Mastectomy: Indications, Types, and Decision-Making

Mastectomy = surgical removal of one or both breasts.

Primary Indications

1. Breast Cancer Treatment: Large/multifocal tumors, positive margins after lumpectomy, inflammatory cancer, patient choice.
2. Risk Reduction (Prophylactic): BRCA1/2 mutation, strong family history, prior thoracic radiation.
3. Gender-Affirming Surgery: Chest masculinization for transgender men/non-binary individuals.
4. Severe Infection/Necrosis: Refractory mastitis, necrotizing fasciitis (rare).
5. Reconstruction Context: Skin-sparing/nipple-sparing mastectomy for immediate reconstruction.

Types

• Simple (total), modified radical, radical, skin-sparing, nipple-sparing.

Decision-Making

Shared decision-making with breast surgeon, plastic surgeon, oncology team. Consider oncology outcomes, reconstruction options, body image, psychosocial support.