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spelling error corrected, added a little info re radical mastectomy
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Traditionally, in the case of breast cancer, the whole breast was removed. Often the mastectomy was performed during the same operation in which the [[biopsy]] was taken that confirmed the diagnosis. Nowadays the decision to do the mastectomy is usually based on the earlier performed biopsy. Also there is a trend to a more conservative approach to breast cancer. Practice has changed, on the one hand, due to improvements in [[radiotherapy]] and [[Adjuvant#Oncology|adjuvant treatment]] (e.g. [[chemotherapy]] or [[hormonal therapy]]) which mean a wider excision no longer makes local recurrence less likely, and on the other hand a recognition that breast cancer metastasizes early. Radical excision will not prevent later distant secondary tumors arising from micro-metastases prior to discovery, diagnosis and operation.
Traditionally, in the case of breast cancer, the whole breast was removed. Often the mastectomy was performed during the same operation in which the [[biopsy]] was taken that confirmed the diagnosis. Nowadays the decision to do the mastectomy is usually based on the earlier performed biopsy. Also there is a trend to a more conservative approach to breast cancer. Practice has changed, on the one hand, due to improvements in [[radiotherapy]] and [[Adjuvant#Oncology|adjuvant treatment]] (e.g. [[chemotherapy]] or [[hormonal therapy]]) which mean a wider excision no longer makes local recurrence less likely, and on the other hand a recognition that breast cancer metastasizes early. Radical excision will not prevent later distant secondary tumors arising from micro-metastases prior to discovery, diagnosis and operation.


Mastecomy rates vary tremendously world-wide, as was documented by the 2004 '''Intergroup Exemestane Study'''[http://www.fecs.be/emc.asp], an analysis of surgical techniques used in an international trial of adjuvant treatment among 4,700 women with early breast cancer in 37 countries. The mastectomy rate was highest in central and eastern Europe at 77%. The USA had the second highest rate of mastectomy with 56%, western and northern Europe averaged 46%, southern Europe 42% and Australia and New Zealand 34%.
Mastectomy rates vary tremendously world-wide, as was documented by the 2004 '''Intergroup Exemestane Study'''[http://www.fecs.be/emc.asp], an analysis of surgical techniques used in an international trial of adjuvant treatment among 4,700 women with early breast cancer in 37 countries. The mastectomy rate was highest in central and eastern Europe at 77%. The USA had the second highest rate of mastectomy with 56%, western and northern Europe averaged 46%, southern Europe 42% and Australia and New Zealand 34%.


