Mastectomy

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Overview

Mastectomy, which is the surgical removal of a breast, is the most common treatment for breast cancer. There are several types of mastectomy, which are distinguished by the amount of breast tissue and other tissues that are removed. Tumor size and type, cancer stage, and lymph node involvement are factors that are commonly considered to determine which procedure is most appropriate. The age and overall health of the patient also are taken into account.

Types of Mastectomy

Several surgical procedures are used to treat breast cancer: simple (total) mastectomy, modified radical mastectomy, radical mastectomy, skin-sparing mastectomy, subcutaneous mastectomy, partial mastectomy, and lumpectomy.

• Simple or total mastectomy—In this procedure, the entire breast is removed, but the lymph nodes and surrounding muscle are left intact.
• Modified radical mastectomy—This is the most common surgical procedure performed for breast cancer. The entire breast, the lymph nodes under the arm, and the lining over the chest muscles are removed. The muscles remain intact.
• Radical mastectomy—The breast, lymph nodes, muscles under the breast, and some of the surrounding fatty tissue are removed. This procedure is rarely performed. Radical mastectomy is used in cases of extensive tumors and in cases where cancer cells have invaded the chest wall.
• Skin-sparing mastectomy—A relatively new surgical technique called skin-sparing mastectomy may be an option for some patients. During this procedure, the surgeon makes a much smaller incision, sometimes called a "keyhole" incision, circling the areola. Even though the opening is smaller, the same amount of breast tissue is removed. Scarring is negligible and 90% of the skin is preserved. Reconstruction is performed at the same time as the procedure by a plastic surgeon, using tissue from the patient's abdomen or latissimus dorsi, a muscle in the back.
• Subcutaneous mastectomy—The tumor and breast tissue are removed, but the nipple and the overlying skin are left intact. Reconstruction surgery is easier, but some cancer cells may remain.
• Partial mastectomy—In a partial mastectomy, a larger amount of breast tissue and some skin are removed with the tumor. A partial mastectomy also includes removal of the lining over chest muscles below the tumor and, usually, some lymph nodes. This surgery is usually performed for Stage 1 and 2 tumors.
• Lumpectomy—In a lumpectomy, the tumor and a small amount of surrounding tissue are removed. Several lymph nodes may also be removed.

Surgical Procedure

General anesthesia, which renders the patient unconscious, is administered for all types of mastectomy. The surgeon makes a curved cut, called an elliptical incision, into the skin. The incision includes the nipple, areola, and the biopsy scar.

The tumor and all of the breast tissue, including the nipple and areola, are removed. The initial incision may extend to the armpit to allow for removal of the lymph nodes. If a radical mastectomy is being performed, the surgeon also removes the muscles beneath the breast. At the end of the operation, one or two drains are inserted to drain excess fluid that may collect under the skin.

Every effort is made to leave as much healthy skin intact as possible, but sometimes a substantial amount of skin is removed, resulting in a large, possibly disfiguring scar, and making breast reconstruction difficult.

A mastectomy usually takes 2 to 3 hours. A radical mastectomy may take longer because the surgery is more complex.

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