In a simple, or total, mastectomy, the entire breast including the skin, nipple and areola is removed, without removal of the lymph nodes from the armpit. The procedure is done by an elliptical incision leaving a single scar across the chest. Many women seek delayed breast reconstruction after simple mastectomy.
This refers to a technique that preserves as much of the breast skin as possible in order to perform an immediate breast reconstruction. A skin-sparing mastectomy can be performed as a “simple” (also known as “total”) mastectomy or, as a modified radical mastectomy (where the lymph nodes in the armpit are also removed). The breast surgeon removes just the skin of the nipple, areola and the original biopsy scar. Then, through a small opening, the breast tissue is removed. The remaining skin envelope is what provides the optimal shape and form to be able to accommodate an implant or reconstruction with your own tissue (known as autologous tissue). This kind of surgery encourages the most realistic type of reconstruction, with the patient retaining her own skin and a near-natural shape. A possible risk with this procedure is that the skin envelope becomes very thin and the blood supply can be compromised, leading to wound breakdown and skin loss.
In a nipple-sparing mastectomy the breast is removed while retaining the skin, nipple and areola, hence no nipple reconstruction is necessary. The decision for a nipple-sparing mastectomy depends on the location and type of cancer. Furthermore nipple-sparing mastectomy is offered to woman undergoing risk-reducing bilateral mastectomy.
In a radical modified mastectomy the entire breast is removed including the skin, nipple, areola, the lining over the chest muscle and the lymph nodes under the armpit. The chest muscle itself is not removed.
Bilateral risk-reducing mastectomy (or previously called prophylactic mastectomy) refers to mastectomy before a cancer has been found. It is a risk-reducing surgery rather than a prophylactic procedure as even after the mastectomy a small percentage of breast tissue is left, which still bears the risk of developing cancer. The reason for that is that the breast tissue does not sit in a well-defined shell like the kidney or the liver. Every woman carries the risk of developing breast cancer, particularly with ageing. Certain factors can increase the risk, and therefore risk-reducing mastectomy is offered when there is:
- Cancer in one breast: If there is a family history of breast cancer and one breast is already affected, then bilateral mastectomy can be considered.
- Family history of breast cancer: If two or more members of a family have developed breast cancer at a relatively young age, then this is considered a significant family history with an elevated risk of breast cancer.
- Positive Test for hereditary gene: the carriers of the faulty genes BRCA1 and BRCA2 have up to 90% risk of developing breast cancer by the age of 70.
It is important to remember that each surgical procedure will be unique to the individual, so it isn’t possible to give a definitive outcome for everyone. Likewise, every type of surgery involves some risk, and for some women who will have a breast removed, problems may arise. Be sure to explore your own particular risk and likely outcome in detail with your surgeon.