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Mastectomy

What is a mastectomy?

 

A mastectomy is surgery to remove all of the breast tissue. The goal of this surgery is to remove cancerous tissue before it can spread to other areas of the body. Mastectomy may be combined with surgery for the axillary lymph nodes (under the arm), such as a sentinel lymph node biopsy or an axillary lymph node dissection. In most cases, survival is the same for mastectomy and breast-conserving surgery (removal of the breast cancer and some normal tissue). However, some women may not be good candidates for breast-conserving surgery.

 

Your doctor may recommend a mastectomy (rather than breast-conserving surgery) because:

  • The cancer is large in size relative to your breast size
  • The cancer is multicentric, which means there are several tumors present in different sections of the breast
  • The cancer is an "inflammatory breast cancer"
  • The chest wall or breast has received radiation in the past

For many women, the decision for breast-conserving surgery rather than mastectomy is a personal choice that must be made based on each patient's values and needs. There are many reasons why a patient may choose to have a mastectomy. Common reasons include:

  • The patient wants to minimize her risk of the cancer coming back in the breast as much as possible
  • The patient is at high risk of future breast cancer due to family history of a genetic mutation and wants to minimize the risk of developing breast cancer in the future
  • The patient wants to minimize her chance of needing radiation therapy

Patients choosing mastectomy should be aware that although the risk of cancer coming back in the breast or chest wall is lower than after breast-conserving surgery, it is not zero. Cancer can come back in the nearby skin, muscle or remaining breast tissue. For a small number of women, radiation is recommended after mastectomy.

 

Types of Mastectomy

 

There are several types of mastectomy that your surgeon will consider. The mastectomy chosen depends on the type of cancer, additional treatments that may be recommended and if reconstruction will be considered. 

  • Simple Mastectomy: The surgeon removes the breast tissue that contains the tumor as well as the area around the breast tumor, the areola and the nipple. The final scar is flat against the chest wall.
  • Skin-Sparing Mastectomy: The surgeon removes the entire breast, nipple and areola without removing of the breast skin. The surgeon makes a small incision around the areola that maintains the rest of the breast skin. This method is used when patients are having immediate breast reconstruction.
  • Nipple-Sparing Mastectomy: The surgeon removes the entire breast without removing the breast skin or the nipple/areola. This is an option when patients are having immediate breast reconstruction. Your doctor will talk with you about whether this method is appropriate for you. This depends on the size and location of the cancer, as well as the size of your breast.
  • Modified Radical Mastectomy: The surgeon performs a simple, skin-sparing or nipple-sparing mastectomy and an axillary lymph node dissection (removing lymph nodes under the arm). Underlying muscle is not removed.
  • Unilateral: The surgeon removes one side of the breast or one breast.
  • Bilateral: The surgeon removes both sides of the breast or both breasts.

What are my options following mastectomy to create a breast shape?

 

Permanent Prosthesis

 

Many women who do not have breast reconstruction can be fitted for a breast prosthesis. This is an artificial breast form that is specially fitted to your body. Breast prostheses come in many sizes and shapes. The breast form will replace the breast weight to balance your body and help prevent back and neck pain or a sagging shoulder.

 

Prosthetics are made of several types of materials (such as silicone gel, foam and fiberfill) that weigh and feel similar to natural breast tissue. Some prostheses adhere directly to the chest area, while others are held in place with a mastectomy bra. Prostheses can be made with an artificial nipple or in a special shape.

 

If you would like this option, you will get a prescription for a breast prosthesis and for bras. You can be fitted for your prosthesis four to six weeks after surgery (after the incision is healed). Prostheses and bras are available in UW Health’s CareWear store next to the Breast Center, and the American Cancer Society has a list of stores in your area that carry them. Please check with your insurance company about coverage.

 

Breast Reconstruction

 

This is done by a plastic surgeon after a mastectomy to restore the breast mound so that it is about the same shape and size as before removal. For women who did not have nipple-sparing surgery, an areola and nipple can be recreated. Breast reconstruction is a personal decision, one to be made by you.

 

If you would like breast reconstruction, you will meet with a plastic surgeon before breast surgery. You and your surgeon will decide which the type of reconstruction is best for you. This decision will depend on your specific needs, anatomy and previous treatments. It is important to know that not all types of breast reconstruction will work for everyone. Reconstruction may involve the use of implants or may use your own tissue from another area of your body (most often the abdomen).

 

See the publication "A Woman's Guide to Breast Reconstruction" for more information on these options.

 

Immediate Rather than Delayed Reconstruction

 

Immediate reconstruction happens at the same time of the mastectomy, during the same operation and under the same anesthesia. After the breast surgeon removes the breast tissue, a plastic surgeon does the reconstructive surgery.

 

Delayed reconstruction happens several months to several years after a mastectomy. Most often, reconstruction is delayed because radiation therapy was recommended after the mastectomy. To make sure that the skin has healed completely, reconstruction happens six to nine months after radiation and chemotherapy are finished. Your surgeon and team will discuss which option is best for you.