There are three levels of mastectomy.
Total removes the breast tissue, nipple, areola and some skin around the incision. This commonly follows cancers that occur in two or more areas of the breast or those extending beyond a biopsy's edges.
Modified radical is similar to a total mastectomy, but includes an axillary dissection or sentinel node biopsy. (This is now the most commonly performed mastectomy). Once standard for all procedures, the radical mastectomy removes muscle, lymph nodes and skin and is now rarely performed.
Do I Really Need a Mastectomy?
In some cases, a lumpectomy with radiation is as effective as mastectomy.
Given the choice, most American women choose mastectomy - even when the outcomes of the two procedures will yield the same result. (according to a 1999 study) As with any surgical procedure, it's always advisable to get a second opinion from a surgeon in a different practice.
Advances in mastectomy save normal body tissue, like the breast skin and areola, that doesn't necessarily need to be removed in every patient. Every patient is different and so are mastectomies, preventive mastectomies are different than mastectomies for cancer or when lumpectomies don't work. It is possible under the right circumstances to have a mastectomy and save the nipple.
There are also situations when a mastectomy is done with a "hidden" or "scarless" approach. Ask if your plastic surgeon works with a breast surgeon who considers these options when planning your mastectomy. Also if a reconstruction is scheduled immediately following mastectomy and you have completed chemotherapy and/or radiation, the mastectomy may be done in a way to make the overall result of your reconstruction better.