Depending on your risk factors, there are different types to choose from.
“Most women [who] are diagnosed with breast cancer will have surgery at some point during their treatment,” says Jaime Alberty-Oller, MD, breast cancer oncologist and surgeon at the Dubin Breast Center at Mount Sinai Hospital.
One of the primary types of breast cancer surgery is a mastectomy. This surgery is not only used to treat breast cancer, but just as importantly, to help prevent the cancer from returning in the future.
A mastectomy can be summed up as the complete removal of the breasts, but there are different types:
A total mastectomy removes all parts of the breast, including the nipple, areola, and skin.
A skin-sparing mastectomy removes the breast and nipple while leaving the skin over the breast intact. Then, implants are used to reconstruct the breast, using the woman’s natural skin.
A nipple-sparing mastectomy leaves both the skin and the nipple (and areola, the darker area around the nipple) intact. This is typically followed by breast reconstruction surgery.
A modified radical mastectomy is a total mastectomy that also removes the axillary lymph nodes, which are the lymph nodes under the arm. This is used when the cancer has spread to the nearby lymph nodes.
In some cases, the type of mastectomy that a woman gets may depend on her personal preference, but often there are certain risk factors that must be considered. For example, if the cancer cells are close to the surface of the skin, a skin-sparing mastectomy might not be safe or appropriate.
Breast cancer surgery is often not done alone. Other cancer therapies—such as hormone therapy, chemotherapy, radiation therapy, or targeted therapy—can be done either before or after surgery. Usually, when other therapies are used before surgery, the goal is to shrink the tumor so that a woman can get a lumpectomy instead of a mastectomy. (Learn more about the difference between lumpectomy and mastectomy here.)
Alternatively, using other cancer therapies after surgery can help eliminate any cancer cells that may have spread beyond the breasts and reduce the risk of recurrence.
“The most important thing is to get the cancer out, and do a surgery that is safe, oncologically speaking,” says Dr. Alberty-Oller.
Planning on receiving a mastectomy?
Dr. Alberty is a surgical breast oncologist at the Dubin Breast Center of the Tisch Cancer Institute at Mount Sinai Hospital.
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So mastectomy is a surgery in which
we take out all of the breast tissue.
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There are moments where a mastectomy will
be necessary which means that a patient
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will not be a candidate for
breast conservation or a lumpectomy.
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And that would be one if
the cancer is multicentric,
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which means that the cancer is sort
of scattered throughout the breast.
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Never patient has any medical conditions
that would preclude them from
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getting radiation, and they would
need a mastectomy from the get go.
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When we talk about mastectomy
as a surgery for breast cancer,
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we can talk about different types.
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One would be total mastectomy which is a
surgery where you take out all the breast
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tissue sometimes with the nipple and
the areola, and
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sometimes you will leave
a large portion of skin behind.
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That would make it
a skin-sparing mastectomy, and
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the idea there is that we're trying
to leave as much skin as possible so
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that the reconstructive surgeon
can create a breast mount that
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looks as much as the breast
look before surgery.
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Another type of mastectomy is
a nipple-sparing mastectomy,
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otherwise known as
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And the idea with this surgery is that
you're removing the entire breast tissue
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while leaving behind both the skin and
the nipple-areola complex.
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And again, the idea with this surgery is
that you're trying to make the breast look
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as much as possible that's
how it look before surgery.
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Unfortunately, not every single
patient will be a candidate for this.
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The majority of patients will
get either a total mastectomy or
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a skin-sparing mastectomy.
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Another type of mastectomy is something
we call a modified radical mastectomy.
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And that is a term that will
include both the total mastectomy,
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which again is a surgery that
removes the entire breast tissue and
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it will also include excision of all
the axillary lymph nodes under the arm.
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We do know that if you
do get a mastectomy,
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the chances of the cancer coming back or
having what we call recurrence is very low
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in the range of 1 to 2%,
but it's never zero.
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And so it's important for us to drive
that point that when you decide to choose
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a surgery, whether it be a lumpectomy or
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in the majority of cases,
your overall survival will be the same.
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But you're always gonna have to have
follow up, whether it be with your
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surgeon, whether it be with some imaging,
either mammogram or ultrasound.
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Mastectomy. Atlanta, GA: American Cancer Society, 2017. (Accessed on September 30, 2019 at https://www.cancer.org/cancer/breast-cancer/treatment/surgery-for-breast-cancer/mastectomy.html.)
Mastectomy. Washington, DC: MedlinePlus, U.S. National LIbrary of Medicine. (Accessed on September 30, 2019 at https://medlineplus.gov/mastectomy.html.)
Mastectomy: indications, types, and concurrent axillary lymph node management. Waltham, MA: UpToDate, 2019. September 30, 2019 at https://www.uptodate.com/contents/mastectomy-indications-types-and-concurrent-axillary-lymph-node-management.)