⚕️ NHS & WHO sourced

Breast Cancer Surgery — Your Options Explained

Lumpectomy, mastectomy and reconstruction — the main surgical choices for breast cancer. What each means for recovery, appearance and further treatment.

Reviewed against NHS & WHO guidelines Last reviewed: January 2025 For educational purposes — not medical advice
✓ Lumpectomy plus radiotherapy has equivalent survival outcomes to mastectomy for most early cancers
✓ Sentinel node biopsy avoids unnecessarily removing all lymph nodes
✓ Reconstruction can be immediate (at mastectomy) or delayed
✓ BRCA mutation carriers may opt for preventive bilateral mastectomy

Breast-conserving surgery (lumpectomy / wide local excision)

Removes the tumour and a clear margin of surrounding healthy tissue, leaving most of the breast intact. It is the preferred option for many women with small to medium tumours. It is followed by radiotherapy in almost all cases to reduce the risk of recurrence. Survival outcomes are equivalent to mastectomy for most early cancers.

Mastectomy

Removes the entire breast. Recommended when the tumour is large relative to breast size, when there are multiple tumours in different parts of the breast, when the woman carries a BRCA mutation and wishes to reduce future risk, or when a patient chooses it. A skin-sparing or nipple-sparing mastectomy may be possible in some cases.

Lymph node surgery

To check whether cancer has spread to the lymph nodes, surgeons often perform a sentinel node biopsy — removing the first one to three lymph nodes that drain the breast. If these are cancer-free, no further nodes need to be removed. If cancer is found, axillary lymph node clearance (removal of more nodes) may follow. Lymph node removal carries a risk of lymphoedema (arm swelling).

Breast reconstruction

Women who have a mastectomy can choose to have reconstruction — immediate (at the same time as mastectomy) or delayed (later). Options include:

  • Implant reconstruction: silicone implant inserted under the chest muscle
  • Flap reconstruction: tissue taken from elsewhere in the body (most commonly the back — latissimus dorsi flap — or abdomen — DIEP or TRAM flap)

Reconstruction is a personal choice. Many women live comfortably without reconstruction. Specialist breast nurses can provide information and support for decision-making.

Frequently asked questions

What is the difference between a lumpectomy and a mastectomy? +
A lumpectomy (breast-conserving surgery) removes the tumour and a margin of healthy surrounding tissue, leaving most of the breast intact. A mastectomy removes the entire breast. For most early cancers, survival outcomes are equivalent — the choice depends on tumour size, location, personal preference and whether BRCA mutations are present. Lumpectomy is usually followed by radiotherapy.
Do I have to have a mastectomy? +
Not necessarily. For many women with early breast cancer, lumpectomy plus radiotherapy is as effective as mastectomy and preserves the breast. Mastectomy is recommended when tumours are large relative to breast size, there are multiple tumours, or the woman carries a BRCA mutation. You should be offered a choice and time to discuss it with your surgical team and breast care nurse.
What is breast reconstruction after mastectomy? +
Breast reconstruction rebuilds the breast mound after mastectomy using either an implant or tissue from elsewhere in the body (such as the back or abdomen). Reconstruction can be immediate (at the same operation as mastectomy) or delayed. It is a personal choice — many women choose not to have reconstruction and live comfortably without it.

Clinical sources

  • NHS — www.nhs.uk
  • World Health Organization — www.who.int

This content is for educational purposes and does not constitute medical advice. Always consult a qualified healthcare professional for personal medical guidance.

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