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Mastectomy

Mastectomy is a surgery that involves removing the mammary gland entirely, including the mamelon. Even though in some of the situations patients can opt for tumor removal techniques that make it possible to keep the breast, mastectomy is still the most frequently used procedure in treating breast cancer.

Once cancer has been diagnosed, the treatment is established by a multidisciplinary team, which consists of doctors specialized in various fields like surgery, gynecology, radiotherapy, oncology. In most cases the patient’s medical condition makes it impossible to avoid the removal of the mammary gland, mastectomy being the only choice left.

A mastectomy is a treatment option for several types of cancer:

• Ductal Carcinoma in Situ (DCIS):  0 stage breast cancer
• Stages 1 and 2 breast cancer
• Stage 3 mammary gland cancer, preceded by chemotherapy
• Inflammatory breast carcinoma
• Paget breast disease
• Recurrent breast cancer

In accordance with the stage of cancer, the surgeon will choose between one of the following types of mastectomy:

• Radical Mastectomy (Halsted) - consists of the removal of the tegument, the mammary gland, the pectoral muscles, and the axillary lymph nodes
• Modified Radical Mastectomy

1. Modified Radical Mastectomy (Madden) - the pectoral muscles are not removed
2. Modified Radical Mastectomy (Patey) - implies only the removal of the small pectoral muscle

• Subcutaneous Mastectomy – surgical technique, which preserves the tegument, mamelon, and the areola; favorable for an immediate reconstruction
• Simple Mastectomy – implies the removal of the mammary gland, the tegument, and surrounding adipose tissue

Before the intervention, the doctor will explain to the patient how the procedure works and what are the possible risks and complications. He/she will localize the tumor once more by palpation and/or ultrasound.

After that, the patient will discuss with the anesthetist who will ask for a set of tests and investigations in order to decide the anesthetic risk.  

Mastectomy usually requires general anesthesia. An antibiotic and an anticoagulant are given to the patient before the surgical intervention in order to avoid infectious complications and to prevent postoperative deep vein thrombosis.

The mastectomy procedure lasts between 1- 3 hours, according to the complexity of the case. Most of the time, some drain tubes are used to exteriorize the collections from the operative site. After the intervention, the patient will be closely monitored in intensive care. When the anesthetic effect passes, the surgeon who has performed the intervention will discuss with the patient, explaining how the surgery went and what the recovery process implies. 

Lumpectomy is another procedure that can be used for treating breast cancer and consists of surgically removing the cancerous lump and a healthy tissue layer but it is usually used for incipient cancer cases. Mastectomy is recommended to the detriment of lumpectomy when:

• There are more cancerous lumps located in different areas of the breast
• The cancer is associated with pregnancy
• The mammary gland cancer has reappeared after a previous treatment
• The patient has other diseases like Lupus
• The cancerous lump is big and a lumpectomy procedure would lead to an unpleasant aspect of the breast because of the lack of healthy tissue

Mastectomy is also used not just for treating breast cancer, but also when there is a high risk of cancer.

Mastectomy can lead to some risks like:

• Bleeding
• Infections
• Pain
• Arm swelling
• Slowdown of shoulder movements
• Hematoma
• Breast skin necrosis