Types of mastectomy explained | CION Cancer Clinics

There are five main types. A simple mastectomy removes the whole breast. A modified radical mastectomy removes the breast and most of the armpit lymph nodes. Skin-sparing and nipple-sparing operations keep more of the outer skin. A radical mastectomy, which also removes the chest muscles, is now very rarely done.

Why the names confuse people

The names describe two separate things: how much of the breast and skin is removed, and what is done in the armpit. "Radical" sounds frightening, but a modified radical mastectomy keeps the chest muscles. A skin-sparing operation still removes all of the breast tissue. Your consent form may use a different name for the same thing, so ask the surgeon to explain it in plain words.

What every type has in common

All of them are done under a general anaesthetic, so you are asleep. All of them aim to remove the breast tissue that holds the cancer. And all of them send what is removed to the laboratory, where the report decides what treatment comes next.

Your team chooses the type from your scans, your biopsy report and an examination. This page cannot make that choice for you, but it can tell you what they weigh.

The cancer itself

They look at the size of the cancer, how close it sits to the skin and nipple, and whether it is in more than one part of the breast. If the skin is red, swollen or dimpled because the cancer has reached it, the skin-sparing and nipple-sparing types are usually not suitable.

The armpit

If scans and a needle test show cancer in the armpit nodes, more of them may need removing. If the armpit looks clear, a sentinel node biopsy is usually enough to start with.

You and the rest of your plan

Smoking, poorly controlled diabetes and earlier radiotherapy to the chest all make skin-keeping operations riskier. Whether you want a new breast shape made, now or later, also matters. So does whether radiotherapy is likely after surgery.

It cannot tell you which type is right for you. That depends on your scans, your biopsy report and a surgeon examining you. It also cannot tell you what your chest will look like afterwards.

Questions to ask your surgeon

Ask which type is being planned and what that name means in your case. Ask what will be done in the armpit. Ask whether a skin-keeping operation is possible, and if not, why not. Ask whether a new breast shape can be made now or later, and how often their surgeons do this kind of operation.

Why a second look at the reports is reasonable

Asking another surgical oncologist to review the same scans and biopsy slides is normal, and a good surgeon will not be offended. It is most useful when you have been told a skin-keeping or nipple-keeping operation is not possible and want to understand why. Keep copies of every report so nothing needs repeating.