A mastectomy is a surgery to remove the breast. Five types of mastectomies are available. Each of them has unique features that might make it a good choice for you.
Mastectomies are typically performed to treat breast cancer. They may also be performed to prevent breast cancer in people who are at high risk.
In this article, you can take a closer look at these five types of mastectomies, including what they look like, what they involve, and who is more likely to have each type.
The five types of mastectomies are:
- total mastectomy
- modified radical mastectomy
- radical mastectomy
- partial mastectomy
- nipple-sparing mastectomy
Each of the five types is different. Their unique features may make one type of mastectomy better for you than another type. Your doctor or surgeon will review the options with you if you’re considering a mastectomy as part of your breast cancer treatment.
For all types of mastectomies, most people will stay a night or two in the hospital immediately following the surgery. Your stay may be longer if you experience any complications.
Recovery from a mastectomy can take several weeks. Most people can expect about four weeks to recover. During this time, your movement and activities will be limited.
Your recovery period may be longer if you have any type of reconstruction immediately following the mastectomy. People undergoing a radical mastectomy may also have a longer recovery period because the surgery is so extensive.
Talk with your surgeon about what you can expect from recovery. This will allow you to set realistic expectations about returning to your everyday activities.
A total mastectomy’s also known as a simple mastectomy. The focus of this surgery is removing all the breast tissue, including the nipple and areola.
Your surgeon will not typically remove nearby lymph nodes unless the lymph nodes are within the breast tissue they need to remove. Likewise, no chest muscles or tissue beneath the breast are removed during this type of mastectomy.
Some people get this surgery as a preventive measure. In these cases, a surgeon removes the whole breast in order to reduce the risk of breast cancer in people who are considered high-risk. You may choose to do this to both breasts, which is known as a double mastectomy.
Modified radical mastectomy
During a modified radical mastectomy, your surgeon will remove all breast tissue as well as several lymph nodes under the arm. The lymph nodes will likely be tested to see if the breast cancer has spread beyond the breast tissue.
In a modified radical mastectomy, no muscles below the breast are removed. As with a total mastectomy, those muscles remain intact.
This type of mastectomy is often an option for people who have invasive breast cancer, or for people whose doctors expect to find a higher stage cancer.
About breast cancer staging
Doctors divide breast cancer into stages based on the size of the tumor and how much it has spread. Breast cancers that are large or have spread to nearby tissues or organs are at a higher stage than cancers that are small or still contained within the breast.
During a radical mastectomy, your surgeon will remove all the breast tissue, as well as all the lymph nodes under the arm and around the breast. Your surgeon also removes the chest wall muscles directly below the breast.
In the past, doctors often used radical mastectomy to treat breast cancer. Today, it’s less common. That’s because modified radical mastectomies are often as successful, and they aren’t as extensive. Plus, the modified surgery may have fewer risks and a shorter recovery time.
A partial mastectomy is a surgery that removes the cancerous part of a person’s breast tissue, as well as some of the healthy tissue around the tumor. However, it does not remove all the breast tissue.
You might get this type of mastectomy if you have early stage cancer that has not moved beyond the original cancerous site.
A lumpectomy, a surgery to remove cancerous breast tissue, is a type of partial mastectomy, but they’re not quite the same. A partial mastectomy removes more tissue than a lumpectomy.
As the name suggests, a nipple-sparing mastectomy aims to remove all the breast tissue while leaving the nipple intact. However, if any of the tissue surrounding the nipple or areola shows signs of cancer, your surgeon may ultimately need to remove these, too.
This type of mastectomy is typically only an option for people who have early stage breast cancer with a very small tumor.
Despite preserving the nipple during surgery, you may lose feeling and sensitivity. It’s worth speaking with your doctor about the pros and cons of preserving the nipple during a mastectomy.
After cancerous breast tissue is removed, you may be thinking about restoring your breast’s shape. People who have had a mastectomy often want to restore the breast mound, but it’s also not uncommon to skip the restoration and “go flat” instead.
