Mastectomy 42047 225782943 2008-07-15T11:16:44Z Joseph Solis in Australia 957447 /* Gallery */ Gallery to the center In [[medicine]], '''mastectomy''' is the medical term for the surgical removal of one or both [[breast]]s, partially or completely. Mastectomy is usually done to treat [[breast cancer]]; in some cases, women and some men believed to be at high risk of breast cancer have the operation [[prophylaxis|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. Currently the decision to do the mastectomy is based on various factors including breast size, number of lesions, biologic aggressiveness of a breast cancer, the availability of adjuvant radiation, and the willingness of the patient to accept higher rates of tumor recurrences after lumpectomy and radiation. Outcome studies comparing mastectomy to lumpectomy with radiation have suggested that routine radical mastectomy surgeries will not always prevent later distant secondary tumors arising from micro-metastases prior to discovery, diagnosis, and operation. ==Rates== Mastectomy rates vary tremendously world-wide, as was documented by the 2004 'Intergroup [[Exemestane]] Study',<ref name="titleFederation of European Cancer Societies">{{cite web |url=http://www.fecs.be/emc.asp |title=Federation of European Cancer Societies |accessdate=2007-12-03 |format= |work=}}</ref> 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 indications == Despite the increased ability to offer breast-conservation techniques to patients with breast cancer, there exist certain groups who may be better served by traditional mastectomy procedures including: * women who have already had radiation therapy to the affected breast * women with 2 or more areas of cancer in the same breast that are too far apart to be removed through 1 surgical incision, while keeping the appearance of the breast satisfactory * women whose initial lumpectomy along with (one or more) re-excisions has not completely removed the cancer * women with certain serious connective tissue diseases such as scleroderma, which make them especially sensitive to the side effects of radiation therapy * pregnant women who would require radiation while still pregnant (risking harm to the fetus) * women with a tumor larger than 5 cm (2 inches) that doesn't shrink very much with neoadjuvant chemotherapy * women with a cancer that is large relative to her breast size * Women who have tested positive for a deleterious mutation on the BRCA1 or BRCA2 gene and opt for prophylactic removal of the breasts * male breast cancer patients ==Types of mastectomy== 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. *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 than 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] *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] *[[Subcutis|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.<ref name="pmid12832974">{{cite journal |author=Gerber B, Krause A, Reimer T, ''et al'' |title=Skin-sparing mastectomy with conservation of the nipple-areola complex and autologous reconstruction is an oncologically safe procedure |journal=Ann. Surg. |volume=238 |issue=1 |pages=120–7 |year=2003 |pmid=12832974 |doi=10.1097/01.SLA.0000077922.38307.cd |doi_brokendate=2008-06-25}}</ref><ref name="pmid17269590">{{cite journal |author=Mokbel R, Mokbel K |title=Is it safe to preserve the nipple areola complex during skin-sparing mastectomy for breast cancer? |journal=Int J Fertil Womens Med |volume=51 |issue=5 |pages=230–2 |year=2006 |pmid=17269590 |doi=}}</ref><ref name="pmid17084333">{{cite journal |author=Sacchini V, Pinotti JA, Barros AC, ''et al'' |title=Nipple-sparing mastectomy for breast cancer and risk reduction: oncologic or technical problem? |journal=J. Am. Coll. Surg. |volume=203 |issue=5 |pages=704–14 |year=2006 |pmid=17084333 |doi=10.1016/j.jamcollsurg.2006.07.015 |url=http://linkinghub.elsevier.com/retrieve/pii/S1072-7515(06)01153-7}}</ref> ==Gallery== <center><gallery> Image:Mastectomie 02.jpg|Mastectomy patient Image:Discrene Breast forms.JPG|[[Breast prostheses]] used by some mastectomy patients Image:BreastCancer.jpg|Mastectomy specimen containing a very large cancer of the breast (in this case, an invasive ductal carcinoma) Image:Breast cancer gross appearance.jpg|Typical macroscopic ([[gross examination|gross]]) appearance of the cut surface of a mastectomy specimen containing a cancer, in this case, an invasive ductal carcinoma of the breast, pale area at the center </gallery></center> ==See also== * [[Breast prosthesis]] * [[Breast reconstruction]] * [[Sex reassignment surgery female-to-male]] ==References== {{reflist}} ==External links== * [http://mrbra.com/mastectomy.ivnu Types of Mastectomy] at mrbra.com * [http://www.cancer.gov/cancertopics/pdq/treatment/malebreast/healthprofessional Advice for Men with Breast Cancer] at [[National Cancer Institute]] * [http://news.bbc.co.uk/2/hi/health/3727554.stm Mastectomy study] at [[BBC]] * [http://www.center4research.org/health8.html When is a mastectomy not necessary?] at center4research.org * [http://www.breastcancer.org/tre_surg_mastectomy.html Mastectomy summary] at breastcancer.org * [http://www.emedicinehealth.com/mastectomy/article_em.htm Mastectomy article] at [[eMedicine]] {{Operations and other procedures of the integumentary system}} [[Category:Surgical removal procedures]] [[Category:Breast]] [[br:Mastektomiezh]] [[de:Mastektomie]] [[es:Mastectomía]] [[fr:Mastectomie]] [[it:Mastectomia]] [[nl:Mastectomie]] [[pl:Mastektomia]] [[pt:Mastectomia]] [[sk:Mastektómia]] [[fi:Rinnanpoisto]] [[sv:Mastektomi]] [[tr:Mastektomi]]