Mastectomy

A mastectomy removes the breast tissue and, depending on the type performed, may also remove the nipple and areola, surrounding skin, and nearby lymph nodes. The main types include a simple or total mastectomy, which removes the breast tissue and nipple; a skin-sparing mastectomy, which preserves most of the breast skin to facilitate reconstruction; and a nipple-sparing mastectomy, where the nipple and areola are kept intact when the tumor location and anatomy allow.

A modified radical mastectomy removes the breast tissue, nipple, and the lymph nodes in the axilla (underarm), and is used when cancer has spread to nearby nodes. A bilateral mastectomy removes both breasts — either because cancer is present in both, or as a risk-reduction strategy for women at very high genetic risk. The choice of mastectomy type depends on tumor size and location, breast size, personal preference, and reconstructive goals.

Breast reconstruction can begin at the time of mastectomy (immediate reconstruction) or at a later date (delayed reconstruction). Options include implant-based reconstruction or using the patient's own tissue from the abdomen, back, or thighs. Many women find discussing reconstruction options before surgery helps them feel more prepared and in control of the overall experience.

Deciding whether to have a mastectomy — and which type — is one of the most significant decisions in a breast cancer journey. For many women, lumpectomy with radiation offers equivalent survival outcomes to mastectomy, making the choice deeply personal rather than medically dictated. Understanding your options allows you to weigh factors like convenience, peace of mind, body image, and reconstruction possibilities.

For women with BRCA1 or BRCA2 mutations, a preventive (prophylactic) bilateral mastectomy can dramatically reduce lifetime breast cancer risk. This is a major surgery, and the decision deserves careful consideration with a genetic counselor, surgeon, and oncologist. Whatever path you choose, knowing that mastectomy techniques and reconstruction options have advanced significantly in recent decades can be reassuring as you move through the decision-making process.