Mastectomy

Mastectomy is a procedure that removes the entire breast. The operation has several variations in which different degrees of surrounding muscle and lymph nodes are taken out, too. All forms of mastectomy are performed under general anesthesia or with an epidural block plus intravenous sedation. In certain circumstances, a mastectomy is a better option than breast-conservation surgery, in which most of the breast is left intact.

Modified radical mastectomy
The most commonly performed procedure for patients with invasive breast cancer, modified radical mastectomy is the removal of the entire breast, including the nipple, areola, and axillary lymph nodes (see Modified Radical Mastectomy). This type of mastectomy has several variations in which nerves and chest wall muscles are also excised if cancer has invaded those areas. If an immediate breast reconstruction is desired, the nipple and areola are excised, but as much remaining skin as possible is preserved. The plastic surgeon joins the surgical team to perform the reconstructive part of the operation.

Radical mastectomy
Many health care teams decide to defer the reconstruction portion of the treatment plan until the mastectomy has been completed and the entire analysis of the removed breast and breast cancer is fully examined. For example, it is important to know that the removed cancer does not include any cancer cells that are present at the so called surgical margin. This can be determined only after a detailed analysis is undertaken by a pathologist. A pathologist is a medical doctor that specializes in the analysis of specimens to help determine a diagnosis and prognosis. Further surgery may then be necessary prior to proceeding with the breast reconstruction.

Simple (total) mastectomy
In a simple mastectomy, the surgeon removes the entire breast, including the nipple and areola, but not the lymph nodes or muscles underneath.

Radical mastectomy. Rarely performed today, this extensive operation removes the entire breast, the pectoral muscles of the chest wall, and all the axillary lymph nodes up to the collarbone. A common side effect of this procedure is the painful swelling and tenderness of the arm known as lymphedema (see Lymphedema). This procedure is now seldom used because, overall, modified radical mastectomy has proved to be equally effective with fewer side effects.

Next >> Surgeries That Conserve the Breast

In This Article:
Treating Breast Cancer
Local and Systemic Treatments
Breast Surgery
Mastectomy
Surgeries That Conserve the Breast
Lymph Node Surgery
Radiation Therapy

From the Harvard Health Publications Special Health Report, Breast Cancer: Strategies for Living. Copyright 2004 by the President and Fellows of Harvard College. Illustrations by Harriet Greenfield, M.A., and Jesse Tarantino. All rights reserved. Used with permission of StayWell. Harvard Medical School does not endorse products.
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