A mastectomy is a surgical procedure in which part, or all, of the breast is removed. Healthy tissue around the breast, including lymph nodes in the armpit, may also be removed.
Following are the most common types of mastectomy:
modified radical mastectomy, which involves removal of the whole breast. Most of the lymph nodes under the arm are removed, which is called axillary node dissection. The lining of the chest muscles may also be removed.
radical mastectomy, also known as a Halsted radical mastectomy. This procedure is seldom used today. It involves the removal of the breast, both chest muscles, all lymph nodes in the armpit, and surrounding fat and skin.
segmental, or partial, mastectomy. This procedure involves the removal of the cancer and an area of healthy tissue around it.
total, or simple, mastectomy. This operation involves the removal of the entire breast and sometimes lymph nodes from the armpit.
Some breast lumps are removed with breast-sparing surgeries, such as a lumpectomy.
Who is a candidate for the procedure?
A mastectomy is generally done in women with a diagnosis of breast cancer. It may also be done to prevent breast cancer. Women with a personal family history of breast cancer may choose to have a mastectomy. Women who are positive for a breast cancer gene, such as BRCA 1 and BRCA 2, may also make this choice.
How is the procedure performed?
The woman is put to sleep under general anesthesia. The skin over the affected breast, the chest, and the upper arm is cleansed with an antiseptic. An incision is made to include the nipple and the pigmented skin around the nipple, called the areola. The incision may be horizontal from the breastbone to the underarm. Occasionally, if the tumor is higher up, the incision is diagonal from the upper part of the armpit down to the breastbone. The surgeon may be able to include any previous biopsy incision, for cosmetic reasons.
The chest wall incision is closed with sutures or staples. Small tubes are placed through the skin to drain any fluid that might build up in the area. A large bandage is placed over the incision and taped firmly in place. This pressure dressing keeps the skin against the chest wall muscles. This lessens the fluid buildup and promotes drainage. However, most women lose sensation in the surgical area.