Mastectomy: Overview and Types

Mastectomy is a term used for the surgery in which one or both the breasts are removed. It might include the removal of other tissues other than breasts like nearby muscles and lymph nodes. There are multiple types of Mastectomy procedures available depending on how extensive the surgery is and how many tissues are removed.

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Why is a Mastectomy done? What are the surgical treatment options for primary breast cancer? What stage of breast cancer requires a mastectomy?

It is done as a primary treatment for most breast cancer.

There are two surgical treatment options for primary breast cancer: Lumpectomy and Mastectomy.

Lumpectomy

It is also popularly known as Breast Conservation Surgery as the whole breast is not removed. Only the lesion area with a 1 cm margin of normal tissue is removed. It has the benefit of a better cosmetic appearance.

·Mastectomy

One or both the breasts are completely removed. along with other nearby tissues

Your doctor might recommend Mastectomy if you:

• Are unable to have radiation therapy like during pregnancy where radiation possess a risk to the growing baby

• Had a previous history of radiotherapy exposure to breast

• Have connective tissue disorders like systemic lupus erythematosus

• Already underwent Breast Conservative surgery with re-excision which did not completely remove the cancer

• Have a very large tumor and may not have enough tissue left after Lumpectomy for the better cosmetic appearance

• Have multicentric breast cancer: Two or more areas of cancer in different quadrants of the same breast

• Have Multifocal breast cancer: Presence of multiple well-marked invasive tumor foci separated from each other by uninvolved healthy breast tissue, regardless of the distance between the foci

Can mastectomy prevent breast cancer?

Through genetic testing, you can find out if you have any mutation in BRCA1, BRCA2, or p53 genes and have a higher risk of having breast cancer or if breast cancer runs in your family then your doctor might advise you for a Prophylactic Mastectomy. In cases like this, Mastectomy decreases the risk of developing breast cancer by 85% to 100%.

What are the various types of Mastectomy?

Radical Mastectomy

This type of surgery is rarely done today as this is very extensive. In this, the whole breast with Nipple-areola complex, overlying skin, underlying lymph nodes, and chest wall muscles (pectoral muscles- pectoralis major and minor) are removed. Nowadays this type of surgery is only performed when the tumor has already spread to the chest wall muscles and can not be shrieked using chemotherapy.

Modified Radical Mastectomy

In this type of surgery, the chest wall muscles are preserved. The surgeon only removes the breast tissue with Nipple-areola complex, overlying skin, underlying lymph nodes, and the fascia covering the chest wall muscles but the chest wall muscles are not removed. In some cases, part of the chest wall might be removed (only pectoralis minor muscle).

Simple Mastectomy

Chest wall muscles and lymph nodes are preserved in this kind of Mastectomy. The surgeon removes the whole breast with the Nipple-areola complex, overlying skin, and the fascia (membranous sheath) covering the chest wall but leaving the underlying lymph nodes and muscles in place. This type of surgery is preferred in Phyllodes tumors, DCIS, or fungating breast cancer.

Double Mastectomy

Both the breasts are removed in this type of Mastectomy. It is usually done as a preventive measure if there is an increased risk of having breast cancer or hereditary breast cancer. Also done in cases of bilateral breast cancer.

Skin Sparing Mastectomy

The surgery is similar to Simple Mastectomy except that in skin-sparing surgeries, the skin over the breast is preserved and Breast reconstruction is done either with implants or tissues from other body parts. This type of surgery is usually preferred by most women as it gives the best cosmetic outcome but comes with a risk of recurrence

Nipple Sparing Mastectomy

In this type, the Nipple-areola complex is conserved and is more done in women who have a small, early-stage cancer, away from the nipple and areola, with no signs of cancer in the skin or the nipple.

Removal of Lymph Nodes

(Lymph nodes are bean-shaped structures that filter substances that travel through lymphatic vessels).

Breast cancer commonly spreads to the lymph nodes of the arms and neck in the side of the breast cancer and usually presents as enlarged lymph nodes. So, it is important to check and remove the lymph nodes (axillary lymph node clearance) to prevent recurrence and further complications

This includes :

Sentinel lymph node biopsy

Sentinel lymph nodes are the first draining lymph nodes of breast cancer. If no lymph nodes are enlarged then Sentinel lymph nodes biopsy is done. If it comes negative then there is no need for axillary lymph node clearance.

Axillary lymph node dissection

If there are enlarged lymph nodes or if Sentinel lymph node biopsy comes positive then the lymph nodes are removed (At least 10).

Breast Reconstruction Surgery: Post-Mastectomy

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Most women are worried about the appearance of breasts after Mastectomy and prefer to restore the breast's appearance. This can be done using breast reconstructive surgery in which the breast is rebuilt with implants or tissues from other parts of the body.

Women who don't want to undergo reconstructive surgery can opt for breast prosthesis and specially designed clothes for Mastectomy like a Mastectomy bra.

How Long Does It Take To Recover After Mastectomy?

In general, women have to stay for 2 nights post-surgery and then can go home and resume their normal activities in a month. But this depends on the health condition. They may have to do frequent hospital visits for follow-up of undergoing chemotherapy or radiation therapy.

Disclaimer: Your surgeon will recommend the type that is best for your specific diagnosis.

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References

1. Mastectomy. American Cancer Society. [Link]

2. Breast cancer. Merck Manual Professional Version. [Link]

3. Mastectomy. [Link]