Types of Mastectomy

Non-nipple-sparing-breast-reconstruction

Simple Mastectomy

During a simple mastectomy, the entire breast, including the skin, nipple and areola are removed (without removal of the lymph nodes from the armpit). The procedure is done by an elliptical incision leaving a single scar across the chest.

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Skin Sparing Mastectomy

During a skin sparing mastectomy, a surgeon preserves as much of the breast skin as possible. The breast surgeon removes the skin nipple, areola and then, through a small opening, breast tissue is removed. It can be performed as a simple mastectomy or as a modified radical mastectomy (the lymph nodes in the armpit are also removed).

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Nipple Sparing Mastectomy

During a nipple sparing mastectomy, an inframammary incision (in the breast fold) is made through which the underlying breast tissue is removed, while retaining the skin, nipple and areola. This procedure is most often utilized in a risk-reducing, prophylactic mastectomy.

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Radical Mastectomy

During a radical modified mastectomy the entire breast is removed including the skin, nipple, areola, the lining over the chest muscle and the lymph nodes under the armpit. The chest muscle itself is not removed.

Breast-Implant-Reconstruction-Non-Nipple-Sparing

Preventative Mastectomy

A risk-reducing (prophylactic) mastectomy refers to breast surgery before a cancer has been found. Certain factors can increase the risk of developing breast cancer, such as: cancer in one breast, a family history of breast cancer, positive test for hereditary breast cancer gene, such as BRCA.


Unilateral/Bilateral Mastectomy

A mastectomy is used to remove all breast tissue if you have breast cancer or are at very high risk of developing it. You may have a mastectomy to remove one breast (unilateral mastectomy) or both breasts (bilateral mastectomy).

Simple mastectomy

Simple mastectomy concentrates on the breast tissue itself:

  • The surgeon removes the entire breast.
  • The surgeon does not perform axillary lymph node dissection (removal of lymph nodes in the underarm area). Sometimes, however, lymph nodes are occasionally removed because they happen to be located within the breast tissue taken during surgery.
  • No muscles are removed from beneath the breast.

Who usually gets simple mastectomy?

A simple or total mastectomy is appropriate for women with multiple or large areas of ductal carcinoma in situ (DCIS) and for women seeking prophylactic mastectomies — that is, breast removal in order to prevent any possibility of breast cancer occurring.


Modified radical mastectomy

Modified radical mastectomy involves the removal of both breast tissue and lymph nodes:

  • The surgeon removes the entire breast.
  • Axillary lymph node dissection is performed, during which levels I and II of underarm lymph nodes are removed (B and C in illustration).
  • No muscles are removed from beneath the breast.

Who usually gets a modified radical mastectomy?

Most people with invasive breast cancer who decide to have mastectomies will receive modified radical mastectomies so that the lymph nodes can be examined. Examining the lymph nodes helps to identify whether cancer cells may have spread beyond the breast.


Radical mastectomy

Radical mastectomy is the most extensive type of mastectomy:

  • The surgeon removes the entire breast.
  • Levels I, II, and III of the underarm lymph nodes are removed (B, C, and D in illustration).
  • The surgeon also removes the chest wall muscles under the breast.

Who usually gets a radical mastectomy?

Today, radical mastectomy is recommended only when the breast cancer has spread to the chest muscles under the breast. Although common in the past, radical mastectomy is now rarely performed because in most cases, modified radical mastectomy has proven to be just as effective and less disfiguring.


Partial mastectomy

Partial mastectomy is the removal of the cancerous part of the breast tissue and some normal tissue around it. While lumpectomy is technically a form of partial mastectomy, more tissue is removed in partial mastectomy than in lumpectomy.


Nipple-sparing mastectomy

During nipple-sparing mastectomy, all of the breast tissue is removed, but the nipple is not removed.

 


Lumpectomy

Surgery to remove cancer or other abnormal tissue from your breast. Unlike a full mastectomy, only a portion of the breast is removed. Also referred to as an excisional biopsy.

Mastectomy for breast cancer treatment

A mastectomy may be a treatment option for many types of breast cancer, including:

  • Ductal carcinoma in situ (DCIS), or noninvasive breast cancer
  • Stages I and II (early-stage) breast cancer
  • Stage III (locally advanced) breast cancer — after chemotherapy
  • Inflammatory breast cancer — after chemotherapy
  • Paget’s disease of the breast
  • Locally recurrent breast cancer

Your doctor may recommend a mastectomy instead of a lumpectomy plus radiation if:

  • You have two or more tumors in separate areas of the breast.
  • You have widespread or malignant-appearing calcium deposits (microcalcifications) throughout the breast that have been determined to be cancer after a breast biopsy.
  • You’ve previously had radiation treatment to the breast region and the breast cancer has recurred in the breast.
  • You’re pregnant and radiation creates an unacceptable risk to your unborn child.
  • You’ve had a lumpectomy, but cancer is still present at the edges (margin) of the operated area and there is concern about cancer extending to elsewhere in the breast.
  • You carry a gene mutation that gives you a high risk of developing a second cancer in your breast.
  • You have a large tumor relative to the overall size of your breast. You may not have enough healthy tissue left after a lumpectomy to achieve an acceptable cosmetic result.
  • You have a connective tissue disease, such as scleroderma or lupus, and may not tolerate the side effects of radiation to the skin.

Mastectomy to prevent breast cancer

You might also consider a mastectomy if you don’t have breast cancer, but have a very high risk of developing the disease.

A preventive (prophylactic) or risk-reducing mastectomy involves removing both of your breasts and significantly reduces your risk of developing breast cancer in the future.

A prophylactic mastectomy is reserved for those with a very high risk of breast cancer, which is determined by a strong family history of breast cancer or the presence of certain genetic mutations such as BRCA 1 and 2 that increase the risk of breast cancer.

There are many options and what you choose is a decision based on your health history and personal preferences. There are three main types of reconstruction:

Implant – A saline or silicone breast implant is placed under or over the pectoral muscle to recreate the natural shape of a breast

Autologous or Tissue “Flap” – Rebuilding the shape of a breast using skin, fat and muscle from another part of the body (There are several types: DIEP, Latissimus Dorsi Flap, GAP Flap, TUG Flap, Fat Grafting etc.)

No Reconstruction – The breast is not reconstructed, but instead, the excess skin is removed leaving a flat surface on the chest. Along with their reconstruction method, women must choose whether or not they would like to retain their nipple, which could potentially develop breast cancer even after a mastectomy.

For a detailed explanation of all of your options visit our Reconstruction section.