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Mastectomy removes the entire breast, including all of the breast tissue and sometimes other nearby tissues. Most men with breast cancer will have a mastectomy since men have a small amount of breast tissue.

There are several types of mastectomies:

• Simple or total mastectomy: The surgeon removes the entire breast, including the nipple. A few underarm lymph nodes might be removed as part of a sentinel lymph node biopsy (see below), depending on the situation.
• Modified radical mastectomy: The surgeon extends the incision to remove the entire breast and lymph nodes under the arm as well (known as an axillary lymph node dissection – see below).
• Radical mastectomy: This is a more extensive operation. It involves removing the entire breast, axillary lymph nodes, and the chest wall muscles under the breast. This is only needed if the cancer has grown into the pectoral muscles under the breast.

Breast reconstruction in men

Some men choose breast reconstruction after a mastectomy, though it’s less common than in women. These procedures are usually done by a plastic surgeon and may help:

• Restore a more natural chest appearance
• Create symmetry with the other breast
• Reconstruct the nipple and areola

Reconstruction options might include:

• Creating a new nipple and areola from nearby skin
• Tattooing the area to match the other breast
• A combination of surgery and tattoo
• Transferring fat from another part of the body to fill an indented chest wall
• Placing an implant under the skin to help match the other breast

If you’re interested in breast reconstruction, ask your doctor about your options.

Breast-conserving surgery (BCS) might also be called a lumpectomy, quadrantectomy, partial mastectomy, or segmental mastectomy.

For this surgery, only part of the breast is removed. The goal is to remove the cancer as well as some surrounding normal tissue. How much of the breast is removed depends on the size and location of the tumor and other factors.

BCS is used much less often in men than in women because men typically have much less breast tissue. This makes it harder to remove only part of the breast without leaving some cancer behind. Male breast cancers also tend to be located behind the nipple and often grow into it, so it usually requires more extensive surgery to remove it completely.

If BCS is done, it is typically followed by radiation therapy.

For an SLNB, the surgeon finds and removes the sentinel node (or nodes), the first lymph node(s) into which a tumor drains and the one(s) most likely to contain cancer cells if it has started to spread.

To find the sentinel nodes:

• The surgeon injects a substance (a radioactive substance and/or blue dye, or a liquid containing iron oxide particles) into the area around the tumor, the skin over the tumor, or the tissues just under the areola.
• Lymph vessels will carry these substances into the sentinel node(s) over the next few hours.
• The surgeon then locates the sentinel nodes by checking for the ones that have changed color (blue or brown) or by using a special machine to detect radioactivity or iron oxide particles in the nodes.

When the sentinel nodes are found, the surgeon cuts the skin over the area in the armpit and removes them.

A pathologist will check the removed nodes for cancer cells using a microscope. Sometimes this is done quickly during the surgery.

• If cancer is found in the sentinel lymph node during surgery, the surgeon may go on to do a full ALND (see below).
• If no cancer cells are seen in the lymph node at the time of the surgery, or if the sentinel node is not checked during surgery, the removed node(s) will be examined more closely at some point over the next several days.
• If cancer is found in the lymph node later, the surgeon may recommend a full ALND at a later time.

If there are no cancer cells in the sentinel node(s), it's very unlikely that the cancer has spread to other lymph nodes, so no further lymph node surgery is needed. This lets you avoid some of the potential side effects of a full ALND.

An SLNB is not always the best option for checking the lymph nodes. If an underarm lymph node looks or feels large or abnormal by touch or by a test like ultrasound, it may be checked by fine needle aspiration (FNA). If cancer is found, a full ALND is typically recommended, so an SLNB is not needed.

SLNB is a complex technique that requires a great deal of skill and should only be done by an experienced surgical team. If you are thinking about having this type of biopsy, ask your health care team if this is something they do regularly.

In an ALND, many (usually up to 20) lymph nodes are removed from the area under the arm (axilla) and checked for cancer spread.

Because it can lead to more serious side effects (see below), ALND is not done as often as it was in the past. But it might still be the best way to look at the lymph nodes in some situations, such as:

• If a previous SLNB found cancer cells in underarm lymph nodes
• If swollen underarm or collarbone lymph nodes can be felt before surgery or seen on imaging tests, and a needle biopsy shows they contain cancer
• If the cancer has grown large enough to extend outside the lymph node(s)