Thinking about cancer or dealing with cancer risk can be scary or overwhelming, but we believe that receiving information and resources is comforting, empowering, and lifesaving.
A generation ago, mastectomy meant one thing: removal of the breast and chest muscle. Today, different types of mastectomy are available. Sometimes circumstances determine which mastectomy is best for a patient, particularly when there is already a diagnosis of breast cancer. Further, the type of mastectomy may affect a woman’s options for reconstruction. When mastectomies are performed to reduce risk of breast cancer, reconstruction can be done at the same time. This “immediate reconstruction” has cosmetic advantages over “delayed reconstruction” which is performed anytime after mastectomy, and is sometimes necessary when mastectomy is recommended as treatment for breast cancer. It is important to have a discussion with your surgeon about the benefits, risks and limitations of each option.
A modified radical mastectomy removes the entire breast and includes “axillary dissection” (removal of the lymph nodes from the armpit).
A simple mastectomy removes the entire breast but does not include axillary dissection. Only lymph nodes that might be located within the breast tissue are removed during a simple mastectomy.
Skin-sparing mastectomy is performed to facilitate immediate breast reconstruction. Skin-sparing mastectomy incisions are smaller than those required for a modified radical or simple mastectomy. Most of the breast tissue is removed, but most of the breast skin is saved to hold and shape the reconstructed breast. In a skin-sparing mastectomy, the incision is made around the areola. Sometimes it is necessary to make another incision extending down or to the side to remove as much breast tissue as possible. Research shows skin-sparing mastectomies do not increase the risk for breast cancer recurrence in patients with early stage breast cancer. Skin-sparing mastectomies are now commonly used for prophylactic mastectomy followed by immediate reconstruction.
Nipple-sparing mastectomy is a type of skin-sparing procedure that allows a woman to retain her own areola and nipple. There are several different approaches to nipple-sparing mastectomy, so it's important to speak with your surgeon about their preferred approach. Some surgeons use an incision underneath the breast in the inframammary fold. This approach is sometimes known as a "Hidden Scar" procedure. By working through the incision under the breast, the new breast is reconstructed without visible scars. This approach can sometimes leave more breast tissue behind than a nipple-sparing mastectomy using a visible incision. Most physicians will not use the inframammary fold incision for women with cancer of the breast skin, or with tumors close to the nipple or areola.
Other surgeons prefer to make an incision around the areola. In this procedure, the nipple-areola complex may be completely removed from the breast, scraped clean of tissue and regrafted back onto the breast. During the surgery, a sample of the patient’s tissue beneath the nipple is tested. If cancer cells are found, the entire nipple-areolar complex is removed. Removing and regrafting the nipple usually causes it to lose most, if not all of its normal sensation and can change and flatten its shape.