Choosing the breast surgery that is right for you
Many studies show that people with early-stage breast cancer (stage 1 or stage 2A) who have breast-conserving surgery (BCS) followed by radiation therapy have the same survival rates as people who have a mastectomy. This means that your doctor may give you a choice between the 2 surgeries, if there isn’t a medical reason for you to have one rather than the other.
The choice between BCS and a mastectomy is a very personal one. Your feelings, preferences, priorities and lifestyle all play a part in your decision. You may choose to have BCS because you want to keep as much of your breast as possible. Or having a mastectomy may give you better peace of mind because it removes more breast tissue. Talk to your healthcare team about the advantages and disadvantages of each type of surgery. It may help you to also talk to others who have had each type of surgery.
Advantages and disadvantages of BCS
BCS doesn’t remove as much tissue as a mastectomy. This means that it causes fewer changes to how the breast looks and feels. After BCS, there is still usually feeling in your breast, nipple and the dark area around your nipple (called the areola). BCS may leave a scar or change the shape of the breast, but it may have less impact on your feelings about your body image or sexuality.
BCS does not take as long as a mastectomy and there is less chance of complications during and after BCS. Recovery time from BCS is also shorter. You may be able to return to your regular activities within 2 weeks of having BCS.
Compared to a mastectomy, there is a slightly higher risk that the breast cancer will come back (recur) in the remaining breast tissue after BCS.
BCS is followed by radiation therapy 5 days a week for 1 to 6 weeks. This means that treatment takes longer overall than if you had only a mastectomy. Radiation therapy is given in a treatment centre, so you may need to travel or find transportation. You may also have short- and long-term side effects from radiation therapy.
Advantages and disadvantages of a mastectomy
A mastectomy removes the breast and the nipple, so you will have a scar and a flat chest on the side of your body where the breast used to be. The scar will be shorter for smaller breasts and longer for larger breasts. The skin in the area where the breast was removed and under your arm may feel numb. This numbness may improve over time, but it may never completely go away.
A mastectomy takes longer than BCS because it removes more tissue. This means that a mastectomy has a longer hospital stay (usually 1 or 2 nights), a longer recovery time (usually 3 to 4 weeks) and a greater chance of complications during and after surgery.
You may choose to have breast reconstruction surgery. If the surgeon does the reconstruction at the same time as the mastectomy, you will be in the operating room longer. This can increase the risk for complications during surgery. If reconstruction isn’t done at the same time as the mastectomy, you will need to have more surgery to have the breast reconstruction. Having breast reconstruction also makes your recovery time longer.
Some people with early-stage breast cancer who have a mastectomy don't need to have radiation therapy. This means that they can avoid the side effects of radiation therapy. But if you have cancer in the lymph nodes or a very large tumour, you will usually have radiation therapy after a mastectomy.