Who should get a mastectomy?
Mastectomy is the removal of the breast, including the nipple and areola. Women who are advised to have mastectomy instead of lumpectomy are women who have:
- Had radiation to the breast
- Multiple tumors in the breast occupying several quadrants of the breast
- Extensive DCIS that occupies a large area of the breast tissue
- A large tumor compared to breast volume
- A strong family history of breast cancer or who test positive for certain genetic mutations like BRCA1 and BRCA2
Your physician will guide you in deciding which mastectomy to have, but as always, you should be an active part of any decisions that directly affect your treatment. Your surgeon should explain all the options to you in full, listening carefully to your questions and addressing each and every one of your concerns.
For iPad and iPhone users, watch the YouTube version of the animation of a mastectomy procedure.
MYTH: If I’ve had a mastectomy, I cannot have a breast cancer recurrence. Get the facts.
What are the types of mastectomy?
At the Johns Hopkins Breast Center, our team of breast cancer specialists is committed to preserving as much as possible of a woman’s natural look and feel of her breast when combined with reconstruction.
At Johns Hopkins, the skin sparing mastectomy is the most common type of mastectomy surgery performed for breast cancer treatment. This animation shows and describes this advanced surgical procedure, which preserves the skin during the removal of one or both breasts, allowing for a better breast reconstruction result.
There are several types of mastectomies:
- Total simple mastectomy – This is removal of the breast, nipple and areola. No lymph nodes from the axillae are taken. Recovery from this procedure, if no reconstruction is done at the same time, is usually one to two weeks. Hospitalization varies; for some it may be an outpatient procedure and other patients may require an overnight stay.
- Modified radical mastectomy – This procedure is removal of the breast, nipple and areola as well as axillary node dissection. Recovery, when surgery is done without reconstruction, is usually two to three weeks.
- Skin sparing mastectomy – This is the removal of the breast, nipple and areola, keeping the outer skin of the breast intact. It is a special method of performing a mastectomy that allows for a good cosmetic outcome when combined with a reconstruction done at the same time. A tissue expander may also be placed as a space holder for later reconstruction.
- Nipple sparing mastectomy – A newer technique, this kind of mastectomy is reserved for a smaller number of women with tumors that are not near the nipple areola area. Your surgeon will make an incision on the outer side of the breast or around the edge of the areola and hollow out the breast, removing the areola and keeping the nipple intact. This method involves simultaneous reconstruction. Sometimes the completed reconstruction is done at the same time and in other cases, a tissue expander is inserted as a space holder for later reconstruction.
- Nipple and areola sparing mastectomy – In this newer procedure, your surgeon will make the incision on the side of your breast or in some cases, around the edge of the areola. The breast will be hollowed out and reconstruction is performed at the same time. In some cases, a tissue expander may be placed as a space holder for later reconstruction
- Scar sparing mastectomy – This is a fairly new form of surgery which was developed at Johns Hopkins Medicine, as well as other major cancer centers. The affected breast is hollowed out. Whether done as skin sparing, nipple sparing, areola sparing or a combination, one goal of this surgery is to minimize the surgical incisions that are visible. It is not uncommon for an entire mastectomy procedure to be performed through an opening that is less than two inches in length.
- Preventive/prophylactic mastectomy – Prophylactic mastectomy is a surgery designed to remove one or both breasts in order to dramatically reduce the risk of developing breast cancer. Women who test positive for certain genetic mutations like BRCA1 and BRCA2, or who have a strong family history of breast cancer, may elect to do this kind of surgery. They may also elect to have their ovaries removed at the same time. Genetic counseling may help to confirm or eliminate any nagging suspicion about family history.
When preventive this type of mastectomy is performed, no lymph nodes need to be removed, since there is no evidence of cancer. For preventive purposes, you should have a mammogram performed within 90 days of the procedure to ensure that the breast tissue being removed is healthy. Women can undergo simultaneous reconstruction of any kind after mastectomy; there is no medical need to delay reconstruction. All forms of mastectomy listed above are options, excluding modified radical mastectomy. This is a complicated decision and requires the guidance of breast cancer specialists who can explain all the potential risks and complications of taking this extraordinary step.