A mastectomy is an operation that removes the entire breast tissue. Mastectomy, which was the original surgery offered for breast cancer, is an effective way to obtain local control of many breast cancers, but it comes at the cost of losing the breast.
There are several different types of mastectomies:
- Radical mastectomy—A radical mastectomy is a historical surgery rarely performed today. The procedure removed the breast tissue, including the nipple, along with the chest muscles (pectoralis) and most of the lymph nodes underneath the arm. It was used prior to the development of modern chemotherapy and radiation therapy. Radical mastectomy has little place in modern medicine.
- Modified radical mastectomy—A modified radical mastectomy removes the nipple, the breast tissue, and lymph nodes from the underarm. The chest wall muscle (pectoralis) is not removed. Lymph nodes in the lower portion of the underarm (axilla) are removed. During the procedure, the surgeon will avoid injuring two specific nerves that help control muscles in the shoulder and back region.
- Total (or simple) mastectomy—A total mastectomy, also known as simple mastectomy, removes the nipple and breast tissue but does not attempt to remove lymph nodes under the arm. Some excess breast skin is removed during a total or simple mastectomy so that a flat, straight-line incision results. A total or simple mastectomy is frequently combined with a sentinel lymph node biopsy.
- Skin-sparing mastectomy—A skin-sparing mastectomy, like a total or simple mastectomy, removes the breast tissue and nipple. But in a skin-sparing mastectomy, the surgeon saves as much of the overlying breast skin as possible. The preserved skin is used to house a breast implant or other form of reconstructive tissue. A skin-sparing mastectomy is almost always followed by an immediate breast reconstruction, which is performed by a plastic surgeon. The cosmetic result of the reconstruction is usually superior with this approach as the normal breast skin is left intact.
- Nipple sparing mastectomy—A nipple-sparing mastectomy saves a woman’s nipple, as well as her breast skin, although the underlying breast tissue is removed. While patients who have a nipple-sparing mastectomy must meet very strict criteria, it is a good option for some women. The nipple-sparing mastectomy is followed by immediate breast reconstruction.
Long-term survival in early-stage breast cancer patients is the same for patients who choose mastectomy and patients who choose lumpectomy combined with radiation therapy.
Which patients choose mastectomy?
- Those who are not candidates for radiation therapy
- Those who do not want to have follow-up mammograms after a lumpectomy
- Those who have multiple sites of cancer in different locations in their breast
- Those who have widespread ductal carcinoma in situ, or DCIS (noninvasive breast cancer)
- Those who have a very large cancer relative to the size of their breast (especially if attempts to shrink the cancer with chemotherapy have failed)
- Those who have certain types of locally advanced breast cancer (for example, inflammatory breast cancer)
- Those who have a genetic change that predisposes them to breast cancer
- Those who want breast reconstruction
- Those who have had breast cancer therapy previously (especially with prior radiation) and have a recurrent cancer or new cancer in that same breast