Definition & Overview
Subcutaneous mastectomy is the surgical procedure of removing all of the breast tissue through an incision. It allows the surgeon to spare the skin, areola, and nipple, leaving them intact. It is indicated for women suffering from different breast-related diseases including cancer.
Breast cancer is considered one of the leading causes of death among women all over the world. However, the survival rate for this disease has been steadily improving because of increased awareness, availability of screening tests, and improved treatment. Like other types of cancer, there are several treatment methods available for the patient. These include radiation therapy, chemotherapy, and surgery. In some cases, women opt to remove their entire breast tissue to stop the advancement of this disease. This procedure is called mastectomy.
Aside from subcutaneous mastectomy, other types of mastectomies include:
- Simple or total mastectomy, where the entire breast is removed
- Modified radical mastectomy, which also entails the removal of the entire breast along with fatty tissues and lymph nodes
- Radical mastectomy, in which breast and its axillary contents are removed as well as a good part of the muscle tissues behind the breast.
A good number of women diagnosed with breast cancer would still want to retain the shape and form of their affected body part while removing the cancerous cells. This makes subcutaneous mastectomy a good treatment option for them.
Who Should Undergo and Expected Results
Women diagnosed with the following conditions can be advised to undergo subcutaneous mastectomy:
Lobular carcinoma - This is a type of invasive cancer that develops from the lobules or milk-producing glands of the breast. Women who are diagnosed with this condition typically do not feel any lumps forming in their breasts. Instead, there is a marked fullness or thickening in just one part. There is also a change in the overlying skin, and the nipple becomes inverted. This condition often manifests little to no symptoms during its early stages and could only be detected when cancer has progressed.
Fibrocystic breast disease - This condition gives the breast a lumpy texture. It is also characterised by the presence of fibrous tissues. Swelling and tenderness of the affected part are the most common complaint. Though the disease is considered benign, women who had multiple biopsies to evaluate these lumps may choose to remove the breast tissues entirely while retaining the enveloping skin and areola.
Chronic mastitis - This refers to the recurring breast infection particularly in the ducts or small channels that carry milk to the nipple. For women who are not breastfeeding, this condition is often brought about by hormonal changes that lead to clogging of the ducts. As bacterial infection sets in, swelling and tenderness of the breast occur. If left untreated, chronic mastitis can lead to abscess, fever, and chills. Physicians may recommend subcutaneous mastectomy if the condition persists and has caused considerable pain and discomfort.
Silicone mastopathy - Silicone breast implants can leak and cause lesions. This can lead to swelling, tenderness, and chronic pain. In cases wherein the silicone has diffused to a large area of the breast, subcutaneous mastectomy could be an appropriate treatment.
Large benign breast tumours - Subcutaneous mastectomy is also performed on those who suffer from large-sized benign tumours. Though these abnormal cell growths do not pose any immediate health threats, this condition results in considerable pain and discomfort.
High genetic risk of developing breast cancer - Women who had close relatives diagnosed with breast cancer can also opt to undergo subcutaneous mastectomy as a preventative measure.
Subcutaneous mastectomy has a high success rate and most patients recover well after the procedure. Since this is considered a major surgery, patients are advised to rest for several weeks to allow their wounds to heal. Cancer patients may undergo further treatment such as radiotherapy or chemotherapy. Hormonal therapy may also be advised.
Those with benign conditions do not usually require additional treatment.
How is the Procedure Performed?
For the procedure, the patient is placed under general anaesthesia. After marking the surgical site, the surgeon will make an incision, typically within the fold under the breast. Some surgeons opt to make an incision around the nipple area. The breast tissue is then removed. Tissue samples from the lymph nodes are also taken and sent to a pathology lab for evaluation.
In some cases, plastic surgeons perform breast reconstruction during the same operation. There are several ways of reconstructing the form and shape of the actual breast. One option is using tissues from another part of the body, such as tissues from the stomach or the back. Another option is to use a silicone implant to replace the removed breast tissue.
The surgeon also places drainage tubes inside the breast before closing the incision with sutures. The tubes will help remove any fluid accumulating in the surgical site to prevent complications.
Possible Risks and Complications
Subcutaneous mastectomy is a safe procedure. But since it is performed using incisions and anaesthesia, it is not without risks and complications. These may include:
- Infection at the surgical site
- Bleeding, especially among those who are taking blood thinners
- Seroma, or the collection of fluid under the skin
- Deep vein thrombosis, in which blood clots cause swelling and pain in the lower extremities. A small part of this clot can possibly break off and go into the lungs, leading to embolism.
- Cancer recurrence, in cases when not all cancer cells were removed during the procedure
- Lymphedema or when the arm near the surgical site swells and causes discomfort.
- Collapsed lungs
Damage to the nerves, which can cause numbness or paralysis of the arm, chest wall, or back
CancerNet (database on Internet). National Cancer Institute (NCI); 1996-, updated monthly. Prevention of breast cancer. Updated 01/2001. Available from the NCI, Bethesda, MD.
Eisinger F, Alby N, Bremond A, Dauplat J, Espie M, Janiaud P, et al. Recommendations for medical management of hereditary breast and ovarian cancer: the French National Ad Hoc Committee. Ann Oncol 1998;9:939–50.