A mastectomy, or breast removal surgery, is often an important part of breast cancer treatment. While your doctor may also recommend a mastectomy for other reasons, or you may want one for gender affirming surgery (Mayo Clinic Staff, 2022), we will be focusing on breast cancer in this article.
One decision in the mastectomy process is whether to get a single or a double mastectomy–in other words, to remove one breast or both.
It can be difficult to weigh your choices in that matter, so below, we’ll answer some common questions about this procedure in plain language.
What Are the Types of Mastectomies?
There are three main types of mastectomies (John Hopkins Medicine, 2021):
1. Radical mastectomy.
This was one of the first types of mastectomies developed (Plesca et al, 2016). The procedure involves removing the entire breast, as well as the underlying lymph nodes and chest muscles. Although it is not as common as it once was, your doctor may still recommend a radical mastectomy if the cancer has spread to your chest muscles.
2. Modified radical mastectomy.
This type of mastectomy often removes the lining over the chest muscles and the lymph nodes (where cancer often spreads) in addition to removing the entire breast.
3. Total (simple) mastectomy. A total mastectomy removes the entire breast, including most of the skin of the breast.
There are also forms of mastectomy that attempt to save the skin and/or the nipple and areola. Your doctor will be able to advise you on what kind of surgery is right for your situation based on where your cancer has spread.
How Common is a Double Mastectomy?
A 2013 study found that breast cancer will occur in 1 in 8 women in their lives (DeSantis, 2014). In addition, a 2017 study that looked at reports of breast cancer rates and surgery from 1998 to 2012 found:
- 59.6% underwent breast-conserving surgery
- 33.4% underwent unilateral [single] mastectomy
- 7.0% underwent CPM [double mastectomy]
In fact, the average of double mastectomy operations tripled between 2002 (3.9%) and 2012 (12.7%) (Wong et al, 2017).
Does a Double Mastectomy Improve Survival Rates?
It’s worth asking why the rate of double mastectomy is growing among women; does it, for instance, improve your rate of survival? The 2017 study we were just quoting (Wong, 2017) says no; of the women who opted for a double mastectomy, there was no significant difference in survival.
And according to Dr. Lynne Eldridge writing for VeryWell Health, “The prevailing thought at this time for women who do not have known genetic risk factors or strong family history is that the survival benefits from having a double mastectomy—if present—is relatively low” (Eldridge, 2021).
Why Get a Double Mastectomy?
So, if it doesn’t improve survival chances, why would someone want to get a double mastectomy?
If your breast cancer is hereditary, you might benefit from getting a double mastectomy, not to improve your survival rates in your existing cancer, but to prevent a second cancer from forming.
Many people choose to get a double mastectomy for quality-of-life reasons. Women who get a double mastectomy are more likely to get breast reconstruction surgery as well, which may make statistics appear as though a double mastectomy improves quality of life, when it may be the breast reconstruction improving quality of life.
However, not every cancer patient can afford a double mastectomy nor the breast reconstruction that often comes with it (Eldrige, 2021).
What Are the Risks?
Breast removal surgery is generally quite safe unless you have other medical concerns that might make it risky to be under anesthesia for too long. Your pain or risk of infection may go up if you choose to do a double mastectomy, but those chances still exist in a single mastectomy as well.
In addition, it’s likely that you will have reduced sensations in both breasts if you opt for a double mastectomy; the importance of this will vary according to each person’s needs and priorities (Eldrige, 2021).
With one in eight women predicted to get breast cancer throughout their lives, there’s a good chance that mastectomy will one day be a concern for you or someone you know.
There is no direct impact on survival rates in single versus double mastectomy, though a double mastectomy may be the right choice if your breast cancer is hereditary, as this makes it more likely that you will get a second occurrence of cancer.
It helps to know all of the facts and all of your options when you go into a decision of this gravity. We hope we’ve given you the background knowledge you need to make a more informed decision, but your doctor will be able to give you advice more tailored to your particular treatment plan and how your cancer operates.
- Mayo Clinic Staff (2022). Top surgery for transgender men and nonbinary people. Mayo Clinic. https://www.mayoclinic.org/tests-procedures/top-surgery-for-transgender-men/about/pac-20469462
- John Hopkins Medicine (2021). Mastectomy. https://www.hopkinsmedicine.org/health/conditions-and-diseases/breast-cancer/mastectomy
- Plesca, M., Bordea, C., El Houcheimi, B., Ichim, E., & Blidaru, A. (2016). Evolution of radical mastectomy for breast cancer. Journal of medicine and life, 9(2), 183–186. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4863512/
- DeSantis, C., Ma, J., Bryan, L. and Jemal, A. (2014). Breast cancer statistics, 2013. CA A Cancer Journal for Clinicians, 64: 52-62. https://doi.org/10.3322/caac.21203
- Wong, Stephanie M. MD; Freedman, Rachel A. MD, MPH; Sagara, Yasuaki MD; Aydogan, Fatih MD; Barry, William T. PhD; Golshan, Mehra MD (2017). Growing Use of Contralateral Prophylactic Mastectomy Despite no Improvement in Long-term Survival for Invasive Breast Cancer. Annals of Surgery - Volume 265 - Issue 3 - p 581-589. https://journals.lww.com/annalsofsurgery/Abstract/2017/03000/Growing_Use_of_Contralateral_Prophylactic.23.aspx
- Eldridge, Lynn, MD (2021). Choosing Between Single vs. Double Mastectomy: Weighing the risks and benefits of a contralateral prophylactic mastectomy. VeryWell Health. https://www.verywellhealth.com/single-vs-double-mastectomy-pros-and-cons-4686361