What are the three levels of mastectomy?Let’s start with understanding the three levels of mastectomy: 1) A total mastectomy removes the breast tissue, nipple, areola, and some skin around the incision. This procedure commonly follows cancers that occur in two or more areas of the breast or those that extend beyond a biopsy's edges. 2) A modified radical is similar to a total mastectomy, but includes an axillary dissection or sentinel node biopsy. This is now the most commonly performed mastectomy. 3) Previously, the radical mastectomy was the most common procedure—removing muscle, lymph nodes, and skin. However, now this is rarely performed.
Do I really need a mastectomy?In some cases, a lumpectomy with radiation is as effective as mastectomy. Given the choice, most American women choose a mastectomy—even when the outcomes of the two procedures will yield the same result. As with any surgical procedure, it's always advisable to get a second opinion from a surgeon in a different practice. Recent advances in the mastectomy procedure help save normal body tissue, such as the breast skin and areola, that doesn't necessarily need to be removed in every patient. Every patient’s circumstances are unique and so are mastectomies. For instance, preventive mastectomies are different than mastectomies for cancer or when lumpectomies don't work.
Will my nipple be removed, and will there be scaring?It depends on the individual’s situation, however, it is possible to have a mastectomy and save the nipple. There are also situations when a mastectomy is done with a "hidden" or "scarless" approach. Advances in microsurgery and breast surgery allow surgeons to perform mastectomies with hidden scars, similar to a breast lift or augmentation procedure, without leaving scars on the breast skin. Patients who are candidates for this surgery preserve their breast skin—including the nipple and areola. This technique begins with an incision under the arm, under the breast fold, around the nipple, or down the bottom of the breast below the bra line. Reconstruction involves using a one of the perforator flap techniques (DIEP, SIEA, or GAP), where the relocated tissue fills in and shapes the breast. Ask if your plastic surgeon works with a breast surgeon who considers these options when planning your mastectomy. Also if a reconstruction is scheduled immediately following mastectomy and you have completed chemotherapy and/or radiation, the mastectomy may be done in a way to make the overall result of your reconstruction better.
Have more questions? Our doctors are happy to provide their expertise.