Mastectomy

About Mastectomy

Mastectomy is the surgical removal of breast tissue, performed to treat breast cancer or to reduce risk in people at very high inherited risk. Types include total or simple mastectomy, which removes the breast including the nipple and areola; skin sparing mastectomy, which preserves the skin envelope for reconstruction; nipple sparing mastectomy, which also preserves the nipple and areola; and modified radical mastectomy, which removes the breast together with the axillary lymph nodes. The radical mastectomy described by William Halsted in the 1890s, which also removed the chest wall muscles, is now rarely performed. Large randomized trials, including the NSABP B 06 trial in the United States and the Milan trial in Italy, showed that for early breast cancer, breast conserving surgery followed by radiation gives survival equivalent to mastectomy, which led to lumpectomy becoming a common choice. Sentinel lymph node biopsy, which identifies the first draining nodes with a radioactive tracer and blue dye, has replaced routine axillary dissection for many patients without clinically involved nodes and has substantially reduced the risk of lymphedema. Immediate breast reconstruction with implants or with tissue from elsewhere on the body, such as a DIEP or latissimus dorsi flap, is increasingly common. Removal of the healthy opposite breast has become more frequent, although for most people without a high risk mutation it has not been shown to improve survival. Complications include seroma, wound problems, infection, chronic pain and lymphedema.