Type of mastectomy

Page 3 of Breast Cancer Surgery: When Mastectomy Is Best

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  • Simple or total mastectomy. In a simple mastectomy, the entire breast is removed. Doctors typically recommend simple mastectomy when a biopsy of the sentinel lymph node doesn't show any cancer in the lymph nodes.
  • Radical mastectomy. When the pectoral muscles, underlying chest wall, and all underarm lymph nodes are removed along with the breast tissue, it's called a radical mastectomy. This used to be the standard treatment for breast cancer, but more recently doctors have concluded that it's only necessary when cancer has spread to the chest muscles.
  • Modified radical mastectomy. This is the most common type of mastectomy used today. The difference between this procedure and a radical mastectomy is that with the modified version, the surgeon removes the lymph nodes but preserves the muscles of the chest wall. Along with the benefit of keeping the muscles themselves, it allows for breast reconstruction for those who want it.
  • Skin-sparing mastectomy. A new technique that's gaining in popularity, skin-sparing mastectomy uses an incision that circles the nipple and areola, instead of a traditional incision across the breast. This technique minimizes scarring and leaves the plastic surgeon more flexible options for reconstruction. Skin-sparing mastectomies are usually performed only for women who definitely plan to have reconstructive surgery. A skin-sparing mastectomy is only safe when doctors are sure cancer cells have not spread within the skin.
  • Subcutaneous or total skin-sparing mastectomy. The entire breast tissue is removed, but the nipple and areola remain. (This is also called nipple-sparing mastectomy.) Total skin-sparing mastectomy can't be done if cancer is located in or close to the nipple, which is a common location for breast tumors. Usually the requirement is that the tumor be smaller than 2 centimeters and located more than 2 centimeters away from the nipple. The surgeon makes an incision around the nipple, leaving the areola intact.
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