The Who, What, Where, When and Sometimes, Why.

Mastectomy

Mastectomy is the surgical removal of the entire breast.

Some women have the option of mastectomy or lumpectomy (also called breast-conserving surgery) plus radiation therapy, and choose mastectomy. For other women, mastectomy is the only breast cancer surgery option.

With mastectomy, the surgeon removes all of the breast tissue. In most, but not all cases, the nipple and areola are also removed.

Learn more about the surgical procedure and what to expect after the surgery.

Treatment for breast cancer in women

Mastectomy is an option for women who have:

Mastectomy is also used to treat breast cancer that has recurred (come back) after treatment with lumpectomy plus radiation therapy.

Treatment for breast cancer in men

Mastectomy is the main treatment for breast cancer in men. This is because men have little breast tissue and most tumors in men occur under the nipple.

Learn more about treatment for breast cancer in men.

Contralateral prophylactic mastectomy

Contralateral prophylactic mastectomy is the removal of the opposite (contralateral) healthy breast in a woman with breast cancer in one breast. It’s usually done at the same time as breast cancer surgery.

Sometimes, there may be cosmetic reasons to consider surgery to the contralateral breast. For example, some women may choose to have a breast reduction of the contralateral breast to create a more even look with a reconstructed breast.

However, removing the contralateral breast does not lower the risk of dying from the original breast cancer [6].

The National Comprehensive Cancer Network (NCCN) recommends contralateral prophylactic mastectomy only be considered for women who have a very high risk of breast cancer due to a BRCA1 or BRCA2 (or certain other inherited gene mutations) to try and prevent breast cancer in the contralateral breast [7].

Bilateral prophylactic mastectomy

Women with BRCA1/2 or certain other inherited gene mutations who haven’t been diagnosed with breast cancer, may have both breasts removed to try to prevent breast cancer. This is called bilateral prophylactic mastectomy.

Types of mastectomy

There are 2 main types of mastectomy: total (simple) and modified radical. Your diagnosis guides the type of mastectomy you will have.

Figure 5.2 below shows the types of mastectomy and describes when each is used.

Figure 5.2

Total (simple) mastectomy

The surgeon removes the entire breast and the lining of the chest muscle, but no other tissue.

For some women, much of the skin of the breast may be left intact for breast reconstruction (called a skin-sparing mastectomy).

In some cases, the nipple may also be left intact (called a nipple-sparing mastectomy).

A sentinel node biopsy may be done, or no lymph nodes may be removed, depending on the breast cancer.

Total (simple) mastectomy may be used to treat:

  • Ductal carcinoma in situ (DCIS)
  • Paget disease of the breast with underlying DCIS
  • Invasive breast cancer
  • Breast cancer recurrence

Total mastectomy is also used for women at high risk who have prophylactic mastectomy.

Sometimes breast reconstruction is done at the same time as a mastectomy.

Modified radical mastectomy

The surgeon removes the entire breast, the lining of the chest muscles and the lymph nodes in the underarm area (axillary nodes).

Modified radical mastectomy may be used to treat:

  • Invasive breast cancer
  • Inflammatory breast cancer
  • Paget disease of the breast with underlying invasive breast cancer

Sometimes breast reconstruction is done at the same time as a mastectomy.

Skin-sparing mastectomy and nipple-sparing mastectomy

If you are having breast reconstruction at the same time as a mastectomy, the surgeon may be able to use a skin-sparing technique, or possibly a nipple-sparing technique.

A skin-sparing mastectomy removes all of the breast tissue, but saves much of the skin of the breast. The plastic surgeon can use this skin as an envelope to help form the reconstructed breast.

A nipple-sparing mastectomy is a skin-sparing mastectomy that also preserves the nipple and areola.

Mastectomy with breast reconstruction

Some women choose to have breast reconstruction to help restore the look of the breast that was removed.

Reconstruction may be done at the same time as the mastectomy (immediate) or later (delayed). In general, cosmetic results are better with immediate reconstruction.

Discuss your reconstruction options with your plastic surgeon before breast surgery.

Not all women choose to have reconstructive surgery. Some women choose to get a breast prosthesis. Others choose to “go flat”, with no reconstruction or prostheses.

Learn more about breast reconstruction.

