A mastectomy is the removal of all of the tissue from one (unilateral) or both (bilateral) breasts.
The most common reasons for a mastectomy are to remove cancerous tissue in the breast area and to reduce the risk of cancer of the breast area. There are also a number of motivations for having a mastectomy that are not related to cancer.
- What is a mastectomy?
- Why are mastectomies performed?
- When a lumpectomy with radiation is not suitable
- Mastectomy as a preventive measure
- Risks of the mastectomy procedure
- Recovery from a mastectomy
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Fast facts on mastectomies
Here are some key points about mastectomies. More detail and supporting information is in the main article.
- Mastectomies are primarily performed to remove or prevent breast cancer
- The earliest known mastectomies were conducted in ancient Greece
- In some cases, mastectomies are performed as a preventive measure
- There are different types of mastectomy to deal with different situations
- Many women opt to have breast reconstruction during the breast removal procedure
- Risks include lymphedema, shoulder pain and nerve damage
- Mastectomies can successfully treat a number of different cancer types
- Some experts think that mastectomies are inappropriate for the majority of women, with little, if any, survival benefit
- In some high-risk women, prophylactic mastectomy could cut the risk of breast cancer by up to 90%.
What is a mastectomy?
There are a number of different types of mastectomy, all primarily designed to remove or prevent cancer.
The mastectomy operation has been practiced since at least 548 AD when Aëtius of Amida offered the procedure to Theodora, a Byzantine empress.
The operation has been widely used as an effective method of removing existing cancerous cells within the breast and thereby reducing the potential for breast cancer to spread.
Many patients opt for breast-conserving surgery or a lumpectomy, where such a procedure is possible. A lumpectomy involves the removal of a tumor and surrounding tissue, and leaves the breasts largely intact; the procedure is typically used in conjunction with radiation therapy. Lumpectomies, however, are not suitable for all patients.
A quadrantectomy is a partial mastectomy that involves the removal of more breast tissue than a simpler lumpectomy, but which still spares the majority of the breast tissue.
Newer mastectomy procedures called skin-sparing mastectomies preserve breast skin, allowing for the reconstruction of a more natural looking breast. This may only be an option if there is no sign of cancer cells close to the skin.
Some women have reconstructive breast surgery as part of the same procedure as the mastectomy or major lumpectomy, while others wait and have the option to undergo a second operation at a later date.
There are a number of types of mastectomy, including:
- Total (simple) mastectomy: entire breast removed but muscles under the breast and lymph nodes are kept in place
- Radical mastectomy: entire breast, underarm lymph nodes and chest wall muscles removed
- Modified radical mastectomy: entire breast and underarm lymph nodes removed, but the chest wall muscles are left intact
- Skin-sparing mastectomy: breast tissue and nipple are removed but the skin is left in order to reconstruct the breast in the same operation
- Nipple-sparing mastectomy: this relatively new procedure leaves the skin, nipple and peripheral breast tissue intact.1
Why are mastectomies performed?
Mastectomies are used for a number of different cancers including:
- Non-invasive breast cancer: including ductal carcinoma in situ (DCIS), the most common type of non-invasive breast cancer - 1 in 5 new cases of cancer in the US are DCIS. This cancer forms in the milk ducts but does not spread out into the rest of the breast tissue2
- Stages I and II: early stage breast cancer
- Stage III: locally advanced breast cancer (after chemotherapy)
- Inflammatory breast cancer: an aggressive disease in which cancer cells block lymph vessels in the skin of the breast (mastectomy is only suitable after chemotherapy for this form of cancer)
- Paget's disease of the nipple/breast: a rare type of cancer affecting the nipple3
- Locally recurrent breast cancer: cancer returning to the same breast.
If a mastectomy is recommended, the type of mastectomy performed will depend on a range of factors, including:
- The age of the patient
- The patient's general health
- Menopause status
- The size of the tumor
- The stage of the tumor (how far it's spread)
- The grade of the tumor (its aggressiveness, i.e. how quickly it is growing or spreading)
- Whether the tumor is hormone-receptive
- The involvement of lymph nodes.
A mastectomy may also be performed for reasons not related to a diagnosis of breast cancer, such as where a person has severe chronic breast pain, fibrocystic breast disease, dense breast tissue, cancer phobia or a family history of breast cancer. These reasons for surgery are much less common and are not standard practice.
When a lumpectomy with radiation is not suitable
Many people initially decide that they would prefer a lumpectomy with radiation treatment rather than a full mastectomy. A lumpectomy is not always a viable choice, however, such as in the following situations:
- Where there is more than one tumor in different regions within the breast
- Where previous radiation treatment did not prevent the tumor from recurring
- When a lumpectomy has already been conducted but cancer is still visible on the margins of the operated area
- If the tumor is relatively large compared with the breast
- If the radiation facility is a long distance from home, making it difficult to attend regularly for a number of weeks
- Where there is a disease of the connective tissue and the patient may not be able to tolerate radiation treatment
- Where a gene mutation is present that increases the chance of developing further tumors in the breast
- If the patient is pregnant, as radiation therapy may be a significant risk to the baby.
In some cases, a patient is given the option of whether they want to undertake a mastectomy or a lumpectomy. This can be a difficult decision.
When faced with the choice, most women prefer the less invasive lumpectomy procedure. However, some weigh up the pros and cons and decide to err on the side of caution and remove the entire breast.4
Deciding on whether to have a lumpectomy or a mastectomy is a particularly difficult choice in some cases.
Some studies have shown that women, even when given the opportunity to take the less invasive procedure, are increasingly more likely to opt for the more invasive mastectomy.5,6
Other America-wide studies have yielded contradictory results, with some finding regional differences in choices over breast surgery.7
The choice of whether to undergo a mastectomy or a lumpectomy when offered the choice does appear to vary dependent on region.
One study looking at regional differences found the lowest rates of mastectomies (where a lumpectomy was an option) in the Middle Atlantic states and New England.8
The highest percentages of people opting for mastectomies over lumpectomies were found in the East South Central states and West South Central states.
The authors also noted that breast-conserving treatments were more common in urban than rural areas, in teaching hospitals rather than non-teaching, and in larger rather than smaller hospitals.8
On the next page, we look at mastectomies as a preventive measure, the potential risks that are involved and recovery from the procedure.