Types of mastectomy compared

A mastectomy is an operation to remove breast tissue, but the word covers several quite different operations. The four you are most likely to hear about are the simple (or total) mastectomy, the modified radical mastectomy, the skin-sparing mastectomy and the nipple-sparing mastectomy. All of them remove the breast gland tissue where cancer starts. What changes is how much skin is kept, whether the nipple and areola stay, and whether lymph nodes in the armpit are removed at the same time. A simple mastectomy removes the breast tissue, nipple and much of the skin, leaving a flat chest with a scar across it. A modified radical mastectomy removes the same tissue and also clears most of the lymph nodes in the armpit, usually when cancer is known to have spread to those nodes. A skin-sparing mastectomy keeps most of the breast skin so that a reconstruction can fill the pocket straight away. A nipple-sparing mastectomy keeps the skin and the nipple too, which suits some women with smaller cancers placed away from the nipple. The older radical mastectomy, which also removed chest muscle, is now rarely needed. No single type is better for everyone. Your surgeon suggests one based on the size and position of the tumour, the lymph node findings, your breast size, whether you want reconstruction and whether radiotherapy is planned.

Every type removes the breast tissue

The differences lie in the skin, the nipple and the lymph nodes, not in how thoroughly the gland is taken.

Lymph nodes are a separate decision

Many women have a small sentinel node biopsy rather than a full clearance of the armpit.

Reconstruction plans shape the choice

Keeping skin mainly matters if you plan to rebuild the breast at the same operation.

Each type of mastectomy involves trade-offs, and it helps to know them before you decide.

Keeping skin does not mean keeping sensation

Even when the nipple is kept, it is usually numb, and it will not respond to touch or cold as it did before.

The nipple may not survive

Its blood supply can be weakened, and sometimes part of the nipple skin dies and needs further treatment.

Radiotherapy can change the plan

If radiotherapy is likely after surgery, some surgeons advise delaying reconstruction or choosing a different type.

More skin kept is not safer or less safe by itself

For suitable women, research shows similar local control with skin-sparing surgery, but suitability matters.

What this page cannot tell you

It cannot say which type suits your tumour, your body or your wishes. That needs your scans, biopsy report and a surgeon's examination.

Recovery is broadly similar across all four types, but a few differences are worth knowing about.

Simple mastectomy

Many women go home within a day or two, often with a drain. Most light daily activities return within a few weeks, and shoulder exercises start early.

Modified radical mastectomy

Removing more nodes usually means a drain for longer, more stiffness in the shoulder and a higher chance of fluid collecting or arm swelling later on.

Skin-sparing and nipple-sparing surgery

Because reconstruction is usually done at the same time, the operation is longer and the hospital stay may be a little longer. Your team will watch the skin and nipple closely for healing problems.