Mastectomy — Surgical Removal of Breast Tissue

Surgically, a mastectomy involves the excision of glandular breast tissue from the overlying skin down to the pectoral chest muscles. Depending on the size, location, and nature of the tumour, surgeons employ different techniques. A total (simple) mastectomy removes the whole breast, including the nipple-areolar complex, whereas a modified radical mastectomy also removes selected axillary lymph nodes.

Modern surgical techniques include skin-sparing and nipple-sparing mastectomies. These approaches preserve the outer skin envelope and natural contours to facilitate immediate or delayed breast reconstruction using synthetic implants or autologous tissue transferred from other parts of the body.

Choosing or needing a mastectomy is a pivotal moment in breast cancer care involving clinical, aesthetic, and emotional considerations. It is often recommended when tumours are large relative to breast size, multifocal, or accompanied by genetic mutations like BRCA1/2. Understanding the types of mastectomy and reconstruction options empowers patients to make decisions aligned with their lifestyle, recovery expectations, and personal goals.

Before a mastectomy, the diagnosis is confirmed by core needle biopsy. Preoperative assessment involves mammography, breast MRI, and axillary ultrasound to map disease extent. Genetic testing for BRCA1, BRCA2, or PALB2 often informs the decision to proceed with bilateral (double) mastectomy rather than unilateral surgery.

Mastectomy is primarily indicated for ductal and lobular breast carcinomas, extensive ductal carcinoma in situ (DCIS), inflammatory breast cancer, and recurrent disease after breast-conserving therapy. It is also used prophylactically in high-risk hereditary conditions, such as hereditary breast and ovarian cancer syndrome.

A mastectomy achieves primary local control. Following pathology review of the removed tissue and sentinel lymph nodes, additional systemic treatments—such as chemotherapy, endocrine therapy, or targeted antibodies—may still be recommended. Post-mastectomy radiation therapy may also be advised if the tumour was large or lymph nodes were involved.