Last updated: 11/24/2009

Simple mastectomy is one of several types of surgical treatments for breast cancer. Some techniques are rarely used; others are quite common. These common surgical procedures include:

• Radical mastectomy is rarely used, and then only in cases...
  
  where cancer cells have invaded the chest wall and the tumor is very large. The breast, muscles under the breast, and all of the lymph nodes are removed. This produces a large scar and severe disability to the arm nearest the removed breast.
• Modified radical mastectomy was the most common form of mastectomy until the 1980s. The breast is removed along with the lining over the chest muscle and all of the lymph nodes.
• Simple, sometimes called total, mastectomy has been the treatment of choice in the late 1980s and 1990s. Generally, only the breast is removed; though, sometimes, one or two lymph nodes may be removed as well.
• Partial mastectomy is used to remove the tumor, the lining over the chest muscle underneath the tumor, and a good portion of breast tissue, but not the entire breast. This is a good treatment choice for early stage cancers.
• Lumpectomy just removes the tumor and a small amount of tissue surrounding it. Some lymph nodes may be removed as well. This procedure is gaining acceptance among surgeons and patients alike.

Two other surgical procedures are variations on the simple mastectomy. The skin-sparing mastectomy is a new surgical procedure in which the surgeon makes an incision, sometimes called a keyhole incision, around the areola. The tumor and all breast tissue are removed, but the incision is smaller and scarring is minimal. About 90% of the skin is preserved and allows a cosmetic surgeon to perform breast reconstruction at the same time as the mastectomy. The subcutaneous mastectomy, or nipple-sparing mastectomy, preserves the skin and the nipple over the breast.

During a simple mastectomy, the surgeon makes a curved incision along one side of the breast and removes the tumor and all of the breast tissue. A few lymph nodes may be removed. The tumor, breast tissue, and any lymph nodes will be sent to the pathology lab for analysis. If the skin is cancer-free, it is sutured in place or used immediately for breast reconstruction. One or two drains will be put in place to remove fluid from the surgical area. Surgery takes from two to five hours; it is longer with breast reconstruction.

Breast reconstruction

Breast reconstruction, especially if it is begun at the same time as the simple mastectomy, can minimize the sense of loss that women feel when having a breast removed. Although there may be other smaller surgeries later to complete the breast reconstruction, there will not be a second major operation nor an additional scar.

If there is not enough skin left after the mastectomy, a balloon-type expander is put in place. In subsequent weeks, the expander is filled with larger amounts of saline (salt water) solution. When it has reached the appropriate size, the expander is removed and a permanent breast implant is installed.

If there is enough skin, an implant is installed immediately. In other instances, skin, fat, and muscle are removed from the patient's back or abdomen and repositioned on the chest wall to form a breast.

None of these reconstructions have nipples at first. Later, nipples are reconstructed in a separate surgery. Finally, the areola is tattooed in to make the reconstructed breast look natural.

Breast reconstruction does not prevent a potential recurrence of breast cancer.