What Is a Mastectomy?

A mastectomy is a surgery performed to remove the breast. In some cases, one breast is removed and in other cases both breasts are removed. The removal of one breast is called a unilateral mastectomy and the removal of both is called a bilateral mastectomy. A mastectomy is a surgical treatment option for breast cancer. Removing the breast tissue can prevent breast cancer from spreading or progressing to a more severe stage. There are different types of mastectomies and these are done most commonly with reconstruction.

A total, or simple mastectomy is the removal of the entire breast, including the nipple, areola and most overlying skin.  We rarely do this nowadays. Newer mastectomy procedures allow the skin and nipple over the breast to be saved. I like to offer most patients this option if it’s clinically indicated.  Most of our patients also opt to have reconstruction, and I have the privilege of working with wonderful plastic surgeons to complete the procedure.

New mastectomy procedures which allow the skin and nipple to be saved along with reconstruction surgery help to keep the appearance of the breast. Certain reconstruction procedures such as the deep inferior epigastric perforator or DIEP flap procedure allow for optimal cosmetic results.

Many patients who have been diagnosed with breast cancer decide with their doctors to undergo a mastectomy to lower the chance of recurrence of the disease. Removing the breast tissue greatly reduces a patient's risk of the cancer returning, and in turn, increases the chances of living a longer life.

Skin-sparing mastectomies are often effective for women, and in these procedures most of the skin over the breast is saved. Breast reconstruction can be performed immediately after the mastectomy in these cases. Skin-sparing mastectomy is only inefficient when there are large tumors or tumors near the surface of the skin.

Many surgeons try to stick with nipple-sparing mastectomies these days, which are also referred to as total skin-sparing mastectomies. The nipple and areola are difficult to reconstruct in a manner that appears natural and at the same time matches the nipple and areola of the other breast that has not been removed.

Patients opt for their nipples to be spared for this reason. They would like their breasts to appear as natural as possible after their mastectomy and reconstruction have been complete.

In previous decades, total mastectomies or simple mastectomies were often performed, before surgeons knew that skin and nipple sparing procedures could be just as effective. In a total mastectomy, the entire breast including the overlying skin, nipple and areola are removed.

Within the breast are 15 to 20 sections of lobes, which are arranged like flower petals. The lobes consist of smaller lobules, and these lobules have itty bitty bulbs at their ends which produce milk. Ducts connect all of these lobes, lobules and bulbs, and fat is present in the spaces between them. The bulbs are linked to the nipple by the ducts, and the area of darker skin around the nipple is called the areola. The breast contains blood vessels, lymph vessels and lymph nodes as well. On the other hand, the breast does not have any muscles within them. Muscles are present underneath the breast between the breast and the ribs.

There is a procedure that is rare nowadays called the radical mastectomy, and in a radical mastectomy, the breast, nipple, areola, overlying skin and the chest muscles are removed. In this procedure, even the lymph nodes under the arm are removed. Only if the cancer has spread to the chest muscles will a radical mastectomy be performed in current times. 

Preventive mastectomies can also be performed. If breast cancer is very common in your family and you are at high risk of developing the disease, you may choose to receive a preventive mastectomy.