Learn about insurance coverage and financial assistance for breast reconstruction

Read our blog, Despite What Doctors Told Me, I’ve Never Regretted My Decision to Go Flat After a Double Mastectomy.

Mastectomy with breast prosthesis

If you don’t want to have breast reconstruction, you can get a breast prosthesis. This is a breast form made of silicone gel, foam or other materials that’s fitted to your chest.

The form is placed directly on top of your skin or in the pocket of a special bra.

The surgeon will leave the area as flat as possible so the prosthesis can be comfortably fitted to your chest.

Your prosthesis can be properly fitted several weeks after your mastectomy surgery.

Your health care provider can discuss breast prosthesis options with you and help you choose the type that best fits your lifestyle.

Learn about insurance coverage for breast prosthesis and financial assistance for breast prosthesis.

Breast prosthesis and air travel

Susan G. Komen® wants to ensure people who have breast cancer are treated with respect and dignity.

When you travel by air, these steps may be helpful:

  • Arrive at the airport earlier than usual, so you have time to go through secondary screening if needed.
  • If you are concerned about going through the body scanner for any reason, request a private pat-down screening.
  • If you choose, or are selected for, a pat-down screening, you may request a private screening away from public areas.
  • If you feel comfortable, tell the Transportation Security Administration (TSA) agent you are wearing a breast prosthesis. If you prefer to give this information discreetly, the TSA has a notification card you can give to the agent (find this card on the TSA website).
  • You will not be asked to remove your prosthesis, but you may be asked to lift or lower clothing to show your breast prosthesis in a private screening area. It’s OK for a companion or other person you choose to go with you to the screening area. A disposable drape will be available upon request. If you have concerns, you can remove your prosthesis before you go through security and put it through the X-ray screening in your carry-on.
  • If you feel uncomfortable for any reason, it’s always OK to ask to talk with a TSA supervisor.
  • It’s strongly advised you pack your breast prosthesis (if not wearing it) or medications in carry-ons, rather than in checked luggage.

Learn about TSA screening if you wear a wig, scarf or other head covering.

Learn about TSA screening if you wear a compression sleeve.

If you have concerns about airline security screening, visit the TSA website.

 

Radiation therapy

Most women who have a mastectomy don’t need radiation therapy.

However, in some cases, radiation therapy is used after a mastectomy to treat the chest wall, the lymph nodes in the underarm area (axillary nodes) and the lymph nodes around the collarbone.

If your treatment plan includes chemotherapy, you will have radiation therapy after you finish chemotherapy.

When is a lumpectomy plus radiation therapy an option to a mastectomy?

Some women can have a lumpectomy plus radiation therapy instead of a mastectomy.

Learn about deciding between lumpectomy and mastectomy.

Treatment guidelines

Although the exact treatment for breast cancer varies from person to person, guidelines help ensure high-quality care. These guidelines are based on the latest research and agreement among experts.

The National Comprehensive Cancer Network (NCCN) and the American Society of Clinical Oncology (ASCO) are respected organizations that regularly review and update their guidelines.

In addition, the National Cancer Institute (NCI) has treatment overviews.

Talk with your health care team about which treatment guidelines they use.

Transportation, lodging, child care and elder care assistance

You may not live near the hospital where you’ll have your surgery.

Sometimes, there are programs that help with local or long-distance transportation and lodging. Some also offer transportation and lodging for a friend or family member going with you.

There are also programs to help you with child care and elder care costs.

Learn about transportation, lodging, child care and elder care assistance programs

 SUSAN G. KOMEN® SUPPORT RESOURCES 

  • If you or a loved one needs more information about breast health or breast cancer, call the Komen Breast Care Helpline at 1-877 GO KOMEN (1-877-465-6636). All calls are answered by a trained specialist or oncology social worker in English and Spanish, Monday through Friday from 9:00 a.m. to 10:00 p.m. ET. You can also email the helpline at helpline@komen.org
  • We offer an online support community through our closed Facebook Group – Komen Breast Cancer group. The Facebook group provides a place where those with a connection to breast cancer can discuss each other’s experiences and build strong relationships to provide support to each other. Visit Facebook and search for “Komen Breast Cancer group” to request to join the closed group.
  • Our fact sheets, booklets and other education materials offer additional information.

Updated 05/19/21