There are a variety of types of mastectomy in use, and the type that a patient decides to undergo (or whether he or she will decide instead to have a lumpectomy) depends on factors such as size, location, and behavior of the tumor (if there is one), whether or not the surgery is prophylactic, and whether or not the patient intends to undergo reconstructive surgery.
There are a variety of types of mastectomy in use, and the type that a patient decides to undergo (or whether he or she will decide instead to have a lumpectomy) depends on factors such as size, location, and behavior of the tumor (if there is one), whether or not the surgery is prophylactic, and whether or not the patient intends to undergo reconstructive surgery.
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*'''Simple mastectomy (or "total mastectomy")''': In this procedure, the entire breast tissue is removed, but axillary contents are undisturbed. Sometimes the "[[sentinel lymph node]]"--that is, the first axillary lymph node that the would be expected to drain into--is removed. This surgery is sometimes done bilaterally (on both breasts) on patients who wish to undergo mastectomy as a cancer-preventative measure. Patients who undergo simple mastectomy can usually leave the hospital after a brief stay. Frequently, a drainage tube is inserted during surgery in their chest and attached to a small suction device to remove subcutaneous fluid. These are usually removed several days after surgery as drainage decrease to less then 20-30 ml per day. [http://www.breastcancer.org/simple_mastectomy.html illustration]
*'''Simple mastectomy (or "total mastectomy")''': In this procedure, the entire breast tissue is removed, but axillary contents are undisturbed. Sometimes the "[[sentinel lymph node]]"--that is, the first axillary lymph node that the would be expected to drain into--is removed. This surgery is sometimes done bilaterally (on both breasts) on patients who wish to undergo mastectomy as a cancer-preventative measure. Patients who undergo simple mastectomy can usually leave the hospital after a brief stay. Frequently, a drainage tube is inserted during surgery in their chest and attached to a small suction device to remove subcutaneous fluid. These are usually removed several days after surgery as drainage decrease to less then 20-30 ml per day. [http://www.breastcancer.org/simple_mastectomy.html illustration]
*'''Modified radical mastectomy''': The entire breast tissue is removed along with the axillary contents (fatty tissue and lymph nodes). [http://www.breastcancer.org/modified_radical_mastectomy.html illustration]
*'''Modified radical mastectomy''': The entire breast tissue is removed along with the axillary contents (fatty tissue and lymph nodes). [http://www.breastcancer.org/modified_radical_mastectomy.html illustration]
*'''Radical mastectomy (or "Halsted mastectomy")''': First performed in 1882, this procedure involves removing the entire breast, the axillary lymph nodes, and the pectoral tissue behind the breast. This operation is reserved for tumors involving the pectoralis major muscle or recurrent breast cancer involving the chest wall.[http://www.breastcancer.org/radical_mastectomy.html illustration]
*'''Radical mastectomy (or "Halsted mastectomy")''': First performed in 1882, this procedure involves removing the entire breast, the axillary lymph nodes, and the pectoral tissue behind the breast. This procedure is more disfiguring than a modified radical mastectomy and provides no survival benefit for most tumors. This operation is now reserved for tumors involving the pectoralis major muscle or recurrent breast cancer involving the chest wall.[http://www.breastcancer.org/radical_mastectomy.html illustration] *'''Skin-sparing mastectomy''': In this surgery, the breast tissue is removed through a conservative incision made around the areola (the dark part surrounding the nipple). The increased amount of skin preserved as compared to traditional mastecomy resections serves to facilitate breast reconstruction procedures. Patients with cancers that involve the skin, such as inflammatory cancer, are not candidates for skin-sparing mastectomy. [http://www.breastcancer.org/skin_sparing_mastectomy.html illustration]
*'''Skin-sparing mastectomy''': In this surgery, the breast tissue is removed through a conservative incision made around the areola (the dark part surrounding the nipple). The increased amount of skin preserved as compared to traditional mastecomy resections serves to facilitate breast reconstruction procedures. Patients with cancers that involve the skin, such as inflammatory cancer, are not candidates for skin-sparing mastectomy. [http://www.breastcancer.org/skin_sparing_mastectomy.html illustration]
*'''Quandrantectomy, or partial mastectomy''': Like a lumpectomy, this is considered a form of breast conservation therapy. However, a quadrantectomy involves removal of more breast tissue than a lumpectomy--up to a quarter of the breast may be removed, whereas a lumpectomy removes only the tumor and a margin of surrounding tissue.
*'''Quandrantectomy, or partial mastectomy''': Like a lumpectomy, this is considered a form of breast conservation therapy. However, a quadrantectomy involves removal of more breast tissue than a lumpectomy--up to a quarter of the breast may be removed, whereas a lumpectomy removes only the tumor and a margin of surrounding tissue.
*'''Subcutaneous mastectomy''': Breast tissue is removed, but the nipple-areola complex is preserved. This procedure was historically done only prophylactically or with mastecomy for benign disease over fear of increased cancer development in retained areolar ductal tissue. Recent series suggest that it may be an oncologically sound procedure for tumors not in the subareolar position [PMID 12832974] [PMID 17269590] [PMID 17084333]
*'''Subcutaneous mastectomy''': Breast tissue is removed, but the nipple-areola complex is preserved. This procedure was historically done only prophylactically or with mastecomy for benign disease over fear of increased cancer development in retained areolar ductal tissue. Recent series suggest that it may be an oncologically sound procedure for tumors not in the subareolar position [PMID 12832974] [PMID 17269590] [PMID 17084333]

Revision as of 01:40, 11 March 2007

In medicine, mastectomy is the medical term for the surgical removal of one or both breasts, partially or completely. Mastectomy is usually done to combat breast cancer; in some cases, women believed to be at high risk of breast cancer have the operation prophylactically, that is, to prevent cancer rather than treat it. It is also, the medical procedure carried out to remove Breast Cancer (tissue) in males. Alternatively, certain patients can choose to have a wide local excision (also called a lumpectomy), an operation in which a small volume of breast tissue containing the tumor and some surrounding healthy tissue is removed to conserve the breast. Both mastectomy and lumpectomy are what are referred to as "local therapies" for breast cancer, targeting the area of the tumor, as opposed to systemic therapies such as chemotherapy, hormonal therapy, or immunotherapy.

