Mastectomy Health Article

Definition

A mastectomy is the surgery to remove the entire breast. It is usually done to treat breast cancer.

Alternative Names

Breast removal surgery; Subcutaneous mastectomy; Total mastectomy; Simple mastectomy; Modified radical mastectomy

Description

You will be given general anesthesia (unconscious and pain-free). The surgeon will make an elliptical cut in your breast:

• For a subcutaneous mastectomy, the surgeon removes the entire breast but leaves the nipple and areola (the pigmented circle around the nipple) in place.
• For a total or simple mastectomy, the surgeon cuts breast tissue free from the skin and muscle and removes it. The nipple and the areola are also removed. The surgeon may do a biopsy of nearby lymph nodes to see if the cancer has spread.
• For a modified radical mastectomy, the surgeon removes the entire breast along with the lining over some of the muscles. Some of the lymph nodes underneath the arm are also removed.
• For a radical mastectomy, the surgeon removes the overlying skin, all of the lymph nodes underneath the arm, and the chest muscles. This surgery is not done unless breast cancer has spread to your chest wall muscles.
• The skin is closed with sutures (stitches) or tape (Steri-Strips).

One or two small plastic drains or tubes are usually left in your chest to remove extra fluid from where the breast tissue used to be.

Your surgeon may be able to reconstruct the breast (with artificial implants or tissue from your own body) during the same operation. You may also choose to have reconstruction later.

See also:

• Breast reconstruction - natural tissue
• Breast reconstruction - implants

Mastectomy generally takes 1 to 3 hours.

Why the Procedure Is Performed

WOMAN DIAGNOSED WITH BREAST CANCER

The most common reason for a mastectomy is breast cancer. Mastectomy may treat several types of breast cancer: invasive ductal carcinoma, invasive lobular carcinoma, medullary carcinoma, mucinous and tubular carcinomas, inflammatory carcinoma, Paget's disease, ductal carcinoma in situ (DCIS), and lobular carcinoma in situ (LCIS).

If you are diagnosed with breast cancer, talk to your doctor about your choices:

• Surgery where only the breast cancer and tissue around the cancer are removed. This is called breast conservation therapy (breast lump removal). Part of your breast will be left.
• Mastectomy: all breast tissue is removed.

You and your doctor must consider:

• The size of your tumor, where in your breast it is located, whether you have more than one tumor in your breast, how much of your breast the cancer affects, and the size of your breasts
• Your age, family history, overall health, and whether you have reached menopause
• Whether the cancer has spread to your lymph nodes or other parts of the body
• The type of breast cancer you have. This is important because some types of breast cancer are more likely to spread or come back.

The choice of what is best for you can be difficult. Sometimes, your doctor may recommend one type of surgery. This is because your doctor can tell you what is known about the type of cancer you have and your risk factors. Other times, your doctor will talk with you about two or more surgical treatments that would be good for your cancer.

WOMEN AT HIGH RISK FOR BREAST CANCER

Your doctor may do either a subcutaneous or total mastectomy to reduce your risk of breast cancer if you are at very high risk of developing breast cancer. This is called prophylactic mastectomy.

You may have a higher risk of getting breast cancer if one close family relative, or more, has had breast cancer, especially at an early age. Genetic tests (such as BRCA1 or BRCA2) may also show you have a high risk. This surgery should be done only after very careful thought and discussion with your doctor, a genetic counselor, your family, and others.

Mastectomy greatly reduces, but does not eliminate, the risk of breast cancer.