When a woman is faced with breast cancer, there are two choices available: lumpectomy and mastectomy.
Lumpectomy is less invasive than mastectomy and it allows a woman to save her breast. Mastectomy involves removal of the entire breast.
Most women, when offered the choice between the two, prefer the less invasive lumpectomy Generally, lumpectomy results in a good cosmetic look. And, if you want to keep your breast, you may decide to have lumpectomy followed by radiation.  However, in rare cases, when a larger area of tissue needs to be removed, lumpectomy can cause the breast to look smaller or distorted.  There are types of reconstructive surgery available for both lumpectomy and mastectomy.  If you need to have a large area of tissue removed and two breasts of matching size are very important to you, you and your doctor will need to decide which surgery is best for your situation.
Research shows that women who live in the United States are more likely to have mastectomies than women who live in other countries.  In the Midwestern and southern parts of the U.S., mastectomies are very common.
Lumpectomy followed by radiation is likely to be equally as effective as mastectomy for women with only one site of cancer in the breast and a tumor under 4 centimeters.  Clear margins are also a requirement (no cancer cells in the tissue surrounding the tumor).
Lumpectomy has a few potential disadvantages:
Radiation therapy is likely to be scheduled for 5 to 7 weeks of radiation therapy– 5 days per week after lumpectomy surgery to make sure the cancer is gone.
Radiation therapy may affect the timing of reconstruction and possibly your reconstruction options after surgery.  Radiation therapy also may affect your options for later surgery to lift or balance your breasts.
There is a somewhat higher risk of developing a local recurrence of the cancer after lumpectomy than after mastectomy.  However, local recurrence can be treated successfully with mastectomy.
The breast cannot safely tolerate additional radiation if there is a recurrence in the same breast after lumpectomy.  This is true for either a recurrence of the same cancer, or for a new cancer.  If you have a second cancer in the same breast, your doctor will usually recommend that you have a mastectomy.
One or more additional surgeries may be needed after your initial lumpectomy.  During lumpectomy, the surgeon removes the cancer tumor and some of the normal tissue around it (called the margins).  A pathologist looks to see if cancer cells are in the margins.  If there are cancer cells, more tissue needs to be removed until the margins are free of cancer. Ideally, this is all done during the lumpectomy, but analyzing the margins can take about a week.  So sometimes after the pathology report is done, the margins are found to contain cancer cells and more surgery (called a re-excision) is needed.
Some women may want the entire breast removed because it provides a greater peace of mind regarding the recurrence of breast cancer.  Radiation therapy may still be needed, depending on the results of the pathology.
Mastectomy means that the woman will have a permanent loss of her breast and that she will have to have additional surgeries if she chooses to have her breast reconstructed. A mastectomy takes longer than a lumpectomy and is more extensive. It also has more post-surgery side effects and a longer recuperation time.
The choices are personal so be sure to weigh your decision carefully after you’ve talked with your doctor.