comscoreTypes of Mastectomy

Types of Mastectomy

There are several different types of mastectomy. You and your doctors will work together to decide which is best for your individual situation.
 

During a mastectomy, the surgeon generally removes all of the breast tissue. Usually the surgeon also removes some underarm lymph nodes to check if cancer has spread beyond the breast.

There are several different types of mastectomy. You and your doctors will work together to decide which is best for your individual situation.

 

Unilateral vs. bilateral mastectomy 

You may have a mastectomy to remove one breast (called unilateral or single mastectomy) or both breasts (called bilateral or double mastectomy).

Your doctors will likely recommend a bilateral mastectomy if there is cancer in both of your breasts, or you have a high risk of developing a second breast cancer due to a strong family history of breast cancer or an inherited genetic mutation linked to breast cancer (such as a BRCA1, BRCA2, or PALB2 mutation). Preventive (prophylactic) mastectomies done in people at high risk who have not been diagnosed with breast cancer are bilateral, as well.

Many women diagnosed with early-stage cancer in one breast have a choice about whether to have a unilateral or bilateral mastectomy. Often, it’s not an easy decision. Some women choose a bilateral mastectomy even though unilateral mastectomy is an option for them because of: 

  • fear that a new, second breast cancer might eventually develop in the unaffected breast

  • anxiety about the ongoing need for surveillance (using breast imaging tests such as mammograms) and the possible need for future biopsies in the unaffected breast

  • concerns about the cosmetic appearance of the chest if only one breast is removed or reconstructed

Over the past twenty years, a lot more women in the United States who are diagnosed with early-stage breast cancer in one breast have been choosing to get a bilateral mastectomy. Removing the other breast that doesn’t have cancer is called contralateral prophylactic mastectomy.

Some doctors are concerned that too many women are choosing to have contralateral prophylactic mastectomy because they think their risk of getting breast cancer in the other breast is higher than it actually is. Studies have shown that for women at average risk, removing the other healthy breast doesn’t improve survival. Their likelihood of developing cancer in the other breast is about 1% or less per year.

Talk with your doctors about what’s best for your particular situation. To make an informed decision about your treatment, it’s important to know your actual risk of the breast cancer coming back (recurrence) or developing a new cancer.

 

Simple (or total) mastectomy

For a simple mastectomy (also called a total mastectomy), the surgeon removes:

  • all of the breast tissue

  • the skin of the breast

  • the nipple and the areola (the dark area around the nipple)

Usually the surgeon will also perform a sentinel lymph node dissection, which means that 1-3 lymph nodes under the arm on the side of the tumor will be removed to check whether the cancer has spread there. The sentinel lymph nodes are the first lymph nodes to which that the cancer might spread.

A procedure called lymphatic mapping is done either the day before, the morning of, or during the surgery to help the surgeon locate the sentinel nodes. This involves injecting a radioactive liquid, a blue dye, or both, underneath the nipple or near the tumor site.

 

Modified radical mastectomy

For a modified radical mastectomy, the surgeon removes:

  • all of the breast tissue

  • the skin of the breast

  • the nipple and the areola

The surgeon will also perform an axillary lymph node dissection, which means that more than a few lymph nodes (usually about 10) under the arm on the side of the tumor will be removed to check whether cancer has spread there.

 

Nipple-sparing mastectomy

During a nipple-sparing mastectomy, all of the breast tissue is removed, but the nipple, areola, and the skin of the breast is left intact.

Lymph nodes are usually removed as well to see if the cancer has spread beyond the breast (unless the mastectomy is prophylactic). Either a sentinel lymph node dissection or an axillary lymph node dissection will be done depending on your specific diagnosis.

Also, some tissue from beneath the nipple and areola is removed to check for cancer cells there. If cancer is found in that location, the nipple and usually the areola will need to be removed. This is usually done later on, in a separate procedure. Another reason the nipple may need to be removed in a separate procedure is if it does not have a good enough blood supply and develops necrosis (tissue breakdown).

In most cases, the breasts are immediately reconstructed during a nipple-sparing mastectomy, with either tissue expanders, breast implants, or tissue flaps. If the nipples need to be removed, they can be reconstructed at a later point with nipple reconstruction surgery, nipple tattoos, or both.

