Women with breast cancer are often treated with a mastectomy, which is a surgery to remove all or part of your breast. The procedure isn’t a one-size-fits-all, and deciding what’s best for you is a personal decision to make with your care team.
Types of Mastectomies
A mastectomy can treat cancer by removing it and may also be used to prevent cancer from coming back. Your surgical options depend on your type of cancer, the size and location of the tumor and if the cancer has spread.
“Most often there are two good procedures, and the role of a breast surgeon before surgery is to educate,” says Dr. David Brenin, a surgical oncologist and the co-director of the UVA Breast Care Program and the High-Risk Breast and Ovarian Cancer Clinic. “We work with patients to compare the pros and cons of available options and arrive at a final decision that’s right for them.”
Types of mastectomies to treat breast cancer include:
- Partial: This is considered breast-conserving surgery. Only the part of your breast that has the cancer is removed, along with some normal tissue around the tumor.
- Total (or simple): This procedure removes the whole breast that has cancer. Your surgeon may also need to remove some lymph nodes under your arm.
- Modified radical: This removes your whole breast and many lymph nodes under your arm.
- Skin-sparing: This procedure removes your entire breast, but leaves most of the natural skin envelope behind for use during reconstruction.
- Total skin-sparing (or nipple-sparing): This procedure removes all your breast tissue, but leaves the nipple and all the skin behind to use during reconstruction.
Deciding What’s Best for You
Choosing how to move forward is a difficult, emotional decision. Some factors to consider with your medical team include your family history and risk of recurrence, as well as your personal feelings about your breasts and body image. In terms of treatment, you want to consider your ability to receive radiation (you’re less likely to need radiation after mastectomy than after a breast-conserving surgery) and whether you plan to have reconstructive surgery.
A Procedure for Preventative Measures
Some women choose to have the surgery to prevent the development of cancer. There are two primary options:
- Contra-lateral prophylactic: If you have cancer in one breast, you may choose to remove both breasts to help prevent developing a new cancer in the unaffected breast. It’s important to talk with your doctor about the risk of surgery versus the risk of developing cancer in the other breast, which is typically low. Dr. Brenin says that on average the risk of developing cancer in the other breast is less than 4 percent.
- Bilateral prophylactic: This procedure removes both breasts if you don’t yet have breast cancer but have a much higher than average risk of developing the disease.
At the UVA Cancer Center, women identified by their primary care physician or gynecologist as high risk would be seen at the High-Risk Breast and Ovarian Cancer Clinic. “We have ways to predict a person’s risk of developing breast cancer,” Dr. Brenin says. “Medical conditions and family history help determine the risk. We also have genetic testing and genetic counseling available. A prophylactic mastectomy may be an option for women who have a very high lifetime risk of developing breast cancer.”
Dr. Brenin emphasizes that mastectomies are one option of many for prevention. It’s important to have a detailed discussion with your medical team before deciding. Regardless of the type of procedure performed, most patients can undergo immediate or delayed breast reconstruction.
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