In a simple (total) mastectomy the entire breast is removed, but not the lymph nodes under the arm or muscle tissue from beneath the breast. The most common form of the surgery, the simple mastectomy includes the removal of the areola and nipple. However, the surgery can be performed using skin and nipple sparing techniques. It also leaves the muscle under the breast intact.
The procedure is typically performed using an elliptical incision six to eight inches in length that begins on the inside of the breast, near the breast bone, and extends upward and outward toward the armpit. The incision can also be altered to remove scar tissue from previous procedures, which can improve the cosmetic outcome if reconstruction is desired.