Mastectomy Types: Pictures, Procedure, Breast Reconstruction

Mastectomy types (plus a picture guide you can actually understand)

A mastectomy removes breast tissue. The “type” mostly describes how much tissue/skin is removed and what happens
to the nipple-areola complex. Some mastectomies also include lymph node surgery under the arm (axilla) to check for spread.

Picture guide: what these surgeries generally look like

If you’re publishing this on the web, consider using simple medical illustrations (not graphic photos) to show incision placement.
Below are suggested figures and alt text. (Incision shape and scar placement can vary by surgeon technique, breast size, and reconstruction plan.)

Total (simple) mastectomy

A total (simple) mastectomy removes the entire breast tissue, usually including the nipple and areola.
Depending on your situation, the surgeon may also remove a few lymph nodes (often via sentinel lymph node biopsy) to stage the cancer.
This approach is common for some breast cancer cases and for prophylactic mastectomy in certain high-risk situations.

Skin-sparing mastectomy

A skin-sparing mastectomy removes breast tissue and typically the nipple-areola complex, but preserves most of the breast skin.
The preserved “skin envelope” can make reconstruction look more natural because it helps shape the rebuilt breast.
This is often chosen when immediate breast reconstruction is planned.

Nipple-sparing mastectomy

A nipple-sparing mastectomy preserves the breast skin and the nipple-areola complex while removing the underlying breast tissue.
It can be a great cosmetic option for the right candidate, especially when combined with immediate reconstruction.
However, not everyone is eligibletumor location, breast anatomy, and cancer involvement near the nipple matter.
Surgeons may sample tissue under the nipple to confirm it’s safe to keep.

Modified radical mastectomy

A modified radical mastectomy removes the entire breast (often including nipple and areola) and also removes many lymph nodes in the axilla.
It’s generally considered when lymph nodes are known or strongly suspected to be involved, or when the staging/treatment plan requires a more extensive node surgery.
(True “radical” mastectomyremoving chest wall musclesis much less common today.)

Radical mastectomy (rare today)

A radical mastectomy removes the breast, axillary lymph nodes, and chest wall muscles under the breast.
Because modern therapies and surgical approaches often achieve similar cancer control with less morbidity, radical mastectomy is rarely performed now.

Partial mastectomy (lumpectomy/segmental mastectomy) vs. mastectomy

Not every breast cancer surgery is a mastectomy. A lumpectomy (also called partial or segmental mastectomy) removes the tumor with a margin of healthy tissue,
usually preserving most of the breast. Many early-stage cancers can be treated effectively with lumpectomy plus radiation.
Your recommendation depends on tumor size, location, genetics, patient preference, and prior treatments.

Unilateral vs. bilateral mastectomy

Unilateral means one breast; bilateral means both. Some people choose bilateral mastectomy for risk reduction (for example, with certain inherited mutations),
symmetry preferences, or peace of mindbut it’s not automatically the “best” choice for every diagnosis. This is a decision worth slowing down for, if time allows.

What “going flat” means

“Going flat” means choosing no breast reconstruction and aiming for a smooth chest contour after mastectomy.
Some patients want this for comfort, recovery simplicity, body autonomy, or just because they’re done negotiating with bras forever.
If this is your preference, ask specifically about an aesthetic flat closure so your surgeon plans the contour intentionally.

What happens during a mastectomy procedure

While the details vary, most mastectomy procedures follow a similar rhythm: pre-op planning, anesthesia, breast tissue removal, possible lymph node evaluation,
drain placement, closure, and pathology. Here’s what that usually looks like in real life (not the glossy pamphlet version).

Before surgery: planning and prep

• Imaging & mapping: Your team reviews mammogram/ultrasound/MRI, biopsy results, and surgical goals.
• Reconstruction consult (if desired): A plastic surgeon helps decide between implant reconstruction, flap reconstruction, or staged approaches.
• Medication review: Blood thinners, certain supplements, and smoking/vaping status can affect healing and complication risk.
• Prehab mindset: If approved by your team, gentle shoulder mobility work and strength can help recovery feel less like a surprise pop quiz.

During surgery: what the surgeon actually does

You’ll be under general anesthesia. The surgeon makes an incision based on your mastectomy type and reconstruction plan, then removes breast tissue carefully,
aiming to remove tissue thoroughly while preserving healthy skin when appropriate. If reconstruction is immediate, the plastic surgeon typically begins rebuilding
the breast mound in the same operation.

Lymph nodes: sentinel lymph node biopsy vs. axillary dissection

Many breast cancers require checking nearby lymph nodes. A sentinel lymph node biopsy identifies and removes the first few lymph nodes most likely
to receive drainage from the breast (often 1–3 nodes, but it varies). Those nodes are examined for cancer cells. If more extensive removal is needed, an
axillary lymph node dissection removes a larger group of nodes.

Why it matters: lymph node surgery can affect arm/shoulder tightness and can increase the risk of lymphedema (swelling due to lymph fluid buildup),
especially with more extensive node removal or radiation.