If you decide to go with reconstruction, know that you don’t have to do so right away. You can put off reconstruction for days, months, or even years. In fact, if you’re undergoing any other breast cancer treatments, like radiation or chemotherapy, you may decide to postpone reconstruction until those treatments are done.
Reconstruction has several forms. Some people may opt for a full silicone implant for their breast reconstruction. In other cases, a plastic surgeon may be able to use body fat, muscle, and tissue from another part of your body to rebuild a breast. Nipple reconstruction is also possible for some people.
If you don’t get reconstruction, you can also choose to use a breast prosthesis. Several options are available, each with its own pros and cons.
A prosthesis may be an ideal first step for some people who are not sure if they’d like a more long-term solution like reconstructive surgery. You can also use a prosthesis if you’re undergoing other breast cancer treatments and are not ready for reconstructive surgery yet.
Type of breast prostheses include:
- External silicone breast prosthesis. This type of breast form is often weighted so it feels more natural. In fact, it’s designed to match your natural breast tissue’s weight. This can make you feel more balanced and even improve posture or balance issues that may occur after a mastectomy.
- Non-silicone breast prosthesis. These lightweight breast forms are often made from foam or a material called fiberfill. These prostheses are ideal for use with exercise, swimming, and on hot days, when the lighter material is more comfortable.
- Soft form in camisole. This prosthesis is a removable breast that you can wear inside a camisole, or a stretchy top often worn under blouses. You can also pull a camisole up over your hips, if you have trouble lifting clothes over your arms.
- Attachable breast. You can use a self-adhesive breast form and attach it to your chest wall with adhesive strips. These strips will help the breast form stay in place comfortably and securely.
- Partial breast prosthesis. This type of prosthesis is also called a shaper or shell. These forms are typically made from lightweight foam or fiberfill, but sometimes heavier silicone is used. You can position them over your chest wall or your breast tissue. They’re designed to balance out the size of your breasts and to make them more uniform.
The Women’s Health and Cancer Rights Act (WHCRA) is a law that was passed in 1998. This law requires group health insurance companies to cover the cost of both breast mastectomy and breast reconstruction following any type of mastectomy.
In fact, the WHCRA says that a health insurance plan must pay for reconstruction at any point, even years after your mastectomy. The insurance company must also pay for breast prostheses and the treatment of any health complications from your surgery.
However, coverage does not mean low cost. If you have insurance, it’s a good idea to talk with your doctor and then with your plan administrator about what costs will look like for you. Your costs will be based on the array of treatment options your doctor gives you and your specific plan’s coverage.
Medicare covers breast reconstruction, but Medicaid’s coverage varies by state.
Keep in mind that total costs for this type of surgery may go beyond the surgery itself. You will want to consider costs like transportation and housing if a family member needs to come to the hospital with you and stay while you’re in the hospital. You may also need short-term treatments like physical or occupational therapy.
Your doctor will be able to provide you with a clear plan for treatment and recovery. This plan will help you understand what services you will need, and what they may cost.
Coverage if you’re uninsured
A mastectomy and breast reconstruction can be costly, but some organizations aim to help people who need the surgeries afford it more easily.
One of these groups is My Hope Chest. Founded in 2003, this nonprofit helps people with breast cancer get reconstruction after a mastectomy. My Hope Chest is funded by donations and works closely with national breast cancer organizations. Together, they find doctors and other health care professionals who want to help people on the My Hope Chest waiting list.
A mastectomy is one possible option for breast cancer treatment. It removes breast tissue, and it sometimes removes lymph nodes and chest muscles near the breast.
Some people may have a mastectomy along with another form of breast cancer treatment, such as radiation or chemotherapy. Your doctor can help you decide if a mastectomy is right for you — and if it is, which of the five types of mastectomies is best.
The earlier a cancer is found through mammogram or self-examination, the better the options for treatment and recovery. But whatever stage you’re at, there is a treatment journey that is right for you.