Last updated: 11/24/2009

Removal of a patient's breast is usually recommended when cancer is present in the breast or as a prophylactic when the patient has severe fibrocystic disease and a family history of breast cancer. The choice of a simple mastectomy may be determined...

by evaluating the size of the breast, the size of the cancerous mass, where the cancer is located, and whether any cancer cells have spread to adjacent lymph nodes or other parts of the body. If the cancer has not been contained within the breast, it calls for a modified radical mastectomy, which removes the entire breast and all of the adjacent lymph nodes. Only in extreme circumstances is a radical mastectomy, which also removes part of the chest wall, indicated.

A larger tumor usually is an indication of more advanced disease and will require more extensive surgery such as a simple mastectomy. In addition, if a woman has small breasts, the tumor may occupy more area within the contours of the breast, necessitating a simple mastectomy in order to remove all of the cancer.

Very rapidlygrowing tumors usually require the removal of all breast tissue. Cancers that have spread to such adjacent tissues as the chest wall or skin make simple mastectomy a good choice. Similarly, multiple sites of cancer within a breast require that the entire breast be removed. In addition, simple mastectomy is also recommended when cancer recurs in a breast that has already undergone a lumpectomy, which is a less invasive procedure that just removes the tumor and some surrounding tissue without removing the entire breast.

Sometimes, surgeons recommend simple mastectomy for women who are unable to undergo the adjuvant radiation therapy required after a lumpectomy. Radiation treatment is not indicated for pregnant women, those who have had previous therapeutic radiation in the chest area, and patients with collagen vascular diseases such as scleroderma or lupus. In these cases, simple mastectomy is the treatment of choice.

Finally, some women, with family histories of breast cancer and who test positive for a cancer-causing gene, choose to have one or both of their breasts removed as a preventative for future breast cancer. This procedure is highly controversial. Though prophylactic mastectomy reduces the occurrence of breast cancer by 90% in high-risk patients, it is not a foolproof method. There has been some incidence of cancer occurring after both breasts were removed.