Mastectomy

When is a mastectomy the right option?

For some women, total removal of the breast followed by its reconstruction is still the best alternative. This is the case for example when the tumor is very large, or has already spread with several foci (locations) throughout the breast.

It can also be a prophylactic (preventive) measure for high-risk women, as in the case of those carrying BRCA mutations.

In this type of surgery, all the affected area of breast is removed, as well as the axillary (underarm) lymph nodes of the affected side. The procedure can be more or less extensive, depending also on the possibility and desire of the woman to opt for breast reconstruction.

TYPES OF MASTECTOMY

The different options for mastectomy – more versus less extensive - should be discussed with your doctor BEFORE surgery, so you can understand the benefits and limitations of each choice.

In principle, all of them can be followed by  surgical reconstruction  of the breast, which can be done during the surgery that removes the tumor

SKIN-SPARING MASTECTOMY

Skin-sparing surgery is an innovative procedure that allows the patient to retain a large part of the breast skin, resulting in a more natural looking reconstruction. 
It can be used on most women, except if the cancer is very close to the skin or the breast reconstruction is not immediate.

In this technique the surgeon removes the inner breast tissues, as well as the areola and the nipple, through a small hole on the breast that leaves an empty pocket of skin. This pouch is then filled with tissues from another part of the body, or an implant placed under the chest muscle. Sometimes a breast tissue expander is used to shape the skin before the implant is put in. The nipple is later reconstructed.

Often women lose sensitivity in the reconstructed nipple, and the remaining breast skin might experience some numbness as well.

NIPPLE-SPARING MASTECTOMY

In a reduced number of patients with small tumors located far from the nipple, the mastectomy can spare both the nipple and the areola. The saved nipple again might lose some of its sensitivity, the ability to get erect or perform normal functions, but looks perfectly natural.

Radical Mastectomy

Rarely performed today, radical mastectomy removes the entire breast, including the areola and nipple, as well as the nearby armpit lymph nodes and chest muscles. It is used when the tumor cells have spread to these areas.

This radical option has been increasingly abandoned by less extensive procedures that preserve the muscles and their function, have better recovery time and reduce the sequels of the operation.