Mastectomy

For a long time, a procedure called a radical mastectomy was the only treatment available to women with breast cancer. No matter what stage of breast cancer you had, mastectomy was your only option. Catching a cancer early didn't give you the benefit of having a less radical, more cosmetically acceptable treatment option. Things have changed a great deal since then. Mastectomy no longer has to be as extensive, scarring, or disfiguring. After 25 years of follow-up, research has shown that more extensive surgery is not necessarily better. Mastectomy can actually be different operations for different people, in different situations.

In a "simple" or "total" mastectomy, the surgeon removes the entire breast but does not take out any axillary lymph nodes (nodes in the underarm area, also called the axilla). No muscles are removed from beneath your breast. Occasionally, lymph nodes may be removed because they are actually located within the breast tissue taken during surgery. A total mastectomy is appropriate for women with ductal carcinoma in situ or DCIS, and for women seeking prophylactic mastectomies—that is, breast removal in order to prevent any possibility of breast cancer occurring.

Woman with total (simple) mastectomy

A pink highlighted area indicates tissue removed at mastectomy

B axillary lymph nodes: levels I

C axillary lymph nodes: levels II

D axillary lymph nodes: levels III

A modified radical mastectomy removes the entire breast and includes a procedure called axillary dissection, in which levels I and II (of three levels) of the axillary lymph nodes in the underarm area) are also removed. Most women who have mastectomies today have modified radical mastectomies.

Woman with modified radical mastectomy

A pink highlighted area indicates tissue removed at mastectomy

B axillary lymph nodes: levels I

C axillary lymph nodes: levels II

D axillary lymph nodes: levels III

Radical mastectomy includes removal of the entire breast, all underarm lymph nodes, and chest wall muscles under the breast. Although it was common in the past, radical mastectomy is now rarely performed because modified radical mastectomy has proven to be just as effective and less disfiguring. Today radical mastectomy is recommended only when cancer has spread to the chest muscles under the breast.

Woman with radical mastectomy

A pink highlighted area indicates tissue removed at mastectomy

B axillary lymph nodes: levels I

C axillary lymph nodes: levels II

D axillary lymph nodes: levels III

E supraclavicular lymph nodes

F internal mammary lymph nodes

Is mastectomy right for you?

Mastectomy may be right for you if:

• Cancer is found in more than one part of your breast.

• Your breast is small or is shaped so that a lumpectomy would leave you with very little breast tissue or a very deformed breast.

• Radiation therapy after surgery is not appropriate for you.

• You believe you would have greater peace of mind with a mastectomy.

When is radiation added to mastectomy?

Radiation may be recommended after mastectomy if

• The tumor is larger than five centimeters.

• The removed tissue has a positive margin of resection.

• Four or more lymph nodes were involved.

• The cancer is multi-centered—it occurred in a number of locations within the breast.