Mastectomy is the removal of one or both breasts surgically, normally done as a treatment for breast cancer. This procedure may involve complete or partial removal, depending on several factors such as the location, size, or progress of the tumor. Mastectomy may also be done prophylactically, wherein the primary goal of the procedure is to prevent the occurrence of the cancer, specifically for individuals who are at high risk for developing the disease. There are different types of mastectomy, all with specific risks and benefits.
Simple mastectomy
Also known as simple mastectomy, this type is one of the most common forms of mastectomy. This procedure involves removing the entire breast tissue, and may include the first axillary lymph node. Cancer cells, which have metastasized, typically drain into the sentinel lymph node and this is often removed as well. If breast reconstruction is not performed immediately, the patient will end up with a flat chest, and a transversely oriented scar of about 8 inches.
Skin-sparing mastectomy
A conservative incision is performed around the areola to preserve as much breast skin as possible. One advantage to this is that it aids in more successful breast reconstruction procedures. However, patients who have skin inflammatory cancer are not suitable for this type of procedure.
Total skin-sparing mastectomy
In this procedure, the surgeon leaves all of the skin while removing the breast tissue. This includes the skin of the nipple as well as the areola. However, this procedure is applicable only to women with whose tumor is no bigger than 2 centimeters and not less than 2 centimeters away from the nipple. This type of mastectomy is ideal for those undergoing prophylactic procedures.
Radical mastectomy
This type of mastectomy involves surgically removing all of the breast tissue, armpit lymph nodes, as well as the chest wall muscles, which are located under the cancerous breast. No tumor is expected to survive during this procedure; however, the post-procedure scars may appear more damaging than when undergoing modified radical mastectomy.
Modified radical mastectomy
Compared to radical mastectomy, modified radical mastectomy spares the pectoral muscles. However, the entire breast tissue, skin of the nipple and areola, as well as any lymph nodes found in the armpit, are all surgically removed. An advantage to the modified radical mastectomy is that the patient can elect to have immediate breast reconstruction after the procedure.
Subcutaneous mastectomy
Subcutaneous mastectomy is also known as nipple-sparing mastectomy. This procedure is suitable for tumors not found in a subareolar position. Although the entire breast tissue is removed, the nipple and areola complex are retained.
The risks of undergoing mastectomy
Although mastectomy is known to prevent the recurrence of cancer, through the removal of both the tumor and the surrounding breast tissues and muscle, the procedure comes with its own risks and benefits. Since mastectomy is a surgical procedure, some of the associated risks range from mild to moderate numbness along the incision site to as crucial as hematoma.
Here are some of the more common risks of mastectomy:
- sensitivity to touch on the location of the surgery
- risk of infection
- numbness of the skin
- delayed wound healing
- blood clots and blood loss
- adverse reactions to medications
- fluid under the scar, typically resulting from hematoma or blood accumulation in the wound
Benefits of undergoing mastectomy
Mastectomy is used to treat cancer, and depending on the stage of metastasis, size of tumor, and general health condition of the patient, the procedure is known to prevent the recurrence of breast cancer. In a study done by the American Society of Clinical Oncology, patients who have undergone mastectomy had a better chance of survival and being cancer-free than those who have opted out of any kind of breast treatment. The overall survival rate of those who have undergone mastectomy is also significantly higher. It has been concluded by the American Society of Clinical Oncology, moreover, that after a patient has been diagnosed of breast cancer, local treatment of the breast such as mastectomy need to be performed as soon as possible.
Prophylactic mastectomy has several advantages as well, especially for individuals who are at high risk for breast cancer. High risk criteria most commonly involve familiar or hereditary status, such as having first and second degree relatives who have been afflicted by the disease. Through genetic testing, it is easier to determine if a patient is a BRCA1/BRCA2 mutation carrier, which means she is at an exceptionally high risk for breast cancer. Prophylactic mastectomy anticipates the disease ahead of time and provides patients with a range of preventive options.
Mastectomy is just one of several options done as treatment for breast cancer. Although it carries a few risks, it has nevertheless improved the chances of survival for many breast cancer patients, depending, of course, on the severity of the disease as well as the manner of post-operative treatment.