Mastectomy

In medicine, mastectomy is the medical term for the surgical removal of one or both breasts, partially or completely. Mastectomy is usually done to combat breast cancer; in some cases, women believed to be at high risk of breast cancer have the operation prophylactically, that is, to prevent cancer rather than treat it. Alternatively, certain patients can choose to have a wide local excision (also called a lumpectomy), an operation in which a small volume of breast tissue containing the tumor and some surrounding healthy tissue is removed to conserve the breast. Both mastectomy and lumpectomy are what are referred to as "local therapies" for breast cancer, targeting the area of the tumor, as opposed to systemic therapies such as chemotherapy, hormonal therapy, or immunotherapy.

Traditionally, in the case of breast cancer, the whole breast was removed. Often the mastectomy was performed during the same operation in which the biopsy was taken that confirmed the diagnosis. Nowadays the decision to do the mastectomy is usually based on the earlier performed biopsy. Also there is a trend to a more conservative approach to breast cancer. Practice has changed, on the one hand, due to improvements in radiotherapy and adjuvant treatment (e.g. chemotherapy or hormonal therapy) which mean a wider excision no longer makes local recurrence less likely, and on the other hand a recognition that breast cancer metastasizes early. Radical excision will not prevent later distant secondary tumors arising from micro-metastases prior to discovery, diagnosis and operation. In developed countries, only a minority of cancers is still treated by the traditional radical mastectomy.

There are a variety of types of mastectomy in use, and the type that a patient decides to undergo (or whether he or she will decide instead to have a lumpectomy) depends on factors such as size, location, and behavior of the tumor (if there is one), whether or not the surgery is prophylactic, and whether or not the patient intends to undergo reconstructive surgery.

Types of Mastectomy

• Simple mastectomy (or "total mastectomy"): In this procedure, the entire breast tissue is removed, but axillary lymph nodes (that is, located in the armpit area) and pectoral tissues are left intact. Sometimes the "sentinel node"--that is, the first lymph node that the tumor drains into--is removed. This surgery is sometimes done bilaterally (on both breasts) on patients who wish to undergo mastectomy as a cancer-preventative measure. Patients who undergo simple mastectomy can usually leave the hospital the next day, although they might have a drain inserted in their breast and attached to a small suction device to drain fluid, which will be removed seven to ten days after.
• Modified radical mastectomy: The entire breast tissue is removed along with some of the axillary lymph nodes.
• Radical mastectomy (or "Halsted mastectomy"): First performed in 1882, this procedure involves removing the entire breast, the axillary lymph nodes, and the pectoral tissue behind the breast. Because the surgery is disfiguring, it is rarely done today.
• Skin-sparing mastectomy: In this surgery, the breast tissue is removed through an incision made around the areola (the dark part surrounding the nipple). The skin of the breast is preserved and reconstructive surgery can be done with tissue from the abdomen or gluteal area. Patients with cancers that involve the skin, such as inflammatory cancer, are not candidates for skin-sparing mastectomy.
• Quandrantectomy, or partial mastectomy: Like a lumpectomy, this is considered a form of breast conservation therapy. However, a quadrantectomy involves removal of more breast tissue than a lumpectomy--up to a quarter of the breast may be removed, whereas a lumpectomy removes only the tumor and a margin of surrounding tissue.
• Subcutaneous mastectomy: Breast tissue is removed, but the nipple-areola complex is preserved. This procedure is usually done prophylactically, since preserving the nipple and areola means leaving a significant amount of tissue intact.