Surgical options
Mastectomy is not one single operation.
Mastectomy removes breast tissue, but the amount of skin and whether the nipple can be preserved vary according to the cancer and the reconstructive plan.
The term “mastectomy” should therefore be followed by a clear description of what will be removed, what will be preserved and whether reconstruction will be performed.
Why might mastectomy be recommended?
- The disease involves a large area of the breast
- Multiple areas of cancer cannot be removed through one breast-conserving operation
- Clear margins cannot be achieved
- The patient has previously received breast radiotherapy
- Radiotherapy is not medically suitable
- There is a high inherited risk of another breast cancer
- Inflammatory or locally advanced disease requires a particular surgical plan
- The patient chooses mastectomy after reviewing reasonable alternatives
Does mastectomy remove the need for radiotherapy?
Not always.
Post-mastectomy radiotherapy may still be recommended according to tumor size, lymph-node involvement, surgical margins, response to preoperative treatment and other pathological findings.
The possibility of radiotherapy should be discussed before reconstruction whenever possible.
Skin-sparing and nipple-sparing surgery
Skin-sparing mastectomy preserves much of the breast skin for reconstruction.
Nipple-sparing mastectomy also preserves the nipple–areola complex. Not every patient is eligible, and preserved skin or nipple tissue can develop problems with blood supply or healing.
Preservation of the nipple does not preserve normal nipple sensation.
Mastectomy without reconstruction
Reconstruction is optional.
Some patients choose to remain flat after mastectomy. The surgical goal should then include a smooth, comfortable chest contour rather than assuming that reconstruction will be performed later.
The decision not to undergo reconstruction is a valid treatment preference.
Questions for the surgical team
- Why is mastectomy being recommended?
- Is breast-conserving surgery still a medically reasonable option?
- Will the skin or nipple be preserved?
- Could the final pathology change the radiotherapy recommendation?
- Is immediate reconstruction appropriate?
- What happens if the skin does not heal adequately?
- Could reconstruction delay chemotherapy?
- What follow-up will be required after I return home?