Traditionally, in the case of breast cancer, the whole breast was removed. Often the mastectomy was performed during the same operation in which the biopsy was taken that confirmed the diagnosis. Nowadays the decision to do the mastectomy is usually based on the earlier performed biopsy. Also there is a trend to a more conservative approach to breast cancer. Practice has changed, on the one hand, due to improvements in radiotherapy and adjuvant treatment (e.g. chemotherapy or hormonal therapy) which mean a wider excision no longer makes local recurrence less likely, and on the other hand a recognition that breast cancer metastasizes early. Radical excision will not prevent later distant secondary tumors arising from micro-metastases prior to discovery, diagnosis and operation.

Mastectomy rates vary tremendously world-wide, as was documented by the 2004 Intergroup Exemestane Study[1], an analysis of surgical techniques used in an international trial of adjuvant treatment among 4,700 women with early breast cancer in 37 countries. The mastectomy rate was highest in central and eastern Europe at 77%. The USA had the second highest rate of mastectomy with 56%, western and northern Europe averaged 46%, southern Europe 42% and Australia and New Zealand 34%.

There are a variety of types of mastectomy in use, and the type that a patient decides to undergo (or whether he or she will decide instead to have a lumpectomy) depends on factors such as size, location, and behavior of the tumor (if there is one), whether or not the surgery is prophylactic, and whether or not the patient intends to undergo reconstructive surgery.

Types of Mastectomy

  • Simple mastectomy (or "total mastectomy"): In this procedure, the entire breast tissue is removed, but axillary contents are undisturbed. Sometimes the "sentinel lymph node"--that is, the first axillary lymph node that the would be expected to drain into--is removed. This surgery is sometimes done bilaterally (on both breasts) on patients who wish to undergo mastectomy as a cancer-preventative measure. Patients who undergo simple mastectomy can usually leave the hospital after a brief stay. Frequently, a drainage tube is inserted during surgery in their chest and attached to a small suction device to remove subcutaneous fluid. These are usually removed several days after surgery as drainage decrease to less then 20-30 ml per day. illustration
  • Modified radical mastectomy: The entire breast tissue is removed along with the axillary contents (fatty tissue and lymph nodes). illustration
  • Radical mastectomy (or "Halsted mastectomy"): First performed in 1882, this procedure involves removing the entire breast, the axillary lymph nodes, and the pectoral tissue behind the breast. This procedure is more disfiguring than a modified radical mastectomy and provides no survival benefit for most tumors. This operation is now reserved for tumors involving the pectoralis major muscle or recurrent breast cancer involving the chest wall.illustration *Skin-sparing mastectomy: In this surgery, the breast tissue is removed through a conservative incision made around the areola (the dark part surrounding the nipple). The increased amount of skin preserved as compared to traditional mastecomy resections serves to facilitate breast reconstruction procedures. Patients with cancers that involve the skin, such as inflammatory cancer, are not candidates for skin-sparing mastectomy. illustration
  • Quandrantectomy, or partial mastectomy: Like a lumpectomy, this is considered a form of breast conservation therapy. However, a quadrantectomy involves removal of more breast tissue than a lumpectomy--up to a quarter of the breast may be removed, whereas a lumpectomy removes only the tumor and a margin of surrounding tissue.
  • Subcutaneous mastectomy: Breast tissue is removed, but the nipple-areola complex is preserved. This procedure was historically done only prophylactically or with mastecomy for benign disease over fear of increased cancer development in retained areolar ductal tissue. Recent series suggest that it may be an oncologically sound procedure for tumors not in the subareolar position [PMID 12832974] [PMID 17269590] [PMID 17084333]

See also


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