If mastectomy is the treatment of choice, the surgeon will remove the entire breast. In case of simple mastectomy, only the breast is removed and the lymph nodes are not explored. This type of surgery is generally not adequate for cancer, which has started invading the surrounding tissues, but if the breast cancer is still intact within a membrane without infiltration to surrounding tissue (a condition called carcinoma in situ) a simple mastectomy may be appropriate. More commonly used version of mastectomy is called modified radical mastectomy and this involves the removal of the entire breast and some muscle layers under the breast with exploration of the lymph nodes in the armpit area. Radical mastectomy is a much more extensive surgery and involves removal of the entire breast, lymph nodes in the arm pit, muscles under the breast and some of the muscles of the chest wall. Radical mastectomy is performed much less frequently now compared to the past because of the extreme disfigurement and complications associated with this procedure. Also it has been shown that radical mastectomy is not any better than modified radical mastectomy in curing the breast cancer. Breast surgery can be complicated with the development of infection, blood collection
or clear fluid accumulation behind the surgery site. If the lymph nodes are removed long term swelling of the arm on the side of the surgery may occur and this condition is called lymphedema. When you are choosing lumpectomy over modified radical mastectomy you are trading the benefit of keeping your breast at the cost added inconvenience in the form of radiation therapy. If the tumor is large lumpectomy may be technically difficult. Women who had mastectomy, if found to have large number of lymph nodes involved with cancer, may still have to go for radiation therapy because they have a higher risk of breast cancer coming back at the same site. If advised by your doctor, a lumpectomy combined with radiation should give you the same chance to beat the cancer compared to having a modified radical mastectomy. If your choice is mastectomy for whatever reason, you can consider breast reconstructions to decrease the feeling of loss of your breast. Sometimes after initial surgery the cancer may be found to involve the edge of the surgery margin and your doctor may recommend a second surgery to remove the residual tumor. If a second surgery also shows tumor cells at cut edge, your surgeon may advise a mastectomy.