Types of Mastectomy Surgeries

While increased screening and early diagnosis has reduced the incidence of breast cancer in the United States, nearly 200,000 women will receive a diagnosis of breast cancer in 2009. There are a tremendous number of ways to treat breast cancer, especially compared to just a few decades ago. The type of treatment, the order, and the duration of therapy is dependent on the type of breast cancer, the extent of tumor involvement, and the health and wishes of the patient. These treatments, including chemotherapy, radiation, mastectomy, adjuvant therapy, hormone therapy and others are specifically tailored to best help the individual breast cancer patient. While treatment may include many modalities, surgery is almost always indicated and some form of mastectomy will take place. This article briefly describes the various types of mastectomy surgeries.

 

 

Mastectomy, by definition, is removal of part or the entire breast. Just as cancer treatment is individualized, the type of mastectomy is individualized as well. There are several types of mastectomy including radical, modified radical, simple/total, partial, and subcutaneous mastectomy. Each of these mastectomy types vary in the extent of breast tissue removal. In general, the type of mastectomy chosen for a particular patient depends on the cancer diagnosis and the degree of cancer spread to surrounding tissues.

 

In the early days of mastectomy surgery, the most common procedure was a radical mastectomy. In a radical mastectomy (Halsted mastectomy) the entire breast is removed along with many of the muscles in the chest plus most of the lymph nodes in the region. The notion at the time that radical mastectomies were common was that an aggressive procedure was felt to be necessary in order to remove all possibility of cancer. Sadly, little consideration was given to the breast as an important part of a woman’s body. Since the chest muscles were removed, women were left with significant weakness in the arm of the treated side. Moreover, without lymph nodes, the region would swell with fluid more or less permanently. Fortunately surgeons realized that a mastectomy need not be so aggressive for the majority of women and other mastectomy types were developed. Today, a radical mastectomy is rarely performed.

 

A modified radical mastectomy is less aggressive than radical mastectomy though it still involves the removal of the breast, some surface muscles and regional lymph nodes. A modified radical mastectomy is performed in patients with fairly extensive disease or when the cancer is of a certain type. Fortunately in a modified radical mastectomy, enough muscle and lymph nodes are left intact that weakness and swelling is kept to a minimum.

The next least aggressive procedure is called a total mastectomy, sometimes called a simple mastectomy. In this mastectomy procedure, the entire breast is removed but muscle and lymph nodes are not. Long term swelling and weakness are not usually a concern in a total mastectomy.

In each of these three mastectomy procedures—radical, modified radical, and total/simple—the breast is completely removed. Women should be offered the option of breast reconstruction at the time of mastectomy or as a follow-up procedure at any time afterwards.

In contrast to the early years of breast cancer treatment, plastic and oncologic surgeons now make every effort to remove as little breast and surrounding tissue as is necessary to completely remove the cancer. To this end, two other mastectomy types have been developed, the partial mastectomy and the subcutaneous mastectomy. A partial mastectomy, sometimes called a lumpectomy, involves removing a portion of the breast that contains the cancer. The breast tissue that remains after a partial mastectomy is reshaped by the surgeon to a cosmetically favorable form. In a subcutaneous mastectomy, the skin of the breast is left intact but deep cancer is removed. Partial and subcutaneous mastectomies are performed when the breast cancer is relatively small or even as a prophylactic procedure in very high risk patients.

 

If you have been diagnosed with breast cancer, you have options. Discuss the various types of mastectomy procedures with your doctor to determine which are appropriate in your particular case.