Mastectomy – a mastectomy is the removal of all breast tissue, as defined by anatomic boundaries of the breast. The most common reason for this procedure is a treatment of breast cancer, but there are other reasons that this procedure may be needed. For example, when a woman is diagnosed with a gene mutation that increases their lifetime risk of breast cancer, a mastectomy can be done prophylactically as a risk-reducing procedure, to avoid a breast cancer diagnosis in the future.
A mastectomy can be done with or without reconstruction or rebuilding a “breast”, which can be done in several ways. If no reconstruction is desired or even recommended, typically due to other health problems, the breast tissue and the excess skin is removed to make the chest flat with a single scar.
If reconstruction is desired, there are three basic ways that a mastectomy can be done to facilitate breast reconstruction, which is often begun on the same day as the mastectomy, during the same surgery.
The first way to do this is called a skin-sparing mastectomy and removes all of the breast tissue and the nipple-areolar complex (nipple projection, all ductal tissue, and the surrounding pigmented skin), but leaves the rest of the skin and subcutaneous fat to facilitate placement of a tissue expander or breast implant. This removes as much breast tissue as possible, while still allowing for breast reconstruction.
The second way to do this is called an areolar-sparing mastectomy and removes only the nipple projection (including the ductal tissue) and leaves the pigmented areolar skin and the rest of the breast skin as well, again to facilitate placement of a tissue expander or implant.
The third way to do this is called a nipple-sparing mastectomy, and removes only the breast tissue, leaving the nipple projection with potentially a very small amount of ductal tissue, surrounding pigmented areolar skin and the rest of the breast skin to facilitate placement of a tissue expander or implant.
Incision locations are variable for each of these types of mastectomies and are dependent on your surgeons’ preference, your breast size and degree of ptosis or “sagging”, which will determine how likely the nipple will survive and/or be in the correct place after the mastectomy and reconstruction.