What to know about having a mastectomy

Each year, more than 100,000 women with breast cancer in the United States undergo some type of mastectomy, or the surgical removal of one or both breasts. In most cases, the procedure is part of breast cancer treatment. But some mastectomies are prophylactic, meaning that they are used to prevent cancer in certain people at high risk.

Making the decision to undergo a mastectomy—and which type to have—involves a number of complex choices. Will you have a partial or total procedure? Will you need the procedure on one or both breasts? Will you opt for breast reconstruction at the time of the surgery? Or have you tested positive for a breast cancer gene (BRCA) mutation, which increases your risk for breast cancer, and are considering mastectomy as a preventive measure?

Here are the facts on the types of mastectomy surgery, plus what you should know as you embark on this process.

Different types of mastectomy

There are several different kinds of mastectomy. These include the following.

Partial mastectomy

Also known as breast-conserving surgery, lumpectomy, and quadrantectomy, this procedure involves removal of the tumor and some of the tissue around it, conserving the rest of the breast tissue. The amount removed depends on the size of the tumor and where it’s located. It might be part of a plan involving other treatments, like chemotherapy (drugs that kill cancer cells or decrease their growth) or radiotherapy (high-dose x-rays to treat cancer).

Total (simple) mastectomy

In this procedure, the whole breast is removed. In some cases, one or more axillary (armpit) lymph nodes are also removed, in an additional procedure called sentinel lymph node biopsy (SLNB). In a double total mastectomy, both breasts are removed.

Modified radical mastectomy

In this procedure, the entire breast and most of the lymph nodes are removed. As with a double total mastectomy, both breasts and sets of lymph nodes can be removed in some cases.

Radical mastectomy

In this extensive procedure, all breast tissue is removed, including the axillary lymph nodes and the chest muscles located under the breast. Radical mastectomy is rare today, and only performed if the cancer has spread to the chest muscles.

Skin-sparing mastectomy

In this procedure, as much of the healthy breast skin as possible is preserved while most of the tissue, the nipple, and the areola (the darker colored part of the nipple) are removed. This is usually used in cases where you opt for immediate breast reconstruction surgery.

Nipple-sparing mastectomy

Depending on the location of the tumor, the breast tissue can sometimes be removed, leaving the nipple, areola, and most of the healthy breast skin for reconstruction. This is usually only possible when the tumor isn’t located in or underneath the nipple. As with the skin-sparing procedure, it’s only used in cases where you are having immediate reconstructive surgery.

It’s not a “one size fits all” procedure

“The type of breast cancer surgery a patient has is based on the size, location, and biology of the tumor,” says Kay Shawchuck, MD, a breast cancer surgeon in Saint Petersburg, Florida. “We know so much more than we did 20 years ago, and that’s a great thing. There are more personalized treatments.”

Based on the tumor and your decision about reconstruction, you and your healthcare provider (HCP) can determine which treatment plan is right for you.

If cancer appears in one breast and the other remains healthy, a single mastectomy is a common treatment. However, some people opt to have a double mastectomy, in which both breasts are removed, as a precaution if there's a heightened risk for further cancer. This procedure, called contralateral prophylactic mastectomy (CPM), is becoming more popular. The number of people with cancer in one breast who opted for CPM doubled between 2016 and 2019 (up to 6.8 percent), according to one 2022 study published in Plastic Reconstructive Surgery – Global Open.

While there is little evidence showing that CPM improves survival rates, studies have found that it lowers breast cancer risk and can reduce concerns about developing and dying from the disease.

Talk to a plastic surgeon first

“It’s almost always appropriate and safe to have breast reconstruction surgery at the time of the mastectomy if the patient wants it,” says Dr. Shawchuck. She always asks her patients to see a plastic surgeon before making a decision to ensure they’re aware of what mastectomy reconstruction options are available.

Recovery times vary

With a partial mastectomy (lumpectomy), you can be back to work in just 5 to 10 days, but your HCP might recommend you avoid certain activities for up to two weeks. Without reconstruction, mastectomy recovery is usually three to four weeks. With reconstruction, recovery tends to be six to eight weeks.

Understand the risks

“The risks associated with having a mastectomy are those that come with any surgery, including bleeding, infection, and scarring after the procedure,” says Shawchuck. Infections that develop after surgery and bleeding occur in about 1 to 3 percent of surgery patients. The size of the surgical scar depends on the type of surgery and the size of your breasts. Other, less common risks include numbness, tingling, shoulder pain or stiffness, swelling of the arm, and nerve damage.

There is good news

“The [5-year] survival rate for breast cancer is much better than it was 30 years ago. [Five-year survival is the percentage of people who are alive five years after being diagnosed with breast cancer],” says Shawchuck. “Given all stages of breast cancer, survival is at least 90 percent."

HCPs are catching the disease earlier, she adds, and the variety of surgery options allows patients to feel confident about the way they look and feel afterward, whether they choose breast reconstruction or not. For further questions about breast cancer surgery and what your insurance covers, speak with your HCP.