A mastectomy is surgery to remove a breast. In the past, a radical mastectomy with complete removal of the breast was the standard treatment for breast cancer. However, surgical breakthroughs over the past two decades have given women more options than ever before. Less invasive breast-conserving therapy may be equally effective as mastectomy for treating breast cancer for some women.
The type of mastectomy and treatment for breast cancer depends on several key factors, including:
tumor stage (how far it has spread)
tumor grade (aggressiveness)
tumor's hormone receptor status
whether or not lymph nodes are involved
Here's information about the various types of mastectomy that are available today for treating breast cancer.
Women who have a high genetic or familial risk of breast cancer may elect to have a preventive mastectomy. Preventive mastectomy is also called prophylactic mastectomy. It may be a total mastectomy with the removal of the entire breast and nipple. Or it may be a subcutaneous mastectomy, where the breast is removed but the nipple is left intact.
Studies show that the occurrence of breast cancer may be reduced by 90% after preventive mastectomy in women with high risk for this disease. Sometimes, women who have had breast cancer in one breast will decide to have a preventive mastectomy to remove the other breast. This can reduce the chance of cancer recurrence. In some cases, both breasts are removed. This is called a double mastectomy.
Breast reconstruction can be done at the time of the preventive mastectomy (immediate reconstruction) or it can be scheduled for a later time (delayed reconstruction). During breast reconstruction, the surgeon may use synthetic implants or tissue flaps from another part of the body to create a breast.
What Is a Partial Mastectomy?
Doctors may perform a partial mastectomy for women with stage I or stage II breast cancer. The partial mastectomy is a form of breast-conserving therapy in which the part of the breast containing the tumor is removed. This procedure is then followed by radiation therapy to the remaining breast tissue. With radiation therapy, powerful X-rays target the breast tissue. The radiation kills cancer cells and prevents them from spreading, or recurring in the area of the breast.
A lumpectomy (wide local excision) removes just the tumor and a small cancer-free area of tissue surrounding the tumor. If cancer cells are found later, the surgeon may remove more of the tissue. This procedure is called re-excision.
Another type of partial mastectomy is called a quadrantectomy. For this procedure, the surgeon removes the tumor and more of the breast tissue than is removed with a lumpectomy.
In some cases, more surgery is required after a partial mastectomy. Sometimes, if cancer cells are still in breast tissue, it may be necessary to remove the entire breast.
What Is a Radical Mastectomy?
A radical mastectomy is the complete removal of the breast, including the nipple. The surgeon also removes the overlying skin, the muscles beneath the breast, and the lymph nodes. Because radical mastectomy isn't more effective than other less extreme forms of mastectomy, it's rarely performed today.
A less traumatic and more widely used procedure is the modified radical mastectomy (MRM). With the modified radical mastectomy, the entire breast is removed as well as the underarm lymph node. But pectoral muscles are left intact. The skin covering the chest wall may or may not be left intact. The procedure may be followed with breast reconstruction.
American Cancer Society: "Surgery for Breast Cancer."
National Comprehensive Cancer Network: "Breast Cancer: Treatment Guidelines for Patients."
Cancer Net: "Guide to Breast Cancer."
BreastCancer.org: "What is Mastectomy?"