Mastectomy
A mastectomy is performed primarily to remove malignant breast tissue and any regional lymphatic metastases. It may be combined with radiation therapy and chemotherapy. The type of mastectomy performed will vary according to the size of the tumor and the presence of any metastases. (See Types of mastectomy, page 560.)
Prophylactic mastectomy of a breast without malignancy may be elected by a female who had breast cancer in the other breast. A female who doesn’t have cancer but does have a family history of breast cancer may elect to have prophylactic mastectomies of both breasts.
Procedure
In a total mastectomy, the surgeon removes the entire breast without dissecting the lymph nodes. He may apply a skin graft, if necessary.
If the surgeon is performing a modified radical mastectomy, he may use one of several techniques to remove the entire breast. He may also resect all axillary lymph nodes, while leaving the pectoralis major intact. He may remove the pectoralis minor. If the patient has small lesions and no metastases, the surgeon may perform breast reconstruction immediately or a few days later.
Types of mastectomy
If a tumor is confined to breast tissue and no lymph node involvement is detected, a lumpectomy or total (simple) mastectomy may be performed. A total mastectomy may also be used palliatively for advanced, ulcerative cancer and for extensive benign disease.
A modified radical mastectomy—the standard surgery for stages I and II lesions—removes small, localized tumors. It has replaced radical mastectomy as the most widely used surgical procedure for treating breast cancer. Besides causing less disfigurement than a radical mastectomy, it reduces postoperative arm edema and shoulder problems.
A radical mastectomy controls the spread of larger, metastatic lesions. Later, breast reconstruction may be performed using a portion of the latissimus dorsi. Rarely, an extended radical mastectomy may be used to treat cancer in the medial quadrant of the breast or in subareolar tissue. This procedure is done to prevent possible metastasis to the internal mammary lymph nodes.
In a radical mastectomy, the surgeon removes the entire breast, axillary lymph nodes, underlying pectoral muscles, and adjacent tissues. He covers the skin flaps and exposed tissue with moist packs for protection and, before closure, irrigates the chest wall and axilla.
In an extended radical mastectomy, the surgeon removes the breast, underlying pectoral muscles, axillary contents, and upper internal mammary (mediastinal) lymph node chain.
After closing the mastectomy site, the surgeon may make a stab wound and insert a drain or catheter. The drain or catheter removes blood that may collect under the skin flaps, where it could prevent healing and lead to infection. Less commonly, he may use large pressure dressings instead.
