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Lumpectomy or Mastectomy?

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For breast cancers of stage 1 and 2, surgical treatment options include mastectomy and breast-conserving surgery, also called lumpectomy. Mastectomy has a higher risk of complications. Dr. Roshni Rao of The University of Texas reported that 18 to 30 percent of mastectomy patients experience flap necrosis, which is death of the skin covering the surgical area. Additional surgery may be needed to treat this complication.

Dr. Virginie Rondeau and colleagues in Bordeaux, France, performed a study on the statistics of cancer recurrence in breast cancer patients who received lumpectomies. They reported that several randomized trials have shown lumpectomy and mastectomy provide equivalent survival rates. However, lumpectomy patients risk recurrence of breast cancer, which requires further surgery.

Rondeau and coauthors studied 919 women treated with lumpectomy for primary invasive breast cancer between 1990 to 1994. Almost all had radiation therapy after surgery. Chemotherapy or endocrine therapy was prescribed according to individual characteristics. The median follow-up time was 12.7 years. During this time, the group of women experienced 150 locoregional cancer recurrences, 69 cancers in the opposite breast, 188 distant metastases, 30 new primary cancers other than breast cancer, and 133 deaths from breast cancer. Multiple cancer events were common in the women who had at least one recurrence. However, the majority of the 919 women (580 patients, 63.1 percent) experienced no further cancer incidents. Women younger than 40 years and those with higher grades of cancer were the most likely to experience additional cancer events.

Women with a family history of breast cancer may want to get genetic testing for BRCA gene mutations. Dr. Marijke R. Wevers and colleagues from a group of hospitals in The Netherlands reported that 5 to 10 percent of women diagnosed with breast cancer have a hereditary form of the disease. These authors developed a protocol for studying the impact of rapid genetic counseling and testing. Women who have a BRCA gene mutation are at elevated risk for developing breast cancer and ovarian cancer. Previous studies cited by the authors indicate that one-half to two-thirds of breast cancer patients who test positive for BRCA1 or BRCA1 mutation choose bilateral mastectomy to prevent future breast cancer development.


1. Rao R et al, “Prediction of post-operative necrosis after mastectomy: A pilot study utilizing optical diffusion imaging spectroscopy”, World Journal of Surgical Oncology 2009; 7:91. http://www.ncbi.nlm.nih.gov/pubmed/19939277

2. Rondeau V et al, “Separate and combined analysis of successive dependent outcomes after breast-conservation surgery: Recurrence, metastases, second cancer and death”, BMC Cancer 2010; 10: 697.

3. Wevers MR et al, “Behavioral and psychosocial effects of rapid genetic counseling and testing in newly diagnosed breast cancer patients: Design of a multicenter randomized clinical trial”, BMC Cancer 2011; 11: 6.

Reviewed August 3, 2011
by Michele Blacksberg R.N.
Edited by Jody Smith

Linda Fugate is a scientist and writer in Austin, Texas. She has a Ph.D. in Physics and an M.S. in Macromolecular Science and Engineering. Her background includes academic and industrial research in materials science. She currently writes song lyrics and health articles.

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