Nipple-sparing mastectomy with immediate reconstruction has become popular because it tends to provide good, natural looking cosmetic results with minimal scarring. If you get a nipple-sparing mastectomy, though, you shouldn’t expect much (or any) sensation in the nipples after the surgery. Also, your nipples may appear to be erect all the time after this surgery.   

You may not be a candidate for nipple-sparing mastectomy if you have a tumor close to or involving the nipple or areola. Also, the procedure isn’t recommended for people with inflammatory breast cancer. Being a smoker, having scarring around the nipples from prior surgeries, or having had radiation to the breast in the past can make you less likely to have a good enough blood supply in the breast skin and nipples to get a good result from nipple-sparing mastectomy.

In some cases, having large and drooping breasts can make it more difficult to get a good cosmetic result from a nipple-sparing mastectomy. There is a risk, for example, that the nipples won’t be in the correct position. Your surgical team may recommend that you have a series of procedures in this situation. For example, you might have a lumpectomy with a breast lift or reduction (or both) and then your nipple-sparing mastectomy will be done later, as a second surgery.

 

Skin-sparing mastectomy

During a skin-sparing mastectomy, the surgeon removes all the breast tissue, the nipple, and in some cases the areola, but most of the skin over the breast is left intact.

Usually a sentinel lymph node dissection or axillary lymph node dissection are also done (unless the mastectomy is prophylactic).

In most cases, the breasts are immediately reconstructed during a skin-sparing mastectomy, with either tissue expanders, breast implants, or tissue flaps. The skin sparing approach may provide better, more natural looking cosmetic results than reconstruction that is done without sparing the skin.

A skin-sparing mastectomy is not usually performed if you’ve decided that you will not be having immediate breast reconstruction at the time of your mastectomy. It also may not be safe for some people who have tumor cells close to or in the skin or those with inflammatory breast cancer.

 

Radical mastectomy

A radical mastectomy is the most extensive type of mastectomy. For a radical mastectomy, the surgeon removes:

  • all of the breast tissue

  • the skin of the breast

  • the nipple and the areola

  • the chest wall muscles under the breast

  • some of the lymph nodes under the arm

Until the 1970s, radical mastectomy was the standard surgical treatment for breast cancer. Now it is only performed in the very rare situation that the tumor is growing into the chest muscles and chemotherapy was already given but it didn’t shrink the tumor. 

 

Prophylactic (preventive) mastectomy

Prophylactic (or preventive) mastectomy is done to reduce the risk of developing breast cancer in someone who is at high risk.

Your doctors might recommend a prophylactic mastectomy if you:

  • had genetic testing and were found to have abnormal changes (mutations) in certain genes that increase your lifetime risk of breast cancer, such as a BRCA1 or BRCA2 mutation

  • you have a strong family history of breast cancer, meaning that more than one close relative — such as a mother, sister, or daughter — has had breast cancer, especially before age 50

  • you have abnormal changes to the breast tissue that can increase your risk of developing breast cancer, such as lobular carcinoma in situ, atypical ductal hyperplasia, or atypical lobular hyperplasia

  • you had radiation therapy to your chest before the age of 30

Some people have more than one of the above risk factors. The last two risk factors on this list (abnormal changes to the breast tissue and radiation therapy before the age of 30) wouldn’t justify a prophylactic mastectomy on their own. But your doctors may recommend that you consider a prophylactic mastectomy if you have one or both of those plus other risk factors. In some cases, hormonal therapy alone can help reduce the risk of breast cancer in people who have abnormal changes in the breast tissue.   

A prophylactic mastectomy is usually done as a bilateral simple (or total) mastectomy, nipple-sparing-mastectomy, or skin-sparing mastectomy. Lymph nodes are not removed and checked for cancer unless your doctors are concerned about the results of an imaging test or biopsy you had. In any case, though, breast tissue that is removed during a prophylactic mastectomy will be sent to a lab for testing and you will receive a pathology report.

Breast reconstruction can be done at the same time as the prophylactic mastectomy or at a later date.

Learn more about Prophylactic Mastectomy.

Some women who are at high risk for both breast cancer and ovarian cancer choose to also have surgery to remove the ovaries and usually the fallopian tubes. Learn more about prophylactic
ovary removal
.

— Last updated on May 11, 2022, 10:18 PM