A mastectomy is the surgical removal of the entire breast, usually to treat serious breast disease, such as breast cancer.

There are four general types of mastectomy:

1. A SUBCUTANEOUS MASTECTOMY removes the entire breast, but leaves the nipple and areola (the pigmented circle around the nipple) in place.
2. TOTAL (OR SIMPLE) MASTECTOMY is the removal of the whole breast, but not the lymph nodes under the arm (axillary nodes).
3. In a MODIFIED RADICAL MASTECTOMY, the whole breast and most of the lymph nodes under the arm (axillary nodes) are removed. Removal of these lymph nodes is called an axillary dissection.
4. RADICAL MASTECTOMY involves removal of the chest wall muscles (pectorals) in addition to the breast and axillary lymph nodes. For many years, this operation was considered the standard for women with breast cancer, but it is rarely used today. It is mostly of historical interest.

While the patient is anesthetized (unconscious and pain-free), an incision is made into the breast. The breast tissue is removed from the overlying skin and the underlying muscle. When an axillary dissection is done, it is typically via the same incision.

One or two small plastic drains are usually left in place to prevent fluid from collecting in the space where the breast tissue used to be.

Your surgeon will decide when these drains are removed, typically when the amount of fluid draining decreases to an acceptable volume. This ranges anywhere from a few days to a week or more. Many women go home with their drains and have them removed during an office visit.

It is possible to reconstruct the breast (with artificial implants or native tissue) at the same operation (immediate reconstruction) or at a later date, after other necessary treatments are given (delayed reconstruction).

Reconstruction adds to the complexity of the surgery. Decisions about whether to undergo breast reconstruction, and the best timing are joint decisions between women and their doctors. It involves the consideration of many different individual factors.

The most common reason for performing a mastectomy is breast cancer.

Breast cancer is usually discovered when a lump, a change in the appearance of the breast (such as dimpling or puckering), or a suspicious mammogram is investigated. There are two main types of breast cancer surgery:

• The first is breast conservation, where only the tumor and a rim of surrounding tissue is removed. Breast conservation surgery, also known as lumpectomy or partial mastectomy, is usually followed by radiation therapy to the breast.
• The alternative to breast conservation surgery is removal of the entire breast, or mastectomy, which is the topic of this article.

Which type of surgery is best for which patients is a complex decision, taking many factors into account. If you are diagnosed with breast cancer, discuss with your doctor the relevant issues for your circumstances thoroughly and in as much detail as you need.

Important issues include the size of the tumor in relation to the size of your breast, whether there is more than one tumor in your breast, the side effects of radiation therapy, and your personal preferences.

Another reason for performing a mastectomy is when a breast contains widespread DCIS, or Ductal Carcinoma in Situ.

DCIS is a pre-cancerous condition, and has the potential to become invasive cancer if left in place. It is typically discovered when a suspicious mammogram alerts your doctor to perform a biopsy.

DCIS present in a small area can be removed with a lumpectomy, but when spread throughout the entire breast, might require a mastectomy. When mastectomy is done for DCIS, it usually does not require removal of the lymph nodes under the arm.

Preventive, or prophylactic mastectomy is the surgical removal of one or both breasts that do not contain cancer or DCIS, in an effort to prevent or reduce the risk of breast cancer.

A subcutaneous or a total mastectomy can be done. This surgery is an option to reduce the risk of breast cancer for women at extremely high risk of developing breast cancer.

Prophylactic (preventative) mastectomy is an alternative to intensive screening, and is undertaken only after very careful consideration, often including genetic testing and a psychiatric evaluation.

Women who might consider propylactic mastectomy include those with a strong family history of breast cancer, especially if relatives are diagnosed at a very early age.

Some families have a known genetic mutation that predisposes to breast cancer (BRCA1 or BRCA2), and individuals can be tested for these genes. Inherited mutations in these genes increase the lifetime risk of developing breast cancer. It is important to note that prophylactic mastectomy greatly reduces, but DOES NOT ELIMINATE the risk of breast cancer.