share your experience or hear other people’s experiences
• Gentle exercise to help combat fatigue
• Include resting periods throughout the day
• Eating a more balanced, healthy diet
• Journaling your experience, and writing down the thoughts and feelings you feel can be helpful as an outlet

Summary

In summary, deciding between a lumpectomy and mastectomy for breast cancer treatment is a choice that requires deep consideration of various factors such as stage of cancer, tumour size, and personal preference. Both options of lumpectomy and mastectomy come with their benefits and risks. It is vital that patients are informed and understand the implications of both treatment options, as well as are aware of the different coping strategies to help ease them through this process of adjustment.