If you are reading about the types of mastectomy, it helps to know that each one removes a different amount of breast skin and nearby tissue.
Knowing these names can help you follow what your surgical team says, and the final choice is always made together with them.
This guide is part of the wider life after breast cancer surgery section, which covers recovery, health and wellbeing.
| Type | In plain language |
|---|---|
| Total (simple) mastectomy | Removes the whole breast, including nipple, areola, breast tissue and skin |
| Modified radical mastectomy | Same as a total mastectomy, plus lymph nodes under the arm |
| Skin-sparing mastectomy | Whole breast removed, skin left; may not be an option for large tumours |
| Nipple-sparing mastectomy | Whole breast removed; skin, nipple and areola are left |
| Radical mastectomy | Now rarely performed; removes chest wall muscles and all lymph nodes |
These summaries come from the National Cancer Institute; information can change, so please check the source for the latest details.
What a mastectomy is
A mastectomy is surgery that removes the whole breast. The National Cancer Institute describes it as an operation in which the surgeon removes the whole breast that contains ductal carcinoma in situ (DCIS) or cancer. The Canadian Cancer Society adds that a mastectomy is done in a hospital while a person is under anesthesia, usually a general anesthetic, as set out on its breast cancer surgery page.
The different types of mastectomy are named for what is removed in addition to breast tissue, such as skin, the nipple and areola, or lymph nodes under the arm. Reading about the names can make appointments easier to follow, though the choice itself is made with a surgical team.
The main types of mastectomy
The table below sets the common types side by side in plain language.
| Type | What the surgery involves |
|---|---|
| Total (simple) mastectomy | The whole breast is removed, including the nipple, areola, breast tissue and skin |
| Modified radical mastectomy | A total mastectomy plus removal of lymph nodes under the arm |
| Skin-sparing mastectomy | The whole breast is removed but the skin is left |
| Nipple-sparing mastectomy | The whole breast is removed but the skin, nipple and areola are left |
| Radical mastectomy | The breast, chest wall muscles and all lymph nodes are removed; now rarely performed |
The descriptions follow the National Cancer Institute mastectomy page and the Canadian Cancer Society surgery page.
Total mastectomy and modified radical mastectomy
In a total mastectomy, also called a simple mastectomy, the surgeon removes the whole breast, including the nipple, areola, breast tissue and skin. Sometimes one or more of the lymph nodes under the arm are removed too, in a procedure called sentinel lymph node biopsy.
A modified radical mastectomy is the same as a total mastectomy, except that the surgeon also removes lymph nodes under the arm in a procedure called axillary lymph node dissection. According to the National Cancer Institute, because cancer cells may spread to the lymph nodes, removing them can help reduce the risk of the cancer coming back, but it is often used only for more advanced stages of breast cancer.
The Canadian Cancer Society notes that this type of mastectomy is used for breast cancer that has spread to the lymph nodes, and also to treat inflammatory breast cancer.
Skin-sparing and nipple-sparing mastectomy
Skin-sparing and nipple-sparing operations are planned around reconstruction. In a skin-sparing mastectomy the surgeon removes the whole breast, as in a total mastectomy, but leaves the skin. The National Cancer Institute says this leaves less scarring and makes for a more natural-looking reconstructed breast, although it may not be an option if the tumour is large or near the skin.
In a nipple-sparing mastectomy the surgeon removes the whole breast but leaves the skin, nipple and areola. It may not be an option if the tumour is large, if cancer cells are found near the skin, nipple or areola, or for people with larger breasts.
The same page states that skin-sparing and nipple-sparing mastectomies require breast reconstruction right after surgery. The Canadian Cancer Society similarly describes a skin-sparing mastectomy as an option if a person plans to have breast reconstruction at the same time and the reconstruction can be done with very little scarring.
Radical mastectomy
A radical mastectomy removes the chest wall muscles and all lymph nodes, as well as the whole breast, nipple, areola and skin. The National Cancer Institute says this operation was common in the past but is now rarely performed because it does not improve how long people live. A surgeon may still suggest it if the cancer cells have spread to the chest wall muscles.
The Canadian Cancer Society also describes a radical mastectomy as very rare, removing more muscle, lymph nodes and other tissues than a modified radical mastectomy.
Single and double mastectomy
Separate from the type of operation is whether one breast or both are removed. In a single (unilateral) mastectomy only the breast with cancer is removed, while a double (bilateral) mastectomy removes both breasts. The National Cancer Institute lists two situations in which a doctor may suggest a double mastectomy: cancer in both breasts, or cancer in one breast with a high risk of developing cancer in the other because of a genetic mutation or strong family history.
The Canadian Cancer Society notes that a double mastectomy is sometimes done to prevent breast cancer in people at very high risk, such as people with BRCA gene mutations.
Reconstruction, going flat and recovery
After a mastectomy a person may stay flat, wear a prosthesis (a breast-like form) in a bra, or have breast reconstruction surgery. Reconstruction can happen at the same time as the mastectomy or at any time after. Staying flat is sometimes called going flat, and the surgeon can perform an aesthetic flat closure to make the chest flat and smooth.
The National Cancer Institute says recovery depends on the type of mastectomy and whether reconstruction was done. Most people begin returning to normal activities 4 weeks after surgery, but recovery could take longer for people who have breast reconstruction. In its comparison of surgeries, the institute adds that it can take 6 to 8 weeks or longer to fully recover from a mastectomy followed by reconstruction, as explained on its lumpectomy and mastectomy comparison page.
Timelines for each stage are covered in the guide to breast reconstruction recovery, and the guide to exercise after breast reconstruction covers a gradual return to movement.
Possible risks of mastectomy
As with any surgery, a mastectomy has possible risks. The National Cancer Institute lists infection, pain or other discomfort that may or may not get better over time, arm and shoulder pain and stiffness, and lymphedema in the arm, especially when many lymph nodes have been removed. Mastectomy with reconstruction has additional risks.
The Canadian Cancer Society lists further possible side effects, including a buildup of blood or fluid in the wound, scarring, numbness in the chest and changes to body image and self-esteem. Decisions about surgery and recovery belong with the reader’s own surgeon and care team, who can explain how these points apply to a specific diagnosis.
Frequently asked questions
Which type of mastectomy is the most common today?
Show answer
Radical mastectomy is now rarely performed, according to the National Cancer Institute, so total, modified radical, skin-sparing and nipple-sparing mastectomy are the types most often discussed. The right one depends on the cancer, and the surgical team explains the options.
Does a mastectomy always include lymph node removal?
Show answer
No. The National Cancer Institute explains that in a total mastectomy some lymph nodes under the arm may also be removed through sentinel lymph node biopsy, while a modified radical mastectomy includes axillary lymph node dissection.
Can reconstruction be done at a later date?
Show answer
Yes. The National Cancer Institute states that reconstruction can happen at the same time as the mastectomy or at any time after, although skin-sparing and nipple-sparing types require it at the same time.
Is it possible to choose not to have reconstruction?
Show answer
Yes. Options include going flat or wearing a breast prosthesis, as described by the National Cancer Institute.
