Mastectomy
Source: BreastCancer.org
What is a Mastectomy?
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.
"Simple" or "total" mastectomy
Simple or total 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.
Simple Mastectomy
Who usually gets simple or total 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
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
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.
Subcutaneous ("nipple-sparing") mastectomy
During subcutaneous ("nipple-sparing") mastectomy, all of the breast tissue is removed, but the nipple is left alone. Subcutaneous mastectomy is performed less often than simple or total mastectomy because more breast tissue is left behind afterwards that could later develop cancer. Some physicians have also reported that breast reconstruction after subcutaneous mastectomy can result in distortion and possibly numbness of the nipple. Because subcutaneous mastectomy is still an area of controversy among some physicians, your doctor may recommend simple or total mastectomy instead.
Skin-sparing mastectomy
Skin-sparing mastectomy is a technique that preserves as much of the breast skin as possible. Skin-sparing mastectomy can be performed as a "simple" or "total" mastectomy or as a modified radical mastectomy to provide the skin needed for immediate reconstruction.
During skin-sparing mastectomy, the surgeon removes only the skin of the nipple, areola, and the original biopsy scar. Then the surgeon removes the breast tissue through the small opening that is created. The remaining pouch of skin provides the best shape and form to accommodate an implant or a reconstruction using your own tissue. Many women choose this type of mastectomy in order to get the most realistic and pleasing results from immediate breast reconstruction.
Most women are eligible for skin-sparing mastectomies. However, there are some exceptions:
- A skin-sparing mastectomy is not usually performed if you’ve decided that you will not have immediate breast reconstruction. If you won’t be having immediate breast reconstruction at the time of your mastectomy, your surgeon will most likely remove as much skin as is required to make your scar and the surface of your chest flat.
A skin-sparing mastectomy is not safe if there is a possibility that tumor cells are close to the skin. If there's any question that the tumor may involve the skin, such as in inflammatory breast cancer, then skin-sparing mastectomy is not an option.
