Types of Mastectomy What I Wish Someone Had Told Me Before Surgery

A breast cancer survivor’s perspective on understanding all your surgical options

When I was diagnosed with breast cancer, I had absolutely no clue what a mastectomy really meant.

I knew I had cancer.

I knew I needed surgery.

And I knew I was terrified.

What I didn’t know was that there were different types of mastectomies. I didn’t know there were reconstruction options. I didn’t know there were women choosing to stay flat. I didn’t know there was something called a Goldilocks mastectomy. I didn’t know some surgeons were preserving sensation. I didn’t know I had choices.

Nobody sat me down and explained all of this.

Looking back, that’s what bothers me most.

I wasn’t asking the right questions because I didn’t know what questions to ask.

I ultimately had an aesthetic flat closure, but I never had the chance to sit down with a plastic surgeon before my surgery. Decisions were being made during one of the most overwhelming moments of my life, and I didn’t fully understand all of my options until many of them were already behind me.

That’s why I’m sharing this.

Because if you’re newly diagnosed, I don’t want you to feel as lost as I did.

This guide was created with the help of Learn Look Locate Medical Advisor Dr. Lauren Kopicky, DO, FACOS, FACS, breast surgical oncologist at Cleveland Clinic, who believes breast cancer surgery is never one-size-fits-all.

You deserve to know every option available to you.

First, What Is a Mastectomy?

A mastectomy is surgery that removes breast tissue.

What many people don’t realize is that there are several different types of mastectomies, and each one serves a different purpose depending on your diagnosis, anatomy, reconstruction goals, genetics, and personal preferences.

For some women, the goal is reconstruction.

For others, it’s preserving sensation.

For others, it’s staying flat.

There is no right or wrong choice.

There is only the choice that feels right for you.

Total (Simple) Mastectomy

A total mastectomy, also called a simple mastectomy, removes:

• All breast tissue
• The nipple
• The areola

This is one of the most common forms of mastectomy and is often recommended when all breast tissue needs to be removed, but extensive lymph node surgery is not required.

Questions women often ask:

• What is a simple mastectomy?
• Is a simple mastectomy the same as a total mastectomy?
• Will I lose my nipple?

Modified Radical Mastectomy

A modified radical mastectomy removes:

• All breast tissue
• The nipple and areola
• Most of the lymph nodes under the arm

This procedure may be recommended when lymph node involvement is suspected or confirmed.

Questions women often ask:

• Why do lymph nodes need to be removed?
• Will lymph node surgery affect my recovery?
• What is a modified radical mastectomy?

Skin-Sparing Mastectomy

A skin-sparing mastectomy removes the breast tissue while preserving most of the breast skin.

This approach is commonly used when reconstruction is planned because preserving the skin can improve cosmetic outcomes.

Questions women often ask:

• What is a skin-sparing mastectomy?
• Can I keep my breast skin?
• Does skin-sparing surgery help reconstruction?

Nipple-Sparing Mastectomy

A nipple-sparing mastectomy removes the breast tissue while preserving:

• The nipple
• The areola
• Most of the breast skin

Not everyone is a candidate, but for some women, this option can help maintain a more natural appearance after surgery.

Questions women often ask:

• Can I keep my nipple?
• Is nipple-sparing mastectomy safe?
• Am I a candidate?

Sensation-Preserving Mastectomy

One of the most exciting advances in breast cancer surgery is sensation-preserving mastectomy.

Traditionally, many women experienced numbness after surgery because nerves were cut during the mastectomy process.

Today, some surgeons use nerve-preservation and nerve-reconstruction techniques designed to help maintain sensation after surgery.

Learn Look Locate Medical Advisor Dr. Anne Peled has been a leading voice in educating patients about preserving sensation and improving quality of life after breast cancer surgery.

If maintaining sensation is important to you, ask your surgical team if nerve-preserving techniques may be available.

Questions women often ask:

• Will I have feeling after a mastectomy?
• What is sensation-preserving mastectomy?
• Can nerves be preserved during surgery?

Goldilocks Mastectomy

This is the procedure I wish more women knew about.

Honestly, I had never heard the term **Goldilocks mastectomy** until after my own surgery.

