Making the Decision to Have a Mastectomy

If you are not able to have breast-conserving surgery, you may want to think about a mastectomy, which may be the better option for you. This is surgery to remove the entire breast and sometimes nearby tissues. There are 3 main types of mastectomies:

  • Total mastectomy. The surgeon removes your whole breast. This is also called a simple mastectomy.

  • Modified radical mastectomy. The surgeon removes your whole breast, most of the lymph nodes under your arm, and often the lining over your chest muscles. Sometimes your doctor has to remove one of your two chest muscles.

  • Radical mastectomy. This is rarely done now because of the side effects. This is also called a Halsted radical mastectomy. The surgeon removes the breast, both of the chest muscles under the breast, and all of the lymph nodes under your arm.

For total mastectomies and modified radical mastectomies, the surgeon may be able to use a skin-sparing technique. In this technique, the surgeon removes the breast tissue but leaves most of the skin over the breast, except for the nipple and areola. A skin-sparing mastectomy is used only when immediate breast reconstruction is planned. 

The type of surgery you have depends on the stage of the cancer and the size and location of the tumor.

Your doctor may suggest that you have a mastectomy if you fit one or more of the following cases:

  • You have inflammatory breast cancer.

  • You’re pregnant and the radiation that is needed after breast-conserving surgery could harm your unborn baby.

  • You have already had radiation treatment on the affected breast.

  • You have more than one tumor, and they are too far apart to do breast-conserving surgery.

  • You’ve had breast-conserving surgery that didn’t get the whole tumor.

  • You have a hardening of your connective tissue due to scleroderma or other conditions that would make radiation impossible.

  • Your tumor is large compared with your breast size.

  • You have lobular carcinoma in situ and you have a high risk of developing breast cancer. Some women choose bilateral prophylactic mastectomy to prevent cancer from developing in either breast.