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Simple Mastectomy: Procedure, Incision, Nipple Handling & Reconstruction

What Is a Simple Mastectomy?

A simple mastectomy (also called total mastectomy) involves removal of the entire breast tissue, including the nipple-areola complex and overlying skin, while leaving the chest muscles and lymph nodes intact. It is typically performed when cancer has not spread beyond the breast or as a risk-reducing surgery.

Incision

The incision follows the natural curve of the breast, allowing for optimal placement of a prosthesis or future breast reconstruction. The curved scar usually lies within the bra line for minimal visibility.

Nipple Handling

In a standard simple mastectomy, the nipple and areola are removed along with the breast tissue because they contain ductal tissue that could harbor cancer cells. Nipple-sparing mastectomy is a separate procedure that preserves the nipple-areola complex when oncologically safe; this decision is made preoperatively based on tumor location and margins.

Reconstruction Options

Breast reconstruction can be performed immediately (during the same surgery) or delayed (months to years later). Options include implant-based reconstruction, autologous tissue flaps (e.g., DIEP, TRAM), or a combination. Your surgical team will discuss the best approach for your anatomy, cancer stage, and personal preferences before the mastectomy.

Scarring

The scar typically extends in a curved line across the chest wall, following the breast crease. With careful surgical technique and proper wound care, the scar usually fades significantly over 12–18 months. If reconstruction is performed later, the incision is often placed to optimize aesthetic outcomes.

Risks and Complications

  • Infection – may require antibiotics or drainage.
  • Bleeding / Hematoma – collection of blood under the skin.
  • Seroma – accumulation of clear fluid; often resolves spontaneously or with aspiration.
  • Pain – managed with analgesics; chronic pain occurs in a minority.
  • Skin necrosis – death of skin edges, more common in smokers or after radiation.
  • Lymphedema – swelling of the arm/hand if sentinel node biopsy or axillary dissection is added.

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