Types of Mastectomy: Preventive, Partial, and Radical

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. But medical breakthroughs over the past two decades have given women with breast cancer more options than ever before. One of those options is breast-conserving therapy (BCT). That means some women are able to choose treatment procedures that are far less invasive and just as effective.

The appropriate type of mastectomy and treatment for breast cancer depend on several key factors, including:

• age
• general health
• menopause status
• tumor size
• 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.

What is preventive mastectomy?

Women who have a high genetic or familial risk of breast cancer may elect to have preventive mastectomy surgery. 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% or more 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. When it is, it's called an immediate reconstruction. It can also be scheduled for a later time. When it is, it's known as delayed reconstruction. During breast reconstruction, the surgeon may use synthetic implants or tissue flaps from another part of the body.

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 breast-conserving therapy in which the part of the breast containing the tumor is removed. This procedure is then followed by radiation therapy for the remaining breast tissue. With radiation therapy, powerful X-rays target some of the breast tissue. The radiation kills cancer cells and prevents them from spreading.

A lumpectomy 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.