Definition and Overview
A mastectomy is a surgical breast removal procedure commonly performed for the treatment of breast cancer. It is a more radical or aggressive course of treatment when compared to a lumpectomy, which purposely removes only the tumor and a margin of healthy tissue around it so that the breast can be preserved. A mastectomy can also be performed as a preventive measure among women who have a higher risk of breast cancer.
Who should undergo and expected results
A mastectomy is a medical procedure used to treat breast cancer. Unlike systemic therapies such as chemotherapy and immunotherapy, it locally targets the tumor and malignant cells.
The decision to perform a mastectomy on a breast cancer patient depends on several factors, such as:
- The size of the breast
- The number of cancerous lesions
- The stage of the cancer
- How aggressive the cancer is or how fast it is growing
- The patient's preferences
Before making the decision, patients are informed about the risks and effects of breast removal surgery as well as its advantages over other cancer therapies. For example, both lumpectomy and radiation therapy do not rule out the possibility of cancer recurrence and even metastatic cancer. A mastectomy, however, can significantly reduce this risk and thus raises the patient's chance of a full recovery.
Given these considerations, mastectomies are often recommended for:
- Patients who have had unsuccessful radiation therapy
- Patients who have two cancerous lesions on separate parts of the same breast; this rules out a lumpectomy
- Patients who have had an initial lumpectomy but still have some of the cancer left
- Patients who have existing health issues that make it risky for them to undergo radiation therapy
- Patients who are pregnant and thus cannot undergo radiation therapy due to its potentially harmful effects on the child
- Patients with tumors larger than 2 inches that do not respond to chemotherapy
- Women with deleterious mutations in their BRCA1 and BRCA2 genes, which place them at high risk of breast cancer
- Male patients who also suffer from breast cancer
How the procedure works
A mastectomy is a major surgical procedure performed in a hospital setting. The exact manner in which the procedure is performed depends on what type of mastectomy the patient and the surgeon has agreed upon as the most appropriate given the circumstances of the patient's case. The different types of breast removal procedures available today include:
- Simple or total mastectomy – This procedure removes the entire breast tissue without disturbing the axillary contents, such as the lymph nodes. This requires only a short hospital stay and the patient goes home with a tube that drains out subcutaneous fluid. She then has to come back after a couple of days to have the tube removed.
- Modified radical mastectomy – This removes not only the breast but also the axillary contents of the breast, i.e. the lymph nodes and the fatty tissues.
- Radical mastectomy – Also known as a Halsted mastectomy, this procedure removes the breast, the axillary contents, and the pectoral muscles behind it. This causes severe disfigurement, and is thus only used if cancer has spread to the chest wall or the patient has had recurrent cancers.
- Extended radical mastectomy – This involves the resectioning of the internal mammary lymph node.
- Nipple-sparing mastectomy – This procedure removes only the breast tissue while retaining the part that contains the nipple and the areola.
- Skin-sparing mastectomy – This is a more conservative form that removes breast tissue through a small incision made around the areola, thus saving a larger amount of skin compared to other types of breast removal surgery.
- Prophylactic mastectomy – This is a preventative procedure performed even before breast cancer develops.
Regardless of the type of procedure to be performed, patients are given an IV line before the surgery. Due to the complexity of the procedure, they are also hooked to an ECG machine and a blood pressure monitor. All breast removal surgeries are performed under general anesthesia.
After the procedure, the patient will be asked to stay in the hospital for up to 2 nights, sometimes more, depending on their condition. The breast area will be covered with a bandage, which has to be changed periodically while the patient is recovering. This procedure is followed by a long recovery period during which the patient is advised to refrain from engaging in strenuous activities.
Possible risks and complications
A mastectomy comes with certain risks and complications. Primary among these is the obvious change in the shape or overall appearance of the breasts. Some women may have a difficult time getting used to this, especially if the procedure caused severe disfigurement. Some opt to use breast or nipple prostheses, but some choose to undergo breast reconstruction surgery.
Other risks associated with a breast removal surgery include:
- Post-surgical pain
- Wound infection
- Seroma, or when fluid builds up in the wound
- Hematoma, or when blood builds up in the wound
- Numbness/loss of feeling or decreased feeling in the breasts
- Tingling in the chest radiating towards the arms
To minimize these risks, patients who had a breast removal surgery performed are given post-surgical instructions and a schedule of follow-up appointments, the first of which is scheduled 1 to 2 weeks after the procedure. They are also usually given antibiotics to prevent possible infections.
Cuzick J, DeCensi A, Arun B, et al. Preventive therapy for breast cancer: a consensus statement. Lancet Oncol. 2011;12(5):496-503. PMID: 21441069 www.ncbi.nlm.nih.gov/pubmed/21441069.
Giuliano AE, Hunt KK, Ballman KV, et al. Axillary dissection vs no axillary dissection in women with invasive breast cancer and sentinel node metastasis: a randomized clinical trial. JAMA. 2011;305(6):569-75. PMID: 21304082 www.ncbi.nlm.nih.gov/pubmed/21304082.