While it typically involves removing the entire breast, a mastectomy may spare certain tissues depending on the extent of the cancer and the wishes of the patient.
Types of Mastectomy
The term mastectomy is used to describe several different surgical procedures, including the following: Radical mastectomy involves removing the entire breast, nipple, areola (dark skin around nipple), axillary chest wall muscles underneath the breast, and lymph nodes under the arm. This surgery is less common now than in the past, but may still be the best option for some people with large tumors, or whose cancer has spread to the lymph nodes. Modified radical mastectomy involves removing the entire breast, nipple, areola, and some lymph nodes while leaving the chest wall muscles intact. Simple mastectomy (also known as total mastectomy) involves removal of the breast, nipple, areola, and sentinel lymph node or nodes. It leaves the chest wall and more distant lymph nodes intact. Partial mastectomy involves removing a whole segment or quadrant of breast tissue, possibly along with some of the lining over the chest muscles. Skin-sparing mastectomy involves removal of the inner breast, nipple, areola, and lymph nodes, but keeps the breast skin in place so that breast reconstruction can be performed immediately afterwards. It may not be the best option for people with larger tumors. Nipple-sparing mastectomy involves removal of only inner-breast tissue, keeping the skin, nipple, and areola so that breast reconstruction can be done immediately afterward.
When Is Mastectomy Performed?
Mastectomy may be an effective treatment option for several types of breast cancer, including:
Ductal carcinoma in situ (DCIS), or noninvasive breast cancerStage I, stage II, or stage III breast cancerInflammatory breast cancerPaget disease of the breastLocally recurrent breast cancer
Your doctor may recommend a mastectomy instead of other treatment options (such as a lumpectomy) for any of the following reasons:
You have two or more tumors in different parts of your breastCancerous calcium deposits are found throughout the breastYour cancer has returned following radiation therapyYou’ve had a lumpectomy, but cancer is still presentYou have a large tumor compared to your overall breast sizeYou have a connective tissue disease, such as scleroderma or lupus, that makes it difficult to tolerate the side effects of radiationYou can’t undergo radiation after the surgery because you’re pregnantIt’s too difficult for you to travel to a radiation facilityYou have a genetic mutation like BRCA1 or BRCA2 that places you at high risk for developing cancer in your other breast, or for your cancer to return following treatment
Preventive Mastectomy
Women who do not have breast cancer, but who are at very high risk for the disease, may opt to have a mastectomy to reduce their risk. Preventive (also called prophylactic or risk-reducing) mastectomy involves removing both of your breasts while they are healthy. This type of mastectomy has been shown to significantly reduce the risk of developing breast cancer in women who are at very high risk for it. High risk can mean a strong family history of breast cancer, or carrying certain genetic mutations that increase the risk of breast cancer, such as BRCA1 and BRCA2. Talk with your doctor about genetic testing if you think you’re at high risk for breast cancer.
Mastectomy Risks and Side Effects
The following side effects can occur after a mastectomy:
Scabbing, blistering, or skin loss along the surgical incision lineFormation of hard scar tissue (keloid) where surgery took placeBuildup of blood in the surgical siteInfectionShoulder pain and stiffnessFeeling of “pins and needles” where the breast used to be, and underneath the armNumbness and swelling in your arm (called lymphedema) if you had lymph nodes removedDamage to nerves that extend to the muscles of the arm, back, and chest wall
Reconstruction Surgery
Following a mastectomy, most women are candidates for breast reconstruction surgery, in which a surgeon rebuilds your breast (or breasts) to resemble the original shape and size. In this procedure, either a silicone implant or the body’s own tissue from the abdomen, back, thighs, or buttocks (called a tissue flap) is used to give the breast its shape. Your surgeon can also reconstruct the nipple and areola to resemble the look of your original breast as much as possible.
