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Mastectomy: Breast Removal Surgery Explained
A mastectomy is the surgical removal of one or both breasts. It is most commonly performed to treat breast cancer and can significantly improve survival outcomes.
Things worth knowing about "Mastectomy"
A mastectomy is the surgical removal of one or both breasts. It is most commonly performed to treat breast cancer and can significantly improve survival outcomes.
What is a Mastectomy?
A mastectomy is a surgical procedure in which one or both breasts are removed, either partially or completely. It is one of the primary surgical treatments for breast cancer (mammary carcinoma) and may also be performed as a preventive measure in individuals at very high risk of developing breast cancer. Several types of mastectomy exist, each differing in extent and surgical technique.
Types of Mastectomy
- Simple (total) mastectomy: Removal of all breast tissue, including the nipple, without removing the axillary lymph nodes or chest muscles.
- Modified radical mastectomy: Removal of all breast tissue along with axillary lymph nodes, while preserving the chest muscles.
- Radical mastectomy (Halsted): Removal of the entire breast, chest muscles, and axillary lymph nodes. Rarely performed today.
- Skin-sparing mastectomy: Removal of breast tissue while preserving most of the overlying skin to facilitate immediate breast reconstruction.
- Nipple-sparing mastectomy: Breast tissue is removed while the nipple and areola are preserved in suitable candidates.
- Prophylactic mastectomy: A preventive procedure for individuals at significantly elevated genetic risk, such as carriers of BRCA1 or BRCA2 gene mutations.
When is a Mastectomy Recommended?
A mastectomy is typically recommended when:
- the tumor is too large or unsuitable for breast-conserving surgery (lumpectomy),
- multiple tumors are present within the breast (multifocal or multicentric carcinoma),
- radiation therapy following breast-conserving surgery is not possible or not desired,
- a relapse (recurrence) occurs after prior radiation treatment,
- there is a very high genetic predisposition (prophylactic indication).
Preparation and Procedure
Prior to surgery, patients undergo thorough medical consultation, imaging studies (e.g., mammography, MRI), and often a biopsy to confirm the diagnosis. The procedure is performed under general anesthesia and typically lasts between one and four hours, depending on the type of mastectomy. In many cases, a sentinel lymph node biopsy is performed simultaneously to assess whether cancer has spread to the lymph nodes.
Breast Reconstruction
After a mastectomy, patients may opt for breast reconstruction. This can be performed immediately (at the same time as the mastectomy) or at a later stage. Common reconstruction methods include:
- Silicone or saline implants
- Autologous tissue reconstruction (e.g., TRAM flap, DIEP flap using the patient's own tissue)
- A combination of implants and autologous tissue
Risks and Side Effects
As with any surgical procedure, mastectomy carries certain risks:
- Infection and wound healing complications
- Lymphedema (swelling caused by disrupted lymph drainage following lymph node removal)
- Scarring and altered body sensation
- Numbness or pain in the surgical area
- Psychological distress and changes in body image
Follow-up Care and Rehabilitation
Regular follow-up appointments are essential after mastectomy. These include physical examinations, imaging check-ups, and, if needed, physiotherapy to restore full arm mobility. Psycho-oncological support and patient support groups can play an important role in the recovery process. For estrogen- or progesterone receptor-positive breast cancer, long-term hormonal therapy is often recommended following surgery.
References
- World Health Organization (WHO): Breast Cancer Fact Sheet (2023). Available at: https://www.who.int/news-room/fact-sheets/detail/breast-cancer
- Harbeck N., Penault-Llorca F., Cortes J. et al.: Breast cancer. Nature Reviews Disease Primers, 5(1):66 (2019). DOI: 10.1038/s41572-019-0111-2
- National Cancer Institute (NCI): Breast Cancer Treatment (PDQ) - Patient Version (2023). Available at: https://www.cancer.gov/types/breast/patient/breast-treatment-pdq
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