Drains: not glamorous, but very common

Many surgeons place one or more surgical drains to remove fluid while your body heals. Drains are temporary, but they’re a frequent part of recovery.
You’ll be taught how to empty them, measure output, and recognize signs of infection.

Pathology after surgery

Removed tissue goes to pathology to confirm diagnosis details, margins (if applicable), and lymph node status. These results can influence next steps,
such as radiation, endocrine therapy, targeted therapy, or chemotherapy.

Recovery after mastectomy: a realistic timeline

Recovery is not one-size-fits-allespecially if you combine mastectomy with reconstruction. Below is a typical range for uncomplicated healing.
Always follow your care team’s instructions (they’ve seen your surgery site; the internet has not).

Days 1–3: the “I can’t believe my chest is numb” phase

• You may go home the same day or stay in the hospital, depending on your surgery and reconstruction.
• Pain and tightness are common. Numbness is also common because sensory nerves are affected.
• Drains may be in place; you’ll track output.
• Short walks help circulation. Your job is healing, not proving toughness.

Week 1–2: drains, naps, and figuring out your new normal

• Many people still feel fatigue and soreness, especially with arm movement.
• Drains are often removed when output decreases (timing varies).
• Gentle range-of-motion exercises may be recommended to prevent stiffness.
• Watch for fever, increasing redness, worsening swelling, foul drainage, or severe paincall your team.

Weeks 3–6: gradual return to activity

• Many people return to desk work within a few weeks, but physical jobs can take longer.
• Driving usually resumes when you’re off narcotic pain meds and can move comfortably.
• Strength training, heavy lifting, and high-impact exercise typically wait until cleared.

Longer-term considerations

• Sensation changes: Numbness or altered sensation can persist. Some sensation may return over time, but not always fully.
• Scar care: Your team may recommend silicone gel/sheets and sun protection once incisions heal.
• Lymphedema risk: Ask about prevention strategies and early warning signs, especially if you had lymph node dissection or radiation.
• Emotional recovery: Body image shifts are common. Needing support is not a sign you’re “handling it wrong.”

Breast reconstruction after mastectomy: options, timing, and trade-offs

Breast reconstruction is optional. Some people feel it’s an important step in reclaiming their body; others want fewer surgeries and choose to go flat.
There’s no moral scoreboard herejust your values, your health, and your life.

Timing: immediate vs. delayed reconstruction

Immediate reconstruction begins during the same operation as the mastectomy. Delayed reconstruction happens later, after healing and/or other treatments.
Some people do a staged approach: a temporary tissue expander now, then a final reconstruction later.

Radiation matters. If post-mastectomy radiation is likely, your surgical team may recommend a strategy that reduces complication risk and improves final cosmetic outcomes.
This is one reason multidisciplinary planning (breast surgeon + plastic surgeon + radiation oncologist) is so valuable.

Option 1: Implant-based reconstruction (tissue expander or direct-to-implant)

Implant reconstruction uses a saline or silicone implant to form a breast mound. Common pathways include:

• Tissue expander → implant: A temporary expander is placed and gradually filled over weeks, then exchanged for a permanent implant.
• Direct-to-implant: In select cases, a permanent implant is placed immediately at the time of mastectomy.

Implants can involve fewer donor-site scars (no belly/thigh incision), and recovery can be shorter than flap surgery for some people.
Downsides can include a higher chance of needing revision surgery over time, tightness or capsular contracture, and more issues when radiation is involved.

Prepectoral vs. subpectoral placement (plain-English version)

An implant can be placed over the chest muscle (prepectoral) or under it (subpectoral). Prepectoral placement may reduce animation deformity
(breast movement with muscle flexing) and can be more comfortable for some patients, but suitability depends on skin flap quality and other factors.
Your plastic surgeon will walk through what makes sense for your anatomy and cancer treatment plan.

Option 2: Autologous (flap) reconstruction using your own tissue

Flap reconstruction uses tissue from elsewhere in your body to create a breast mound. Many people like that a flap can look and feel more natural.
The trade-off: it’s a longer surgery, usually with a longer hospital stay and recovery, and you’ll have scars at the donor site.

Common flap types (examples)

• DIEP flap: Uses skin and fat from the lower abdomen while preserving most abdominal muscle (microsurgery).
• TRAM flap: Uses abdominal tissue; some approaches use more muscle than DIEP.
• Latissimus dorsi (LD) flap: Uses tissue from the upper back, sometimes combined with an implant.
• Thigh-based flaps (PAP, TUG, etc.): Use tissue from the thigh when abdominal tissue isn’t ideal.

Option 3: Hybrid reconstruction and fat grafting

Some reconstructions combine implants and your own tissue. Fat grafting (lipofilling) can refine contour, soften edges, and help symmetry.
It’s often done as a later “touch-up” procedure rather than the first step.

Nipple reconstruction and 3D tattooing

If the nipple is removed, reconstruction may be possible later with local tissue techniques and/or medical tattooing.
Some people skip nipple reconstruction entirely and opt for 3D tattooing alone. Others keep things simple and embrace the minimalist look.
(Your chest, your aesthetic.)

