Prophylactic mastectomies reduce risk of breast cancer by 90%

Rarely, breast cancers arise in residual breast tissue

Rate of local recurrence is higher with BCT, but survival is similar

Women with potentially surgically curable disease (DCIS, small node-negative invasive carcinomas) may have a greater benefit from mastectomy as cancer may recur at a higher stage

Extensive carcinoma or multiple carcinomas that cannot be removed with cosmetically acceptable results

Centrally located carcinomas

Skin or chest wall involvement; many patients will be treated 1st with neoadjuvant chemotherapy

Patients with high risk of subsequent carcinoma (e.g., BRCA germline mutation carriers)

Patients not eligible for radiation due to previous treatment or collagen vascular disease

Patient choice

Removes breast tissue and skin ellipse including nipple

Small amount of muscle may be removed if carcinoma is close to deep margin

Axillary dissection is not performed

Removes breast tissue, skin ellipse (including nipple, pectoralis major, and minor muscles), and axillary lymph nodes

Currently performed rarely except for carcinomas that invade into chest wall

Modified radical mastectomy is a simple mastectomy (without removal of muscle) and axillary dissection

Removes breast tissue and nipple with small amount of surrounding skin

Removes breast tissue

Does not remove nipple or skin

May be appropriate for carcinomas at least 2 cm from nipple with limited amounts of DCIS

Base of nipple is a margin that must be sampled separately and submitted by the surgeon

Removes 85-90% of breast tissue

Does not remove nipple or skin; flaps are usually thick

Similar to nipple-sparing mastectomy but removes less breast tissue

Removes breast tissue and skin ellipse including nipple

Performed for risk reduction; no known carcinoma is present in the breast at time of surgery

Occult invasive carcinomas are found in 3-15% of cases; generally < 1 cm

Sentinel nodes are identified by dye or radioactive tracer

Average number of nodes is 2, but more may be identified in some patients

Metastases are most often found at the pole of the node stained with blue dye

Extent of dissection may include levels I, II, or III

Surgeon should indicate extent of dissection

Ideally, at least 10 nodes should be found

Nodes may be present within the breast and are usually located in upper outer quadrant

Typically not the sentinel node

Number and type of lesions (masses, calcifications, clips, etc.) present

Distance between lesions and distance from nipple

Presence and extent of axillary dissection