Over the last thirty years removal of breast cancers with a margin of surrounding normal breast tissue (breast conserving surgery) has become an alternative to a mastectomy for many women with early breast cancer. Breast conserving surgery is almost always followed by a course of radiotherapy.

For some women, however, a mastectomy is still advisable. There are at least four situations where this might be the case.

• Firstly, if tests, such as a mammogram, suggest there is more than one cancer in the breast then a mastectomy is recommended.
• Secondly, if the cancer is relatively large then a mastectomy is often preferable (although for some women it may be possible to shrink the tumour with chemotherapy before surgery which may allow a breast conserving operation to be done).
• Thirdly, if the cancer lies directly below, or very close to, the nipple then mastectomy is the norm.
• Fourthly, some women actually prefer to have a mastectomy, feeling that once a cancer has been diagnosed they would feel happier if the breast were removed completely even though breast conserving surgery was possible.

Remember the choice of which type of surgery is used should always be fully discussed with you and you can ask for the reasons why a particular operation is recommended. You should also let your surgeon know your own preferences so that the two of you reach an agreed joint decision on what should be done.