Mastectomy

Mastectomy

Mastectomy is surgery to remove the entire breast. All of the breast tissue is removed,
sometimes along with other nearby tissues.
Simple mastectomy: In this procedure, also called total mastectomy, the surgeon
removes the entire breast, including the nipple, but does not remove underarm lymph
nodes or muscle tissue from beneath the breast. Sometimes both breasts are removed (a
double mastectomy), often as preventive surgery in women at very high risk for breast
cancer. Most women, if they are hospitalized, can go home the next day. This is the most
common type of mastectomy used to treat breast cancer.
Skin-sparing mastectomy: For some women considering immediate reconstruction, a
skin-sparing mastectomy can be done. In this procedure, most of the skin over the breast
(other than the nipple and areola) is left intact. This can work as well as a simple
mastectomy. The amount of breast tissue removed is the same as with a simple
mastectomy.
This approach is only used when immediate breast reconstruction is planned. It may not
be suitable for larger tumors or those that are close to the surface of the skin. Implants or
tissue from other parts of the body are used to reconstruct the breast. This approach has
not been used for as long as the more standard type of mastectomy, but many women
prefer it because it offers the advantage of less scar tissue and a reconstructed breast that
seems more natural.
A variation of the skin-sparing mastectomy is the nipple-sparing mastectomy. This
procedure is more often an option for women who have a small early stage cancer near
the outer part of the breast, with no signs of cancer in the skin or near the nipple. In this
procedure, the breast tissue is removed, but the breast skin and nipple are left in place.
This is followed by breast reconstruction. The surgeon often removes the breast tissue
beneath the nipple (and areola) during the procedure, to check for cancer cells. If cancer
is found in this tissue, the nipple must be removed. Even when no cancer is found under
the nipple, some doctors give the nipple tissue a dose of radiation during or after the
surgery to try and reduce the risk of the cancer coming back.

There are still some problems with nipple-sparing surgeries. Afterward, the nipple does
not have a good blood supply, so sometimes it can wither away or become deformed.
Because the nerves are also cut, there is little or no feeling left in the nipple. In women
with larger breasts, the nipple may look out of place after the breast is reconstructed. As a
result, many doctors feel that this surgery is best done in women with small to medium
sized breasts. This procedure leaves less visible scars, but if it isn't done properly, it can
leave behind more breast tissue than other forms of mastectomy. This could result in a
higher risk of cancer developing than for a skin-sparing or simple mastectomy. This was
a problem in the past, but improvements in technique have helped make this surgery
safer. Still, many experts consider nipple-sparing procedures too risky to be a standard
treatment of breast cancer.
Modified radical mastectomy: This procedure is a simple mastectomy plus removal of
axillary (underarm) lymph nodes. Surgery to remove these lymph nodes is discussed in
further detail later in this section.
Radical mastectomy: In this extensive operation, the surgeon removes the entire breast,
axillary lymph nodes, and the pectoral (chest wall) muscles under the breast. This surgery
was once very common, but less extensive surgery (such as modified radical
mastectomy) has been found to be just as effective. This meant that the disfigurement and
side effects of a radical mastectomy were not needed, so these surgeries are rarely done
now. This operation may still be done for large tumors that are growing into the pectoral
muscles under the breast.
Possible side effects: Aside from post-surgical pain and the obvious change in the shape
of the breast(s), possible side effects of mastectomy include wound infection, hematoma
(buildup of blood in the wound), and seroma (buildup of clear fluid in the wound). If
axillary lymph nodes are also removed, other side effects may occur (see the section,
"Lymph node surgery").