Simple or total mastectomy

In this procedure, the entire breast--including the nipple and areola (the darker-colored area of skin around the nipple)--is removed. In contrast to a modified radical mastectomy, the axillary (underarm) lymph nodes are not removed (although surgeons often do remove a so-called sentinel node.

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Simple or total mastectomy is typically offered tumor is large relative to the size of their breast. Patients who undergo this procedure also often have their nodes evaluated with a sentinel node biopsy. A simple mastectomy without reconstruction may be done in one to two hours and usually involves a hospital stay of one or two nights. A single incision across half the chest usually allows the surgeon to remove the breast and any lymph nodes necessary for an evaluation.

After the surgeon completes the mastectomy, a plastic tube about the width of a pen is gently sewn into place to draw off fluids. The end of this drain is attached to a pocket-size suction device. The patient is instructed in the care of the drain and monitoring of draining fluids until the device is removed seven to 10 days after surgery.

Most women do not experience excessive pain following a simple mastectomy. It is common, though, to use some pain medication--whether over-the-counter or prescription--for the first three to seven days. Also, fatigue is to be expected following the surgery, which tends to be emotionally as well as physically taxing. It's a good idea to plan a lighter schedule for the weeks following surgery.

Women often experience numbness under the arm when they've also had an axillary dissection to check lymph nodes. Some of this numbness fades as nerve cells regenerate, but some may be permanent.

Women who choose mastectomy normally can forgo radiation therapy. However, radiation may be recommended if surgery uncovers any of the following:

• The tumor is larger than 2 inches (4 centimeters).
• Cancer cells are found in lymph nodes.
• The cancer cells are close to the chest wall, which increases the likelihood that the cancer may recur on the chest wall.