A Goldilocks mastectomy removes the breast tissue but uses the remaining skin and tissue to create a smaller natural breast mound.

Unlike traditional reconstruction, it does not require:

• Breast implants
• Tissue from another part of the body
• Multiple complex reconstructive surgeries

For many women, it offers a middle ground between reconstruction and aesthetic flat closure.

So is Goldilocks reconstruction? In a sense, it’s both — the breast tissue is removed like a mastectomy, but your own remaining tissue is reshaped to create contour, all in a single surgery.

Goldilocks mastectomy may be a good option for women who:

• Want to avoid implants
• Prefer fewer surgeries
• Want a natural result
• Want some breast shape after surgery
• Are not candidates for more extensive reconstruction

Questions women often ask:

• What is a Goldilocks mastectomy?
• Can I avoid implants?
• Who is a candidate for Goldilocks mastectomy?
• Is Goldilocks reconstruction?

Aesthetic Flat Closure

This was my path.

An aesthetic flat closure creates a smooth, flat chest contour after mastectomy.

And let me be very clear:

It is not “doing nothing.”

It is not “giving up.”

It is not a lesser choice.

It is a valid surgical choice.

Many women choose aesthetic flat closure because they:

• Don’t want implants
• Want fewer surgeries
• Prefer a shorter recovery
• Feel most comfortable living flat

I wish someone had explained this option to me in greater detail before surgery.

Questions women often ask:

• What is aesthetic flat closure?
• Can I stay flat after a mastectomy?
• What does flat closure recovery look like?

Prophylactic (Risk-Reducing) Mastectomy

A prophylactic mastectomy is performed to reduce the risk of developing breast cancer before cancer occurs.

This option is often considered by people with:

• BRCA1 mutations
• BRCA2 mutations
• Other inherited genetic mutations
• Strong family histories of breast cancer

The goal is to significantly reduce future breast cancer risk.

Questions women often ask:

• What is a prophylactic mastectomy?
• Should I have preventive breast surgery?
• Does BRCA mean I need a mastectomy?

Radical Mastectomy

A radical mastectomy is the most extensive type of breast surgery.

It removes:

• The breast
• The nipple and areola
• Lymph nodes
• Chest wall muscles

The good news is that radical mastectomies are rarely performed today.

Advances in breast cancer treatment have made less extensive surgeries effective for most patients.

Questions women often ask:

• What is a radical mastectomy?
• Is radical mastectomy still performed?
• Why would someone need a radical mastectomy?

What I Wish Someone Had Told Me

I wish someone had told me that a mastectomy isn’t just a mastectomy.

I wish someone had explained every option.

I wish I had known about Goldilocks mastectomy.

I wish I had known more about aesthetic flat closure.

I wish I had known sensation preservation was even a conversation.

I wish I had understood all of the possibilities before surgery instead of learning about many of them afterward.

If you’re reading this before your surgery, please ask questions.

Ask about reconstruction.

Ask about staying flat.

Ask about Goldilocks.

Ask about sensation preservation.

Ask whether you’re a candidate for nipple-sparing surgery.

Ask to meet with a plastic surgeon before making your decision whenever possible.

Most importantly, remember this:

You deserve to understand every option available to you before surgery.

Because when it comes to your body, your future, and your quality of life, informed decisions matter.

And you should never have to learn about your choices after they’re already gone.

You Don’t Have to Figure This Out Alone

At Learn Look Locate, we believe no woman should walk into surgery without understanding her choices.

That’s why we created these resources with our medical advisors — so you can walk into your next appointment with the right questions.

Keep exploring:

• Goldilocks Mastectomy: A Complete Guide — our full series with Dr. Lauren Kopicky
• Sensation-Preserving Surgery — with Dr. Anne Peled
• Understanding Aesthetic Flat Closure
• Questions to Ask Your Surgical Team Before Mastectomy

Frequently Asked Questions

Total (Simple) Mastectomy

Q1. What is a simple mastectomy?
A: It removes all the breast tissue, along with the nipple and areola but leaves the underarm lymph nodes in place.

