“Mastectomy techniques have evolved in recent years, becoming less radical in certain cases”

Types of mastectomies

Simple mastectomy

It consists of removing the entire breast (the entire mammary gland, the skin of the breast, the nipple, and the areola). Sentinel lymph node biopsy is usually performed in the same surgical act.

Mastectomy is indicated in cases of extensive intraductal carcinomas, in multifocal or extensive tumors, and in unsuitable or favorable cases for conservative treatment.

Modified radical mastectomy

It is a simple mastectomy associated with axillary lymphadenectomy. It is recommended in patients with indication of mastectomy and who present a positive sentinel node with indication of lymphadenectomy, or in cases with clinically or ultrasound-positive axilla.

Skin-sparing mastectomy

A skin-sparing mastectomy preserves part of the skin and allows for a more natural contour reconstruction with fewer visible scars. The nipple and areola are removed for oncological reasons, as they are closely related to the underlying breast tissue.

The oncological results of skin-sparing mastectomy have shown that it is as effective as traditional oncological radical mastectomy in cases where the tumor is far from the skin. Breast reconstruction after skin-sparing mastectomy can be performed in the same surgical act, and areola and nipple reconstruction are performed in a second stage.

Conservative mastectomy of areola and nipple

Conservative areola and nipple mastectomy is a suitable technique for selected patients. This technique achieves a more natural appearance after breast reconstruction during the same procedure.

A conservative areola and nipple (subcutaneous) mastectomy may be performed in cancer-free patients undergoing risk-reducing surgery or in selected cancer patients in whom the tumor is small and distant from the nipple.

During the procedure, a biopsy of the excised retroareolar tissue will be performed, which will be analyzed by pathologists during surgery to rule out the presence of malignant cells or cells with atypia (<1%). In case of involvement, the nipple-areola complex (NAC) must be resected.