Mastectomy can be therapeutic or risk-reducing. For many early-stage cancers, lumpectomy plus radiation gives similar survival to mastectomy. Modern mastectomy techniques (skin-sparing, nipple-sparing) and immediate reconstruction (implants or autologous flaps) improve outcomes. Sentinel node biopsy reduces axillary morbidity. Treatment planning should be multidisciplinary and individualized, accounting for tumor biology, genetic risk, and reconstruction timing.

Overview

Mastectomy remains a common treatment option for breast cancer and for people at high risk of developing it. Advances in surgical techniques and breast reconstruction have reduced the cosmetic concerns that once made mastectomy less appealing. The choice of procedure depends on cancer stage, tumor characteristics, genetic risk, and patient preference.

When is mastectomy used?

Mastectomy may be recommended for a therapeutic purpose (to remove known cancer) or as risk-reducing (prophylactic) surgery for people with very high lifetime risk. Risk-reducing mastectomy is considered by people with pathogenic variants in genes such as BRCA1 or BRCA2, a strong family history, or other high-risk conditions.

For many early-stage cancers, breast-conserving surgery (lumpectomy) followed by radiation achieves similar long-term survival to mastectomy. The decision between conservation and mastectomy depends on tumor size relative to the breast, number of tumor foci, genetic risk, prior radiation, and personal priorities.

Types of mastectomy

  • Simple (total) mastectomy: removes the breast tissue and nipple-areola complex but not the underlying chest muscles.
  • Skin-sparing mastectomy: preserves most of the breast skin to facilitate reconstruction.
  • Nipple-sparing mastectomy: preserves the nipple-areola complex when oncologically appropriate.
  • Modified radical mastectomy: removes the breast and most axillary lymph nodes but preserves chest muscles.
  • Radical (Halsted) mastectomy: historically included removal of chest wall muscles and is now rarely performed.
Sentinel lymph node biopsy often replaces full axillary dissection when nodes are clinically negative, reducing risk of arm lymphedema.

Reconstruction and timing

Reconstruction can be immediate (at the time of mastectomy) or delayed. Options include implants and autologous tissue flaps (for example, DIEP or TRAM-type reconstructions), sometimes combined with fat grafting. Immediate reconstruction generally preserves breast shape and can improve patient satisfaction, but prior or planned radiation therapy can affect reconstructive outcomes and may influence timing and technique.

Adjuvant treatments and impact on survival

Mastectomy treats the local tumor but does not substitute for systemic treatments when they are indicated. Chemotherapy, radiation, endocrine (hormone) therapy, and targeted therapies are used based on tumor biology and stage to reduce recurrence and improve survival. For most early-stage cancers, breast-conserving therapy plus radiation offers equivalent overall survival to mastectomy, while higher-stage disease and biologic features guide additional therapies.

Deciding factors and next steps

Decisions about mastectomy should follow accurate staging, discussion of genetic testing when appropriate, and a multidisciplinary review (surgery, medical oncology, radiation oncology, and plastic surgery). Considerations include expected cancer control, need for adjuvant therapy, reconstruction goals, recovery time, and long-term surveillance.

Shared decision-making - balancing oncologic safety, personal values, and quality of life - should guide whether to choose mastectomy and which type to perform.

FAQs about Mastectomy

Does having a mastectomy improve survival compared with lumpectomy?
For many early-stage breast cancers, breast-conserving surgery (lumpectomy) followed by radiation provides similar long-term survival as mastectomy. Choice depends on tumor size, multifocal disease, genetic risk, and patient preference.
What is a risk-reducing (prophylactic) mastectomy?
A risk-reducing mastectomy removes breast tissue to lower the chance of developing breast cancer. It is usually considered by people with high-risk genetic variants (for example, BRCA1 or BRCA2) or a very strong family history.
Can I have reconstruction at the time of mastectomy?
Yes. Immediate reconstruction is commonly offered and can use implants or the patient's own tissue. The timing and method may change if radiation is planned, because radiation can affect reconstruction outcomes.
What are the main mastectomy types I should know about?
Common types include simple (total) mastectomy, skin-sparing, nipple-sparing, and modified radical mastectomy. Radical mastectomy is rarely performed today.
Will removing the breast remove the need for chemotherapy or other treatments?
Not necessarily. Mastectomy addresses local disease, but systemic treatments (chemotherapy, endocrine therapy, targeted therapy) are recommended based on the cancer's stage and biology to reduce recurrence and improve survival.

News about Mastectomy

NHS boost for firm in Cornwall helping women after a mastectomy - Tavistock Times Gazette [Visit Site | Read More]

Margate breast cancer survivor who found lack of support after mastectomy creates Breast of Friends Kent charity - The Isle of Thanet News [Visit Site | Read More]

Tattoo artist offers free service to women after mastectomy - ITVX [Visit Site | Read More]

Is Double Mastectomy the Right Choice for You? - Yale Medicine [Visit Site | Read More]

FMD - When should preventive mastectomy be offered for women at higher risk of breast cancer - Queen Mary University of London [Visit Site | Read More]

Paterson pushed breast reconstruction, court hears - BBC [Visit Site | Read More]

Jessie J admits she's 'frustrated' in 'out of my control' breast cancer update - Manchester Evening News [Visit Site | Read More]