Types of Mastectomy

Mastectomy techniques have evolved considerably along with the development of breast reconstruction. Surgeons now have several approaches at their disposal. Factors like breast size, skin quality, symmetry, tumor location, desired breast size, and pre-existing scars all influence which method best suits a given patient.

Mastectomy design and quality impact breast reconstruction options and results. A mastectomy approach should be carefully tailored to the individual patient and the type of reconstruction they hope to have. 

Patients considering reconstruction should make sure that their breast surgeon is in contact with their plastic surgeon during this process. The two doctors can and should work together to determine which type of mastectomy best suits your case and goals.

Traditional Mastectomy

Surgeons place a final breast implant at the time of mastectomy.

A traditional mastectomy removes the central breast skin, including the nipple and areola, with the underlying gland. This approach leaves a scar across the central breast. Advances in breast reconstruction, including immediate breast reconstruction options, have shifted favor away from this method.

Skin-sparing Mastectomy

A skin-sparing mastectomy removes the breast tissue, nipple, and areola while preserving most of the skin over the breast.
A skin-sparing mastectomy preserves most of the normal breast skin and allows for a reconstruction with more natural contour and less visible scarring. It removes the nipple and areola for oncologic reasons, as they are immediately associated with the underlying breast tissue.

Large studies on oncologic outcomes after skin-sparing mastectomy suggest that this approach is just as effective as traditional mastectomy in clearing breast cancer. Reconstruction after skin-sparing mastectomy can be based on implants or the patient’s own tissue (autologous). Nipple-areola reconstruction takes place at a second stage, depending on patient wishes.

Nipple-sparing Mastectomy

A nipple-sparing mastectomy removes the breast tissue while preserving the nipple, areola, and most of the skin over the breast.
A skin-sparing mastectomy can be extended to preserve the nipple and areola (pigmented skin around the nipple) in select patients. This nipple-sparing mastectomy approach is best suited for patients with favorable breast skin (no excessive ptosis or skin redundancy) who meet a very specific set of diagnostic criteria. While it facilitates the most natural-looking breast reconstruction, the nipple’s intimate association with underlying glandular breast tissue presents potential oncologic concerns.

In the past, nipple-sparing procedures showed an increased risk of cancer recurrence when compared to traditional mastectomies. However, more recent studies have defined criteria that appropriately identify patients in whom cancer in the nipple without any additional symptoms is highly unlikely. These patients may be candidates for nipple-sparing mastectomy.

Breast surgeons may consider a nipple-sparing technique for patients with a tumor that is sufficiently small (typically less than 3-4 cm) and far (at least 2-4 cm) from the nipple. This approach is also appropriate for patients undergoing risk-reducing mastectomies.

Implant and autologous reconstruction options are both available after nipple-sparing mastectomy. While nipple-areola reconstruction is not necessary, patients may choose a second stage surgery to refine the reconstruction.

Areola-sparing Mastectomy

An areola-sparing mastectomy removes the breast tissue and the nipple itself while preserving the areola (pigmented skin around the nipple) and most of the skin over the breast.
An areola-sparing mastectomy provides a naturally-appearing breast reconstruction that is almost comparable to a nipple-sparing mastectomy, while decreasing the oncologic concerns associated with a nipple-sparing mastectomy. An areola-sparing technique preserves the pigmented skin around the nipple, while the nipple itself is removed. This approach is typically paired with autologous reconstruction. In those cases, the underlying flap is used to reconstruct the nipple at the time of mastectomy and immediate reconstruction.
An areola-sparing mastectomy is best suited for patients with favorable breast skin (no excessive ptosis or skin redundancy) who are candidates for autologous breast reconstruction.
If an implant reconstruction is utilized with a areola-sparing mastectomy, the nipple can later be reconstructed using the skin of the areola for the nipple mound.

Skin-reducing Mastectomy

A skin-reducing mastectomy uses an incision pattern that removes excess skin.
A skin-reducing mastectomy uses a skin-reduction incision pattern, as is typically used in breast reduction and breast lift procedures. It suits patients with significant breast ptosis and excess skin. This approach allows a surgeon to remove excess skin in a way that creates a more favorable reconstructed breast shape. This technique may also result in less conspicuous scarring as compared to a traditional mastectomy.

This allows the removal of any excess skin in a manner that results in a more favorable shape of the reconstructed breast. Also, this approach may result in a less conspicuous scar as compared to a standard mastectomy approach.