Mastectomy is the removal of the whole breast. There are five different types of mastectomy: “simple” or “total” mastectomy, modified radical mastectomy, radical mastectomy, partial mastectomy, and subcutaneous (nipple-sparing) mastectomy.
Types of Mastectomy:
Simple (or total) mastectomy
In this procedure, the surgeon removes the entire breast, including the nipple, areola, and skin. Some underarm lymph nodes may or may not be removed depending on the situation. Most women, if they are hospitalized, can go home the next day.
In this procedure, most of the skin over the breast is left intact. Only the breast tissue, nipple and areola are removed. The amount of breast tissue removed is the same as with a simple mastectomy. Implants or tissue from other parts of the body are used at the time of surgery to reconstruct the breast.
Many women prefer skin-sparing mastectomy because it offers the advantage of less scar tissue and a reconstructed breast that seems more natural. But it may not be suitable for larger tumors or those that are close to the surface of the skin.
The risk of local cancer recurrence with this type of mastectomy is the same as with other types of mastectomies.
Nipple-sparing mastectomy is a variation of the skin-sparing mastectomy. In this procedure, the breast tissue is removed, but the breast skin and nipple are left in place. This can be followed by breast reconstruction. The surgeon often removes the breast tissue beneath the nipple (and areola) during the procedure to check for cancer cells. If cancer is found in this tissue, the nipple must be removed. Even if no cancer is found under the nipple, some doctors give the nipple tissue a dose of radiation during or after the surgery to try to reduce the risk of the cancer coming back.
It is more often an option for women who have a small, early-stage cancer near the outer part of the breast, with no signs of cancer in the skin or near the nipple. Cancer cells are more likely to be hidden in the nipple if the breast tumor is larger or close to the nipple. This means there is a higher risk the cancer will come back if the nipple is not removed.
There are still some issues with nipple-sparing surgeries. Afterward, the nipple may not have a good blood supply, causing the tissue to shrink or become deformed. Because the nerves are also cut, there often may be little or no feeling left in the nipple. For women with larger breasts, the nipple may look out of place after the breast is reconstructed. As a result, many doctors feel that this surgery is best done in women with small to medium sized breasts. This procedure leaves less visible scars, but if it isn’t done properly, it can leave behind more breast tissue than other forms of mastectomy. This could result in a higher risk of cancer developing than for a skin-sparing or simple mastectomy. This was more of a problem in the past, but improvements in technique have helped make this surgery safer. Still, many experts do not yet consider nipple-sparing mastectomy to be a standard treatment for breast cancer.
Modified radical mastectomy
A modified radical mastectomy combines a simple mastectomy with the removal of the lymph nodes under the arm.
In this extensive operation, the surgeon removes the entire breast, axillary (underarm) lymph nodes, and the pectoral (chest wall) muscles under the breast. This surgery was once very common, but less extensive surgery (such as the modified radical mastectomy) has been found to be just as effective and with fewer side effects, so this surgery is rarely done now. This operation may still be done for large tumors that are growing into the pectoral muscles.
If a mastectomy is done on both breasts, it is called a double (or bilateral) mastectomy. When this is done, it is often a risk-reducing surgery for women at very high risk for getting breast cancer, such as those with a BRCA gene mutation. Most of these mastectomies are simple mastectomies, but some may be nipple-sparing.