What is Mastectomy?
A Mastectomy is the surgical removal of the entire breast, usually to treat serious breast disease, such as breast cancer.
Types of Mastectomy
There are four general types of mastectomy:
A SUBCUTANEOUS MASTECTOMY removes the entire breast, but leaves the nipple and areola (the pigmented circle around the nipple) in place.
TOTAL (OR SIMPLE) MASTECTOMY is the removal of the whole breast, but not the lymph nodes under the arm (axillary nodes).
In a MODIFIED RADICAL MASTECTOMY, the whole breast and most of the lymph nodes under the arm (axillary nodes) are removed. Removal of these lymph nodes is called an axillary dissection.
RADICAL MASTECTOMY involves removal of the chest wall muscles (pectorals) in addition to the breast and axillary lymph nodes. For many years, this operation was considered the standard for women with breast cancer, but it is rarely used today. It is mostly of historical interest.
Other types of Mastectomy
QUANDRANTECTOMY: removal of a quarter of the breast, including the skin and breast fascia (connective tissues). The surgeon may also perform a separate procedure to remove some or all of the axillary (armpit) lymph nodes, either an axillary node dissection or a sentinel node biopsy.
PARTIAL or SEGMENTAL mastectomy: removal of a portion of the breast tissue and a margin of normal breast tissue. This procedure usually involves removing less tissue than a quandrantectomy but more than a lumpectomy or wide excision.
LUMPECTOMY or WIDE EXCISION: removal of the breast cancer tumor and a surrounding margin of normal breast tissue.
EXCISIONAL BIOPSY: also the removal of the breast tumor and a surrounding margin of normal breast tissue. Sometimes further surgery is not needed if an excisional biopsy successfully removes the entire breast cancer tumor. This is most likely to occur if the breast tumor is very small. An excisional biopsy may be performed with “needle” or “wire” localization.
How Mastectomy is performed?
General anesthesia is administered during mastectomy, and an EKG monitor (electrocardiogram) is connected to the patient to monitor heart rates. Blood pressure and vital signs are also monitored throughout the surgery.
To perform a simple mastectomy, a surgeon makes an incision along the perimeter of the breast (closest to the tumor area), leaving most of the skin intact. Typically, the nipple is not removed during simple mastectomy, although milk ducts leading to the nipple are cut. The underlying tissue is gently cut free and removed. Often a plastic or rubber drainage tube is inserted in the affected area. The skin is carefully closed with stitches or clips, which are usually removed within a week, and a dressing (bandage) normally covers the site. Mastectomy with axillary (armpit) lymph node dissection usually lasts between 2-3 hours. Immediate breast reconstruction will increase the duration of surgery.
The drainage tube placed in the breast or under the arm removes blood and lymph node fluid accumulated during the healing process. Drainage tubes are usually removed within two weeks, when the drainage is reduced to less than 30 ccs (1 fluid oz) per day.