What is mastectomy?
Mastectomy is a form of surgery in which the entire breast or a portion of breast tissue is removed in order to prevent or treat breast cancer. Many women think that a mastectomy is the only surgical option. In early stage breast cancer a lumpectomy can be performed where only the cancerous breast lump is removed. Although both the procedures are effective, sometimes mastectomy is preferred over lumpectomy. Newer mastectomy procedures helps in preserving the skin of the breast thereby making it easier to maintain the natural appearance of breast during the reconstructive procedures. The reconstruction procedure can be performed at the same time as a mastectomy.
Reasons for mastectomy
Mastectomy is done to remove breast tissue in patients with breast cancer and also in women who are at high risk of suffering from breast cancer in the future. It is not only the cancerous tissue that is removed but also some or all of the healthy tissue of the breast. Mastectomy may be done on one side (unilateral) or both sides (bilateral).
There are number of breast cancers for which mastectomy are recommended like ductal carcinoma in situ or non-invasive carcinoma, early stage breast cancer (stage 1 and 2), stage 3 breast cancers, after chemotherapy as it reduces the size of the tumor, inflammatory breast cancer along with chemotherapy, Paget’s disease of breast and locally recurrent breast cancer.
Mastectomy vs Lumpectomy
Sometimes mastectomy is preferred over lumpectomy if the patient has :
- two or more tumors in separate areas of the breast,
- presence of microcalcification or calcium deposits all around the breast tissue,
- recurrence of breast cancer following radiation therapy,
- cancer has occurred in pregnant women when radiation and chemotherapy cannot be used,
- presence of cancerous cells following lumpectomy,
- high risk of suffering from breast cancer as there is presence of mutation of BRCA gene,
- presence of connective tissue diseases like scleroderma for which the patient is unable to tolerate radiation therapy,
- tumor size is so large that after lumpectomy only a minimal amount of breast tissue will be available to get a satisfactory cosmetic result in the following reconstructive surgery.
Prophylactic mastectomy is performed in women with very high risk of developing breast cancer in the future as indicated by the presence of gene mutation or strong family history or both. It has gained widespread media attention and public awareness after Hollywood celebrity Angelina Jolie disclosed that she underwent prophylactic mastectomy.
Before undergoing the surgery, the surgeon assesses the patient’s medical, surgical and drug history, discusses outcomes and expectations and decides on the anesthesia plan. Breast reconstruction surgery may be performed at the same setting using silicone implants, natural body tissue or both.
There are different types of mastectomy performed for different reasons.
- In a simple mastectomy the entire breast tissue along with nipple and areola is removed.
- In modified radical mastectomy the breast tissue along with the nipple, areola, part of chest muscles and underarm lymph nodes are removed.
- Skin-sparing mastectomy where breast tissue, nipple and areola are removed keeping the breast tissue and breast reconstruction surgery is performed immediately.
- Nipple sparing mastectomy where only the breast tissue is removed keeping the nipple, areola and chest muscles intact.
The procedure is performed under general anesthesia and patient is likely to stay at hospital for few days after the surgery.