Mastectomy
In medicine, mastectomy is the medical term for the surgical removal of one or both breasts, partially or completely. Mastectomy is usually done to treat breast cancer; in some cases, women and some men believed to be at high risk of breast cancer have the operation prophylactically, that is, to prevent cancer rather than treat it. It is also the medical procedure carried out to remove breast cancer (tissue) in males. Alternatively, certain patients can choose to have a wide local excision (also called a lumpectomy), an operation in which a small volume of breast tissue containing the tumor and some surrounding healthy tissue is removed to conserve the breast. Both mastectomy and lumpectomy are what are referred to as "local therapies" for breast cancer, targeting the area of the tumor, as opposed to systemic therapies such as chemotherapy, hormonal therapy, or immunotherapy.
Traditionally, in the case of breast cancer, the whole breast was removed. Currently the decision to do the mastectomy is based on various factors including breast size, number of lesions, biologic aggressiveness of a breast cancer, the availability of adjuvant radiation, and the willingness of the patient to accept higher rates of tumor recurrences after lumpectomy and radiation. Outcome studies comparing mastectomy to lumpectomy with radiation have suggested that routine radical mastectomy surgeries will not always prevent later distant secondary tumors arising from micro-me tastases prior to discovery, diagnosis, and operation.
Cont ents
Rates
Mastectomy rates vary tremendously world-wide, as was do cumented by the 2004 'Intergroup Exemestane Study',[1] an analysis of surgical techniques used in an international trial of adjuvant treatment among 4,700 women with early breast cancer in 37 countries. The mastectomy rate was highest in central and eastern Europe at 77%. The USA had the second highest rate of mastectomy with 56%, western and northern Europe averaged 46%, southern Europe 42% and Australia and New Zealand 34%.
Mastectomy indications
Despite the increased ability to offer breast-conservation techniques to patients with breast cancer, there exist certain groups who may be better served by traditional mastectomy procedures including: women who have already had radiation therapy to the affected breast
women with 2 or more areas of cancer in the same breast that are too far apart to be removed through 1 surgical incision, while keeping the appearance of the breast satisfactory
women whose initial lumpectomy along with (one or more) re-excisions has not completely removed the cancer
women with certain serious connective tissue diseases such as scleroderma, which make them especially sensitive to the side effects of radiation therapy
pregnant women who would require radiation while still pregnant (risking harm to the fetus)
women with a tumor larger than 5 cm (2 inches) that doesn't shrink very much with neoadjuvant chemotherapy
women with a cancer that is large relative to her breast size
Women who have tested positive for a deleterious mutation on the BRCA1 or BRCA2 gene and opt for prophylactic removal of the breasts
male breast cancer patients
Types of mastectomy
There are a variety of types of mastectomy in use, and the type that a patient decides to undergo (or whether he or she will decide instead to have a lumpectomy) depends on factors such as size, lo cation, and behavior of the tumor (if there is one), whether or not the surgery is prophylactic, and whether or not the patient intends to undergo reconstructive surgery.
Simple mastectomy (or "total mastectomy"): In this procedure, the entire breast tissue is removed, but axillary cont ents are undisturbed. Sometimes the "sentinel lymph node"--that is, the first axillary lymph node that the would be expected to drain into--is removed. This surgery is sometimes done bilaterally (on both breasts) on patients who wish to undergo mastectomy as a cancer-preventative measure. Patients who undergo simple mastectomy can usually leave the hospital after a brief stay. Frequently, a drainage tube is inserted during surgery in their chest and attached to a small suction device to remove subcutaneous fluid. These are usually removed several days after surgery as drainage decrease to less than 20-30 ml per day. illustration
Radical mastectomy (or "Halsted mastectomy"): First performed in 1882, this procedure involves removing the entire breast, the axillary lymph nodes, and the pectoral tissue behind the breast. This procedure is more disfiguring than a modified radical mastectomy and provides no survival benefit for most tumors. This operation is now reserved for tumors involving the pectoralis major muscle or recurrent breast cancer involving the chest wall. illustration
Skin-sparing mastectomy: In this surgery, the breast tissue is removed through a conservative incision made around the areola (the dark part surrounding the nipple). The increased amount of skin preserved as compared to traditional mastecomy resections serves to facilitate breast reconstruction procedures. Patients with cancers that involve the skin, such as inflammatory cancer, are not candidates for skin-sparing mastectomy. illustration
Subcutaneous mastectomy: Breast tissue is removed, but the nipple-areola complex is preserved. This procedure was historically done only prophylactically or with mastecomy for benign disease over fear of increased cancer development in retained areolar ductal tissue. Recent series suggest that it may be an oncologically sound procedure for tumors not in the subareolar position.[2][3][4]
Operative details and information for patients for mastectomy
Operative details of the above operations can be seen in the surgical scripts presented in Wikisurgery/Breast Surgery.
Information for patients is also presented in Wikisurgery/Breast Surgery
See also References
<LI id=cite_note-titleFederation_of_European_Cancer_Societies-0>^ Federation of European Cancer Societies. Retrieved on 2007-12-03. <LI id=cite_note-pmid12832974-1>^ Gerber B, Krause A, Reimer T, et al (2003). "Skin-sparing mastectomy with conservation of the nipple-areola complex and autologous reconstruction is an oncologically safe procedure". Ann. Surg. 238 (1): 120–7. doi:10.1097/01.SLA.0000077922.38307.cd. PMID 12832974. <LI id=cite_note-pmid17269590-2>^ Mokbel R, Mokbel K (2006). "Is it safe to preserve the nipple areola complex during skin-sparing mastectomy for breast cancer?". Int J Fertil Womens Med 51 (5): 230–2. PMID 17269590.
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