A mastectomy is a surgical procedure in which the entire breast is removed. Breast cancer is the most common of the reasons for this operation. The types of mastectomies include tissue-sparing, simple, modified radical, and radical. The exact process differs for each mastectomy procedure.
Before mastectomy surgery, the patient is typically diagnosed with breast cancer. Some women who carry the BRCA1 or BCA2 genes or are at increased risk for developing breast cancer may choose to undergo a preemptive mastectomy procedure. By doing so, they may avoid the condition completely.
A mastectomy procedure may call for the removal of one breast, or a double mastectomy may be performed to remove both. The patient is placed under general anesthesia before the surgery begins. The surgeon removes all of the breast tissue, including fat and the milk ducts, and any nearby tissue to which the cancer has spread. Whether other parts of the breast are removed depends on the stage of the cancer and the type of mastectomy.
A tissue-sparing mastectomy procedure is done when breast cancer does not appear to be widespread. These procedures include the subcutaneous, nipple-sparing and skin-sparing operations. The nipple, areola and skin of the breast are saved for reconstruction in a subcutaneous mastectomy. During a nipple-sparing surgery, the nipple and areola are removed but can be reattached if they are free from cancer cells. Skin-sparing mastectomies only leave behind the breast skin for reconstruction.
A simple or total mastectomy procedure involves removal of not only the breast tissue, but the nipple, areola and majority of the skin as well. If the cancer appears to have spread to the lymph nodes, those may also be removed. A modified radical mastectomy removes the same tissue, along with the lining tissue that lies over the muscles of the chest. In some cases, the chest muscles may also be removed.
A radical mastectomy is the most extensive of the procedures. This breast surgery not only removes breast and overlying tissue, but also the muscles of the chest wall. Other types of mastectomies are more commonly performed, with radical procedures saved for cases in which the cancer has spread to the chest wall.
After a mastectomy, the incisions are closed with tape or sutures. Tubes may be left in the breast to allow fluid to drain out of the body. The patient will typically spend two to three days in the hospital, during which time she will receive mastectomy aftercare instructions. Activity should be slowly increased, with the patient generally able to resume all normal activity about two weeks after the surgery. The patient should also follow up with her doctor about two weeks after the surgery to check healing and discuss reconstruction not done during the mastectomy, if desired.
