Which Breast Cancer Surgery Offers Better Long-Term Quality of Life?

Which Breast Cancer Surgery Offers Better Long-Term Quality of Life?

Women were satisfied with their breasts 10 years after either lumpectomy and radiation or mastectomy and reconstruction for early-stage breast cancer. Still, women who had lumpectomy and radiation had better psychosocial and sexual well-being.
May 6, 2022.

Women were satisfied with their breasts 10 years after surgery for early-stage breast cancer, whether they had lumpectomy and radiation or mastectomy and reconstruction. Still, women who had lumpectomy and radiation had better psychosocial and sexual well-being, according to a small study.

The research was published online on April 13, 2022, by the journal JAMA Surgery. Read the abstract of “Long-term Quality of Life in Patients With Breast Cancer After Breast Conservation vs Mastectomy and Reconstruction.”


Surgery for early-stage breast cancer

Women diagnosed with early-stage breast cancer have two main options for surgery:

  • mastectomy, which is total removal of the breast, often, but not always, followed by breast reconstruction

  • lumpectomy, also called breast-conserving surgery, which removes the cancer, plus a healthy rim of tissue around the cancer, usually followed by radiation therapy

Many studies from the 1970s show that lumpectomy plus radiation to treat stage I or stage II breast cancer offers the same survival rates as mastectomy. Based on these studies, the National Institutes of Health released a statement in 1990 saying that lumpectomy plus radiation is preferred over mastectomy to treat early-stage breast cancer.

A number of studies have compared the survival rates of both types of surgery. Still, there isn’t much research on women’s long-term quality of life after each surgery.


About the study

Between March 2017 and April 2018, the researchers sent a survey to women ages 23 to 85 in the Texas Cancer Registry asking them questions about quality of life. The women were all diagnosed with stage 0, stage I, or stage II breast cancer between 2006 and 2008 and had either lumpectomy and radiation or mastectomy and reconstruction.

Of the 647 women who completed the survey:

  • 356 had lumpectomy and radiation

  • 291 had mastectomy and reconstruction

The women were ethnically diverse:

  • 39.3% were white

  • 23.2% were Hispanic

  • 22.3% were Black

  • 14.2% were Asian American/Pacific Islander

  • 1.1% were American Indian/Alaska Native

Women who had mastectomy and reconstruction were more likely to be:

  • white

  • younger

  • diagnosed with breast cancer that was larger, node-positive, and in both breasts

  • in a higher income bracket

The researchers found that nearly all of the women in both surgery groups were satisfied with their breasts. Neither group had differences in physical well-being or regret about their decision.

But psychosocial well-being and sexual well-being were worse among women who had mastectomy and reconstruction. This difference was statistically significant, which means it was likely because of the choice of surgery and not just due to chance.

Worse long-term quality of life was more likely in women who:

  • were younger

  • had either dropped out of high school or received an associate’s degree in college

  • were in a lower income bracket

“These findings may help inform preference-sensitive decision-making for women with early-stage breast cancer,” the researchers wrote.

In an editorial published with the research, other oncologists recommended doctors share the results with women as they make decisions about breast cancer surgery because more women are choosing mastectomy over lumpectomy.


What this means for you

If you’ve been diagnosed with early-stage breast cancer, there are a number of factors you and your doctor should consider before deciding on the best surgical approach for you:

  • the breast cancer’s characteristics

  • your age

  • any other health conditions you might have

  • your preferences

  • how close you are to treatment facilities

  • your personal risk of recurrence and your concern about the cancer coming back

  • your reconstruction options and preferences

Breastcancer.org supports everyone’s right to make treatment decisions based on their personal circumstances. It’s very important to weigh all the pros and cons of any treatment or procedure you’re considering, and the effect each treatment or procedure may have on your long-term quality of life.

Learn more about Mastectomy vs. Lumpectomy.

Written by: Jamie DePolo, senior editor

— Last updated on August 5, 2022, 7:13 PM

Reviewed by 1 medical adviser
Brian Wojciechowski, MD
Crozer Health System, Philadelphia area, PA
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