Types of Mastectomy

During a mastectomy, the surgeon removes all of the breast tissue. If you’ve been diagnosed with breast cancer, the surgeon will likely also remove some lymph nodes from your armpit 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 you. 

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

Your doctors will likely recommend a bilateral mastectomy if cancer is in both of your breasts or you are at high risk of developing a second breast cancer. A mastectomy without a breast cancer diagnosis is called a prophylactic (risk-reducing) mastectomy. 

Many people diagnosed with early-stage cancer in one breast can choose between a single or double mastectomy. Often, it’s not an easy decision. Some people choose a double mastectomy instead of a single mastectomy because of:

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

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  anxiety about the ongoing need for breast imaging tests, such as mammograms, in the unaffected breast, and the possible need for future biopsies

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

Over the past 20 years, women in the U.S. diagnosed with early-stage breast cancer in one breast have been choosing to get a bilateral mastectomy more than ever before. 

Some doctors are concerned that too many women are choosing to have a mastectomy of a breast that doesn’t have cancer (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 people at average risk, removing the other healthy breast doesn’t improve survival. Their likelihood of developing cancer in the other breast is less than 1% 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. 

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

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  all of the breast tissue

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  the skin of the breast

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

If you’ve been diagnosed with breast cancer, the surgeon will usually also remove one to three lymph nodes from the armpit (called sentinel lymph node dissection or biopsy) during the mastectomy. Examining lymph nodes near the cancer helps your doctors to see if the cancer has spread beyond the breast. 

As a final step, the surgical team may perform a flat closure, immediate breast reconstruction, or a procedure that sets the stage for delayed breast reconstruction.

For a modified radical mastectomy, the surgeon removes:

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  all of the breast tissue

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  the skin of the breast

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  the nipple and the areola

The surgeon will also remove between 10 and 40 lymph nodes from the armpit (called an axillary lymph node dissection) during the mastectomy. Examining this number of lymph nodes near the cancer helps your doctors to see if the cancer has spread beyond the breast.

The surgery will end after your surgical team creates a flat, smooth chest or reconstructs one or both breasts.

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. 

If you’ve been diagnosed with breast cancer, the surgeon will likely remove lymph nodes  (either sentinel lymph node dissection or an axillary lymph node dissection) to see if the cancer has spread. 

Also, the surgeon will remove some tissue from beneath the nipple and areola to check for cancer. If cancer is found in the nipple or areola, they will likely need to be removed in a second surgery. 

In most cases, the breasts are immediately reconstructed during a nipple-sparing mastectomy, with either tissue expanders, breast implants, or tissue flaps. 

Nipple-sparing mastectomy with immediate reconstruction has become popular because it tends to provide good, natural-looking 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 breast cancer 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 appear symmetrical. 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.

There are other scenarios in which your surgical team may recommend a series of procedures. For example, they may recommend that you have a “nipple delay” procedure a couple of weeks before you get a nipple-sparing mastectomy. During this procedure, the surgeon removes some tissue from beneath the nipple and areola to check for cancer cells. The surgeon also makes an incision to separate and nipple and areola from the skin underneath and surrounding it. This causes the blood vessels in the skin under and around the nipple to dilate and improves the chances that the nipple will have an adequate blood supply and remain healthy after the 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.

If you’ve been diagnosed with breast cancer, the surgeon will likely remove lymph nodes (sentinel lymph node dissection or axillary lymph node dissection) to see if the cancer has spread. 

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.

You may not be a good candidate for a skin-sparing mastectomy if you’ve decided that you will not have breast reconstruction immediately following the mastectomy. Also, the procedure may not be safe for people who have cancer cells close to or in the skin or those with inflammatory breast cancer.

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

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  all of the breast tissue

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  the skin of the breast

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  the nipple and the areola

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  the chest wall muscles under the breast

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  some of the lymph nodes under the arm

As a final step, your surgical team will create a flat, smooth chest or reconstruct one or both breasts.

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 (or risk-reducing) 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:

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  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

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  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

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  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

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  had radiation therapy to your chest before the age of 30

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

As a last step, your surgical team can create a flat, smooth chest or reconstruct your breasts.

With so many factors to compare when choosing the right surgical approach for you, it can be a difficult decision to make. This Breastcancer.org video describes how to work together with your doctor to make informed decisions.

 

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