By Dr Ananya Mandal, MD
Mastectomy is a procedure for removing one or both of the breasts. There are several types of procedures available for patients with indications for mastectomy and these include:
Total (simple) mastectomy
For this procedure, a surgeon removes the whole breast including the nipple, areola and skin as well as one or more of the axillary lymph nodes if they happen to be present in the breast tissue that needs to be removed. No muscles from underneath the breast are removed.
A simple mastectomy is a suitable option for women with ductal carcinoma in situ that is present in a large area or multiple areas. When the surgery is performed on both breasts, it is called a double mastectomy and this may be chosen by some patients as a preventative measure. Total mastectomy usually requires a brief stay in hospital. A drainage tube is placed within the incision to drain the subcutaneous fluid and is usually removed several days after surgery.
Modified radical mastectomy
During this procedure, the surgeon removes all of the breast tissue including the nipple and areola as well as level I and II axillary lymph nodes. The muscles beneath the breast are not removed.
This surgery is usually performed in cases of invasive breast cancer. Removing a large proportion of the lymph nodes for examination provides clues about the extent of cancer spread beyond the breast. This surgery may be followed by radiation therapy, which is performed to kill any remaining cancer cells and minimize the chances of cancer recurring. In some cases, chemotherapy, hormone therapy, and/or targeted therapy also follow a modified radical mastectomy.
This is the most extensive and most disfiguring form of mastectomy a woman can receive. The procedure involves removing the entire breast and level I, II and II axillary lymph nodes, as well as the underlying muscles of the chest wall.
Radical mastectomy is only indicated in cases where the cancer has spread to the muscles beneath the breast. It is far less commonly used today because the modified form of the procedure is usually just as effective and also causes less disfigurement.
This operation is also termed subcutaneous mastectomy. The breast tissues and the tumor are removed but the nipple and the areola are preserved. The procedure is less commonly performed than total mastectomy due to the fact that the tissue that remains in place is still at risk of becoming cancerous. Subcutaneous mastectomy is therefore a controversial treatment option and most physicians will recommend a simple mastectomy.
After a mastectomy, women may opt to wear a breast prosthesis or to undergo a breast reconstruction, which may be performed at the same time as the mastectomy or anytime after. A cosmetic surgeon usually collaborates with the surgeon performing the mastectomy and an implant or tissue from another part of the body is used to create a breast-like shape. A nipple and an areola may also be created surgically.
Reviewed by Sally Robertson, BSc