Choosing surgery when radiation is not possible for you

Lumpectomy, also called breast-conserving surgery, is usually followed by radiotherapy to lower the chance of cancer returning in the kept breast. So if radiotherapy is not possible or not advisable for you, the choice of surgery changes. For most women in this situation, mastectomy becomes the recommended operation, because removing the whole breast reduces the need for radiotherapy to that area. There are several reasons radiotherapy may not be suitable. You may have had radiotherapy to the same breast or chest before, for an earlier breast cancer or for lymphoma. You may be pregnant, as radiotherapy is generally avoided until after delivery. Some connective tissue conditions, such as active scleroderma or lupus, can make tissues react badly. Very severe heart or lung disease, being unable to lie flat or raise your arm, or a rare inherited condition such as a TP53 gene change may also count against it. Practical barriers also matter, such as living far from a radiotherapy centre. Before accepting that radiotherapy is impossible, it is worth checking the options. Shorter courses over one to three weeks, partial breast radiotherapy, and support with travel and accommodation can make it manageable for many women. Some older women with small, low-risk, hormone-sensitive cancers may safely have lumpectomy without radiotherapy if they take hormone therapy. Your team will weigh these options with you.

Mastectomy is usually advised

Without radiotherapy, removing the whole breast often gives the best local cancer control.

Check whether radiotherapy is truly ruled out

Shorter or partial courses and travel support may make it possible.

Some women can skip it safely

Selected older women with low-risk cancers may have lumpectomy with hormone therapy alone.

Women who had lumpectomy and radiotherapy years ago sometimes face a new cancer in the same breast.

Mastectomy is the usual recommendation

Because the breast has already had a full course of radiotherapy, mastectomy is generally advised.

Repeat lumpectomy is sometimes discussed

In selected cases, a second lumpectomy with partial breast re-irradiation may be considered by specialist centres.

Reconstruction needs care

Previously irradiated skin heals less well, so flaps are often favoured over implants.

Other breast is separate

A new cancer in the other breast can usually be treated as usual, including with radiotherapy.