Simple mastectomy: In this procedure, also called total mastectomy, the surgeon removes the entire breast, including the nipple, but does not remove underarm lymph nodes or muscle tissue from beneath the breast. (Sometimes lymph nodes are removed in a different procedure during the same surgery.) Sometimes both breasts are removed (a double mastectomy), often as preventive surgery in women at very high risk for getting cancer in the other breast. Most women, if they are hospitalized, can go home the next day. Simple mastectomy is the most common type of mastectomy used to treat breast cancer.
Skin-sparing mastectomy: For some women considering immediate reconstruction, a skin-sparing mastectomy can be done. In this procedure, most of the skin over the breast (other than the nipple and areola) is left intact. This can work as well as a simple mastectomy. The amount of breast tissue removed is the same as with a simple mastectomy.
This approach is only used when immediate breast reconstruction is planned. It may not be suitable for larger tumors or those that are close to the surface of the skin. Implants or tissue from other parts of the body are used to reconstruct the breast. This approach has not been used for as long as the more standard type of mastectomy, but many women prefer it because it offers the advantage of less scar tissue and a reconstructed breast that seems more natural.
A variation of the skin-sparing mastectomy is the nipple-sparing mastectomy. This procedure is more often an option for women who have a small early-stage cancer near the outer part of the breast, with no signs of cancer in the skin or near the nipple. In this procedure, the breast tissue is removed, but the breast skin and nipple are left in place. This is followed by breast reconstruction. The surgeon often removes the breast tissue beneath the nipple (and areola) during the procedure, to check for cancer cells. If cancer is found in this tissue, the nipple must be removed. Even when no cancer is found under the nipple, some doctors give the nipple tissue a dose of radiation during or after the surgery to try to reduce the risk of the cancer coming back.
There are still some problems with nipple-sparing surgeries. Afterward, the nipple does not have a good blood supply, so sometimes it can wither away or become deformed. Because the nerves are also cut, there is little or no feeling left in the nipple. In women with larger breasts, the nipple may look out of place after the breast is reconstructed. As a result, many doctors feel that this surgery is best done in women with small to medium sized breasts. This procedure leaves less visible scars, but if it isn’t done properly, it can leave behind more breast tissue than other forms of mastectomy. This could result in a higher risk of cancer developing than for a skin-sparing or simple mastectomy. This was a problem in the past, but improvements in technique have helped make this surgery safer. Still, many experts consider nipple-sparing procedures too risky to be a standard treatment for breast cancer.
Modified radical mastectomy: This procedure is a simple mastectomy and removal of axillary (underarm) lymph nodes. Surgery to remove these lymph nodes is discussed in further detail later in this section.