Choosing what’s right: a practical decision checklist

• Cancer treatment plan: Will you need radiation? That can influence reconstruction timing and type.
• Health factors: Smoking, diabetes, obesity, and certain vascular issues can affect healing and flap success.
• Body goals: Do you want the most natural feel? The fewest surgeries? The fastest recovery?
• Long-term maintenance: Implants may need replacement over time; flaps often hold up long-term but have donor-site considerations.
• Personal identity: Reconstruction is not mandatory to be “whole.” Going flat is a valid, intentional choice.

Questions to ask your surgeon (bring this listfuture you will be grateful)

• Which mastectomy type are you recommending, and why?
• Am I a candidate for skin-sparing or nipple-sparing mastectomy?
• Will you do sentinel lymph node biopsy or axillary dissection? What does that mean for lymphedema risk?
• What will my scar placement likely look like? (Ask to see example photos or drawings.)
• How many drains will I have, and what’s your typical timeline for removal?
• If I want reconstruction, which options fit my treatment planespecially if radiation is possible?
• How many surgeries might reconstruction involve (including revisions)?
• What is the realistic recovery timeline for work, exercise, and driving?
• If I want to go flat, can you plan an aesthetic flat closure?
• Who do I call after hours if something feels wrong?

Conclusion

Mastectomy is not a single, standard operationit’s a set of choices that balance cancer control, anatomy, and personal priorities.
Understanding the differences between total, skin-sparing, nipple-sparing, and modified radical mastectomy can help you walk into appointments
with better questions and fewer “Wait…what?” moments.

When it comes to breast reconstruction, you have real options: implants, autologous flap reconstruction, a staged approach, or going flat.
The “best” decision is the one that fits your health, your treatment plan, and the life you want to return to. Get a second opinion if you need it,
ask for pictures or diagrams, and remember: you’re allowed to take up space in the decision-making processironically, even if the goal is to remove tissue.

Experiences after mastectomy and reconstruction (what people often report)

Let’s talk about the part no one can fully prepare you for: the lived experience. Everyone’s recovery is different, but certain themes show up so often
that it’s worth naming themespecially if you’re reading this at 2 a.m. while bargaining with the concept of “normal.”

The drain era: awkward, annoying, and strangely educational

Many patients say the drains are the most memorable part of early recoverynot necessarily because they hurt, but because they’re inconvenient.
You learn a new daily ritual: empty, measure, record, repeat. People get creative: hoodie pockets become drain holsters, lanyards become shower hacks,
and “fashion” becomes whatever doesn’t snag tubing. The surprising part is how quickly you adapt. After a few days, it feels less like medical equipment
and more like a temporary roommate you didn’t invite but have to keep alive with attention.

Numbness can feel emotionally louder than pain

A common shock is numbness across the chest and underarm. Some describe it as “tight armor,” others as “a patch of skin that forgot it’s attached.”
Pain meds help pain, but they don’t change the weirdness of altered sensation. People often say it gets easier once they understand it’s commonand that
some sensation may return gradually, though it may never feel exactly the same. Many find it helpful to talk about this early with their surgeon so it’s not a surprise.

Body image comes in waves (and it’s not always sad)

A lot of stories include two truths at once: relief to be past surgery and grief about changes. Even those who feel confident in their choice can have moments
of “Who is this in the mirror?” It’s also common for people to experience unexpected pridelike a fierce appreciation for what their body endured.
If you go flat, you may feel empowered by simplicity. If you reconstruct, you may feel grateful for shape and symmetry. Some people feel both, depending on the day.
None of these reactions are “wrong.” They’re human.

Reconstruction reality: it’s a process, not a single reveal

Many patients expect reconstruction to be one surgery and then a dramatic movie-montage ending. More often, it’s a series of steps: expanders, fills,
exchanges, revisions, fat grafting, nipple reconstruction or tattoos. People frequently describe the early reconstructed breast as “high and tight”
or “not mine yet.” Over months, tissues settle, scars soften, and the result feels more familiar. The most helpful mindset patients report is treating reconstruction
like remodeling a house: it looks worse before it looks better, and there’s usually at least one moment where you question every decision you’ve ever made.

Support can be practical (and still deeply loving)

Patients often say the best help wasn’t grand speechesit was meals, laundry, rides, drain log reminders, and someone who didn’t flinch when you asked,
“Can you check if this looks normal?” If you’re supporting someone, ask specific questions: “Do you want company at your follow-up?” “Can I refill your water?”
“Want me to take notes?” The goal is not to be inspirational; it’s to be useful.

Returning to life: small milestones matter

People celebrate unexpected wins: sleeping comfortably again, putting on a real shirt without help, taking a longer walk, lifting a grocery bag, driving without fear,
or simply laughing at something that has nothing to do with cancer. Recovery is often measured in inches, not miles. If you’re in it right now, consider keeping a tiny
list of “firsts” you’ve already donebecause on hard days, your brain may conveniently forget your progress.

If there’s one shared experience that stands out, it’s this: most people wish they had asked for more clarity earlierabout scars, drains, sensation, the number of stages,
and what “normal healing” looks like. So bring your questions. Ask for drawings. Ask for photos. Ask again. This isn’t being difficult; it’s being informed.

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