A simple or total mastectomy is a surgical procedure that removes the all of the breast tissue when cancer is present, or if a person is at high risk for developing cancer. There are several types of mastectomies performed, and a simple mastectomy is less invasive than so-called radical procedures. In a more radical procedure, breast tissue and lymph nodes are entirely removed, and the chest muscles located underneath the breast are also surgically excised. Radical procedures are now often modified so that breast tissue and lymph nodes are removed but the chest muscles are not.
There are actually several surgical options that may be considered total mastectomy. Sometimes surgeons prefer to remove and biopsy one lymph node in the underarm with removal of the breast. This could give more information about the cancer or its spread. Alternately, there are several surgeries that are called skin or nipple-sparing. While these remove the breast tissue underneath the skin, they may leave all or most of the skin and/or the nipple intact.
If the spread of cancer is significant, skin-sparing procedures may not be adequate, and along with breast tissue most skin and the nipple is removed in the classic total mastectomy procedure. When spread is not a concern, women may very well opt for skin-saving surgeries because they make breast reconstruction much easier to accomplish. There aren’t precise numbers on the increased risk of cancer recurrence if skin remains, but doctors may estimate this at one to five percent, depending on the type of cancer.
The basic indication for a total mastectomy is the presence of cancer, or a high risk of cancer that prompts consideration of a prophylactic mastectomy. At the time of the surgery, physicians can remove a single breast (unilateral) or both (bilateral). Candidates for a simple mastectomy usually don't show an indication of cancer spreading to the lymph nodes, or the modified radical procedure is considered instead.
From a surgical standpoint, total mastectomy is common and usually a simple procedure. Skin-sparing variants use different incisions and may take a little more finesse, but are performed often. An uncomplicated surgery without reconstruction takes a couple of hours to perform, and the last step is typically placement of a drain in the breast that helps siphon off fluid accumulation. This is removed in a few days once drainage tapers off, and women typically go home from the hospital two to three days after surgery, though they may need to stay longer if chemotherapy or other treatments are initiated.
The fact that total mastectomy is common doesn’t mean it is easy. While the surgery isn’t associated with high physical pain levels, it can be uncomfortable and emotionally daunting. Women need ongoing support as they face such a radical change in physical appearance, while still fighting a challenging disease. Family and friend support very helpful, and professional assistance of counselors or therapists is also recommended to cope with these changes.
