MASTECTOMY

Mastectomy is the medical term for surgical removal of the breast. It refers to a number of different operations, ranging from those that remove the breast, chest muscles and underarm lymph nodes, to those that remove only the breast lump.

The different types of breast surgery are described below. Based on the size and location of the lump, your doctor will recommend the type of surgery that offers you the best chance of successful treatment.

Most medical and surgical procedures carry some risk. The risks are categorized small or serious, frequent or rare. Because there is such a wide range of potential risks and benefits from various treatments for the different stages and kinds of breast cancer, you should discuss with your doctor the particular benefits and risks of treatment methods suitable for you.

MODIFIED RADICAL MASTECTOMY OR TOTAL MASTECTOMY WITH AXILLARY NODE DISSECTION

This procedure removes the breast, the underarm lymph nodes, and the lining over the chest muscles. It is also called “total mastectomy with axillary (or underarm) dissection.”

Today, it is the most common treatment of early stage breast cancer where lymph node involvement has been proven.

ADVANTAGES – Keeps the chest muscle and the muscle strength of the arm. Swelling is less likely, and when it occurs, it is milder than the swelling that can occur after a radical mastectomy. It leaves a better appearance than the radical mastectomy. Survival rates are the same as for the radical mastectomy when cancer is treated in early stages. Breast reconstruction is easier and can be planned before surgery.

DISADVANTAGES – The breast is removed. In some cases, there may be swelling of the arm because of the removal of the lymph nodes. (8%-10% risk of lymph edema).

TOTAL OR SIMPLE MASTECTOMY

This type of surgery removes only the breast. Ideally a few of the underarm lymph nodes closest to the breast are removed to assure complete removal of the axillary tail of the breast. This is most often used to treat noninvasive breast cancers or in prophylactic mastectomies.

ADVANTAGES – Most or all of the underarm lymph nodes remain, so the risk of swelling of the arm is greatly reduced. Breast reconstruction is easier.

DISADVANTAGES – The breast is removed. If cancer has spread to the underarm lymph nodes, it may remain undiscovered.

SKIN SPARING MASTECTOMY

The mastectomy is performed through a small keyhole using the nipple/areola complex as the only skin that is removed. It allows for excellent cosmetic results from reconstruction and does not increase the risk of local recurrence, as long as the skin is not involved by tumor.

ADVANTAGES-Cosmetic results are superior to a standard mastectomy scar.

DISADVANTAGES- The skin flap may lose adequate blood flow to remain alive.

NIPPLE SPARRING MASTECTOMY

This procedure essentially removes the breast tissue and leaves the skin and nipple complex in place. It may be ideal for patients undergoing prophylactic surgery and women with cancers that are located away from the nipple complex

ADVANTAGES- Cosmetically, in the appropriate patient, the cosmetic results are superior to other reconstruction options.

DISADVANTAGES- The remaining nipple complex will usually lose it’s sensation. There is a 20% chance that the nipple will lose a portion of it’s skin due to lack of blood flow. We currently have no means of imaging the remaining tissue of the nipple. The nipple is considered part of the breast, and therefore there is a slightly higher risk that a cancer could grow in the nipple complex.

RADICAL MASTECTOMY

This type of surgery removes the breast, the chest muscles, all of the underarm lymph nodes, and some additional fat and skin. It is also called a “Halsted Radical” (after the surgeon who developed the procedure). A radical mastectomy was the standard treatment for breast cancer for over 70 years and is rarely used for treatment.

ADVANTAGES – Cancer can be completely removed if it has not spread beyond the breast or nearby tissue. Examination of the lymph nodes provides information that is important in planning future treatment.

DISADVANTAGES – Removes the entire breast and chest muscles, and leaves a long scar and a hollow chest area. May also cause lymphedema (swelling of the arm), some loss of muscle power in the arm, restricted shoulder motion, and some numbness and discomfort. Breast reconstruction is also more difficult.This procedure is rarely done for treatment of primary breast cancer.