About Mastectomies

Mastectomy is removal of breast tissue. Most patients think, somewhat mistakenly, that a mastectomy removes all of the breast tissue. It turns out, that is not possible. There is breast tissue that extends right up to the skin and out into the arm pit. A mastectomy aims to remove most, or about 90%, of the breast tissue. Even though 10% of breast tissue remains, we still tend to say that mastectomy “removes all the breast”. There are several different types of mastectomy.

  • “Simple” or “Total” mastectomy – In this procedure the surgeon removes the breast tissue along with the nipple areolar complex. The surgeon does not perform an 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. The surgeon may recommend a sentinel lymph node biopsy, a procedure that removes the lymph nodes that receive the drainage from the breast. No muscles are removed from beneath the breast.

  • Variations on the Total mastectomy – skin sparing mastectomy and nipple sparing mastectomy. In order to try to improve the cosmetic outcome of a breast reconstruction, surgeons started to leave more and more skin for the Plastic Surgeons to use as part of the reconstruction. Eventually, surgeons reached a point where they were only taking the nipple areolar complex and otherwise preserving the skin envelope. The technique of saving most of the skin has now been demonstrated to be a safe cancer surgery in appropriately selected patients. This approach is now called a “Skin sparing mastectomy” and is common in women who desire a reconstruction. To try to further improve the natural appearance of the breast, surgeons and patients started to look at saving the nipple areolar complex. This is known as a Nipple sparing mastectomy. This is one of the newer advances in breast surgery. It has become very common in appropriately selected patients. It appears to be safe but we are still waiting on long term studies to finalize that assessment. This is a particularly good option for prophylactic surgery where the goal is risk reduction. Small breast cancers that are well removed from the nipple tissues are also candidates for this procedure.

  • Modified radical mastectomy involves the removal of both the breast tissue and the associated lymph nodes in the arm pit. A modified radical mastectomy is a total mastectomy combined with an axillary lymph node dissection. No muscles are removed from beneath the breast. This procedure is indicated for women who need a mastectomy for their breast cancer and who also have positive lymph nodes.

  • Radical mastectomy is the most extensive type of mastectomy. The surgeon removes the entire breast plus an axillary lymph node dissection. What defines the radical mastectomy is that the surgeon also removes the muscle that is between the breast and the chest wall, specifically the pectoralis muscle. Before we had other options for treatment like chemotherapy and radiation, this was the standard procedure for breast cancer. Now, it is rare to do this procedure. It is reserved for advanced cases of breast cancer that involve the chest wall.

  • Partial mastectomy is the name of the procedure when the tumor is removed with a margin of normal breast tissue around it but the rest of the breast is left in place. In this case, mastectomy means removing breast tissue and the word partial clarifies that only a portion of the tissue will be removed. This procedure is also called a “lumpectomy” or breast conservation. A variation on the partial mastectomy are many oncoplastic procedures. Oncoplastic surgery use a variety of techniques to reform a breast mound after the lump has been removed. Oncoplastics is a broad term that includes relatively minor tissue rearrangement all the way up to using a breast reduction and lift procedure to remove the cancer. At Alaska Breast Care and Surgery, we are knowledgeable on all the different techniques that can be used to do a lumpectomy. Dr. Sandford even helped to write a textbook that is now used to teach other breast surgeons the wide variety of techniques that are available. Oncoplastic surgery has a place but what we have found is that many patients prefer simpler surgeries to complex ones. When they have cancer, they also prefer quicker recovery and healing to a longer recovery so we tend to do more of the less involved oncoplastic techniques on our Alaskan patients. We do take steps in every surgery to try to ensure the best cosmetic outcome even when the goal is a quick recovery.

    What to expect on the day of your mastectomy.