When a lot of breast tissue must be removed to get rid of the tumor(s),
a mastectomy may be a better option.
This may be the case when:
- There are two or more tumors in different areas of the breast (multi-centric tumors).
- The tumor is large (relative to breast size).
- The tumor has spread throughout the breast (diffuse tumor).
- The mammogram showed large areas of calcifications in the breast.
- The tumor is located just beneath the nipple (such that the cosmetic look
after lumpectomy will not be good).
- The surgeon cannot get negative margins with multiple attempts by lumpectomy
Some patients simply prefer this option. Because the breast tissue is totally
removed with this option, most patients with a small, early stage cancer
do not require radiation therapy afterwards, although there are exceptions.
The potential for radiation therapy will be an important consideration
in discussing the optimal timing and type of breast reconstruction for you.
Breast cancer surgery does not have to be disfiguring or deforming. Advances
in surgical techniques for breast cancer have allowed women to complete
their cancer treatment without sacrificing their body image or self-esteem.
Balancing your cancer treatment with the cosmetic outcome can be an important
consideration when determining the best choice for you.
Types of Mastectomies
Simple mastectomy – removal of the entire breast. The option of immediate breast reconstruction
should be discussed.
Modified radical mastectomy
(simple total mastectomy with axillary node dissection) – removal of the entire breast and the surrounding lymph nodes in
the armpit, but leaving the chest wall muscle intact.
Radical mastectomy – removal of the entire breast, along with the underlying chest
wall muscle and the surrounding lymph nodes in the armpit. This is much
less commonly done today.
Standard – removal of the entire breast and nipple/areola along with enough overlying
skin to allow for closure of the incision. Most commonly performed when
reconstruction is not planned. A breast prosthesis and post-mastectomy
bra are prescribed after recovery.
Skin-sparing total (simple) mastectomy – removal of the entire breast and nipple/areola while keeping the
overlying skin, thus maintaining the natural shape and contour of the
breast. Studies have demonstrated that this is a safe approach, and does
not increase the risk of cancer recurrence. This technique is typically
used when immediate breast reconstruction is planned.
Nipple-sparing total (simple) mastectomy – removal of the entire breast, while keeping the nipple/areolar
and overlying skin. Some breast tissue is left behind the nipple with
this approach. The nipple sensitivity is not preserved. Sometimes, the
nipple does not heal well after surgery. While not as commonly performed,
studies have demonstrated that this is a safe approach in carefully selected
patients. Your surgeon and plastic reconstructive surgeon will help you
decide if this is the right approach for you.
Click here for a list of questions to ask your surgeon about a total mastectomy.