Mastectomy

By Emma Hitt

Procedure Overview

What is a mastectomy?

A mastectomy is a surgical procedure in which all or a portion of a breast is removed as a part of a treatment plan for breast cancer. In some cases, mastectomy is performed prophylactically (to prevent cancer from occurring) in women with a high risk for developing breast cancer.

Surgical treatment for breast cancer is generally divided into two categories: breast-conserving therapy (BCT) or mastectomy. BCT involves removing the least possible amount of breast tissue when removing breast cancer, and usually includes adjuvant (additional) therapy after surgery, most often radiation therapy.

There are several types of mastectomy procedures:

  • Total (or simple) mastectomy - removal of the entire breast, including the nipple, the areola, and most of the overlying skin. In addition, some of the lymph nodes under the arm, also called the axillary lymph glands, may be removed. The bean-shaped lymph nodes under the arm drain the lymphatic vessels from the upper arms, the majority of the breast, the neck, and the underarm regions. Often, breast cancer spreads to these lymph nodes, thereby entering the lymphatic system and allowing the cancer to spread to other parts of the body.

  • Modified radical mastectomy - removal of the entire breast, including the nipple, the areola, the overlying skin, some of the lymph nodes under the arm, and the lining over the chest muscles. In some cases, part of the chest wall muscle is also removed.

  • Radical mastectomy - removal of the entire breast, including the nipple, the areola, the overlying skin, the lymph nodes under the arm, and the chest muscles. For many years, this was the standard operation. However, today a radical mastectomy is rarely performed and is generally only recommended when the breast cancer has spread to the chest muscles.

Some newer mastectomy procedures may offer additional options for surgery. However, further studies are needed to learn whether these procedures are as effective as more standard types of surgery in completely removing or preventing the return of breast cancer.

  • Skin-sparing mastectomy - in this procedure the breast tissue, nipple and areola are removed, but most of the skin over the breast is saved. This type of surgery appears to be similar to modified radical mastectomy in effectiveness for many women. It is used only when breast reconstruction is performed immediately after the mastectomy surgery and may not be suitable for tumors that are large or near the skin surface.

  • Subcutaneous mastectomy - this may be an option for women undergoing prophylactic mastectomy. Breast tissue is removed through an incision under the breast, but the skin and nipple are left in place. This is followed by breast reconstruction. In this procedure, more breast tissue is left behind than other forms of mastectomy, so there are greater chances for developing cancer in the remaining tissue.

  • Nipple-sparing mastectomy - similar to the skin-sparing procedure, the breast tissue and the nipple and areola are removed. However, the tissues under and around the nipple and areola are carefully cut away and examined by a pathologist. If no breast cancer cells are found close to the nipple and areola, they can be reattached.

When all or most of the breast tissue is removed, breast reconstruction surgery may be performed to rebuild the breast. Reconstruction may be performed at the time of the mastectomy or at a later time.

Anatomy of the Breast:

Each breast has 15 to 20 sections, called lobes, that are arranged like the petals of a daisy. Each lobe has many smaller lobules, which end in dozens of tiny bulbs that can produce milk.

The lobes, lobules, and bulbs are all linked by thin tubes called ducts. These ducts lead to the nipple in the center of a dark area of skin called the areola. Fat fills the spaces between lobules and ducts.

There are no muscles in the breast, but muscles lie under each breast and cover the ribs.

Each breast also contains blood vessels and vessels that carry lymph. The lymph vessels lead to small bean-shaped organs called lymph nodes, clusters of which are found under the arm, above the collarbone, and in the chest, as well as in many other parts of the body.



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