Q2. Is a simple mastectomy the same as a total mastectomy?
A: Yes. “Simple” and “total” are two names for the same procedure.

Q3. Will I lose my nipple?
A: In a standard simple mastectomy, yes — though nipple-sparing options exist for some women. Ask your surgeon if you’re a candidate.

Modified Radical Mastectomy

Q1. Why do lymph nodes need to be removed?
A: When cancer may have spread to the underarm nodes, removing them helps your team understand the cancer and treat it fully.

Q2. Will lymph node surgery affect my recovery?
A: It can. Removing nodes raises the risk of lymphedema, so ask about how many will be taken and how to lower that risk.

Q3. What is a modified radical mastectomy?
A: It removes all breast tissue, the nipple and areola, and most of the underarm lymph nodes.

Skin-Sparing Mastectomy

Q1. What is a skin-sparing mastectomy?
A: It removes the breast tissue while keeping most of your natural breast skin.

Q2. Can I keep my breast skin?
A: Often, yes — that’s the point of this approach, and it’s why it pairs so well with reconstruction.

Q3. Does skin-sparing surgery help reconstruction?
A: Yes. Keeping the skin envelope usually gives a more natural cosmetic result.

Nipple-Sparing Mastectomy

Q1. Can I keep my nipple?
A: For some women, yes. It depends on your tumor’s size and location and how close it sits to the nipple.

Q2. Is nipple-sparing mastectomy safe?
A: For carefully selected patients, studies show it’s a safe option. Your surgeon will tell you if it’s right for your diagnosis.

Q3. Am I a candidate?
A: Candidacy varies by tumor and anatomy. It’s a direct question worth asking your surgical team early.

Sensation-Preserving Mastectomy

Q1. Will I have feeling after a mastectomy?
A: Traditionally many women loose sensation, but newer nerve-preserving techniques are designed to help keep it.

Q2. What is sensation-preserving mastectomy?
A: It’s surgery that protects or reconstructs the nerves in the chest to maintain feeling afterward.

Q3. Can nerves be preserved during surgery?
A: In some cases, yes. Ask your team whether nerve-preserving techniques are available to you.

Goldilocks Mastectomy

Q1. What is a Goldilocks mastectomy?
A: It removes the breast tissue, then reshapes your own remaining skin and tissue into a smaller, natural mound — no implants, no flap.Q2. 

Q2. Can I avoid implants?
A: Yes. Avoiding implants is one of the main reasons women choose this option.

Q3. Who is a candidate for Goldilocks mastectomy?
A: It often suits women who want some breast shape, fewer surgeries, and a natural result without implants. Your surgeon will confirm fit.

Q4. Is Goldilocks reconstruction?
A: In a sense it’s both — the tissue is removed like a mastectomy, but your tissue is reshaped to create contour, all in one surgery.

Aesthetic Flat Closure

Q1. What is aesthetic flat closure?
A: It creates a smooth, intentionally flat chest contour after mastectomy. It’s a real surgical choice — not “doing nothing.”

Q2. Can I stay flat after a mastectomy?
A: Absolutely. Many women choose to live flat, and it’s a valid, complete option.

Q3. What does flat closure recovery look like?
A: Recovery is often shorter than reconstruction since there’s no implant or flap, though every body heals at its own pace.

Prophylactic (Risk-Reducing) Mastectomy

Q1. What is a prophylactic mastectomy?
A: It’s surgery to remove breast tissue before cancer develops, to lower future risk.

Q2. Should I have preventive breast surgery?
A: That’s a deeply personal decision based on your genetics, family history, and risk. A genetic counselor and your care team can help you weigh.

Q3. Does BRCA mean I need a mastectomy?
A: No. A BRCA mutation raises risk and opens the conversation, but it doesn’t make surgery mandatory — it’s one of several options.

Radical Mastectomy

Q1. What is a radical mastectomy?
A: The most extensive type — it removes the breast, nipple and areola, lymph nodes, and chest wall muscles.

Q2. Is radical mastectomy still performed?
A: Rarely. Modern, less extensive surgeries are just as effective for most patients.

Q3. Why would someone need a radical mastectomy?
A: Only in unusual cases where cancer has spread into the chest wall muscle.