What is a mastectomy?

There are different types of mastectomies.
There are different types of mastectomies.

Mastectomy is the removal of one or both breasts. You may need a mastectomy for the following reasons

  • Breast cancer: Mastectomy is one of the mainstays of treatment for breast cancer.
  • Preventive breast cancer: Women who have a higher risk of breast cancer due to changes in their genes (unit of heredity) may require a mastectomy.
  • Gender change: One of the gender reassignment surgeries may be required while changing gender from a woman to man.
  • Gynecomastia: This is breast development in a man due to hormonal causes. Such men require mastectomy.
  • Serious connective tissue disease: This includes scleroderma (chronic hardening and tightening of the skin and connective tissues), which may necessitate a mastectomy.

What is a radical mastectomy?

In a radical mastectomy, the entire breast tissue along with the nipple, covering skin, lymph nodes (filter organs for harmful substances) in the armpit and chest wall muscle under the breast is removed. It is known as a standard treatment for breast cancer.

What is a modified radical mastectomy?

In a modified radical mastectomy (MRM), the entire breast is removed, including the skin, areola (surrounding the nipple), nipple and most armpit lymph nodes. Your underlying chest wall muscles (the pecs) will be left intact. Additionally, the skin covering your chest wall may or may not be removed. Therefore, you can go for breast reconstruction later. 

What is the difference between a radical mastectomy and an MRM?

Today, a modified radical mastectomy (MRM) has become the primary standard surgical treatment option for breast cancer. Traditional radical mastectomies are rarely done today because of the success with MRMs. Here are the differences

  • Degrees of parts removal: Radical mastectomy and MRM are performed with varying degrees of tissue and lymph node removal. During an MRM, your surgeon will remove the entire breast, including the nipple and most of the lymph nodes underlying the arm, with or without the underlying skin. However, the underlying chest muscles will be left in the place, unlike a traditional radical mastectomy.
  • Complexity: An MRM is less complicated and less extensive than a radical mastectomy that involves removal of various nearby tissues and may require a longer time to execute. 
  • Effectiveness: Studies have shown that MRM and radical mastectomy are equally effective in the early stages of breast cancer to control the disease.
  • Appearance after surgery: An MRM causes less disfigurement and takes much less of a toll on a woman’s appearance than a radical mastectomy. Following a radical mastectomy, women often have a hollow in the chest. Because the chest muscle is kept in place with an MRM, this doesn’t happen.
  • Side effects and complications
    • Lymphedema: The risk of lymphedema (swollen lymph nodes in the arm) is less in an MRM than in a radical mastectomy.
    • Angiosarcoma: There is a higher risk of a rare soft tissue tumor in the breast after a radical mastectomy known as secondary angiosarcoma. 
    • Other complications: Studies have proven an MRM to be generally safe and effective and it has only complications like any surgical procedure such as bleeding, infection, redness, tenderness of the incisional site, scarring, arm swelling , seroma (fluid pocket formation underneath the incision), decreased range of motion, blood collection outside of a blood vessel, numbness and skin necrosis (degeneration).
  • Stay at the hospital: Radical mastectomy and MRM both require a similar short stay at the hospital.
  • Reconstruction of the breast: Reconstruction of the breast after an MRM is usually easier to accomplish than after a radical mastectomy because the chest wall muscles and sometimes skin coverings are preserved with an MRM.
  • Survival: Studies have demonstrated that there are no differences in the survival rates of women who underwent an MRM and those who underwent a radical mastectomy.
  • Local recurrence: Women treated with an MRM may have a higher risk of local recurrence of cancerous growth, particularly if they had cancer that extended toward the armpit lymph node. Therefore, they may require radiotherapy after an MRM.

The cancer surgeon (oncosurgeon) always aims to remove the entire cancerous growth. Your cancer specialist (oncologist) or oncosurgeon will discuss the available options for you depending on your clinical scenario. They will thoroughly discuss surgical options to achieve the best outcome.

When will your surgeon recommend a radical mastectomy or an MRM?

Your surgeon will choose the surgery depending on your age, general health, menopause status, tumor size, how far your tumor spread, its aggressiveness, the tumor hormone receptor status and whether your breast lymph nodes are involved. Some points are discussed below

  • Stages of breast cancer: A modified radical mastectomy (MRM) is especially helpful for women with early-stage breast cancer (stages I and II) that has extended to the lymph nodes. A radical mastectomy nowadays is recommended only for women with advanced breast cancer (stage III) that extends to the chest muscles underlying the breast.
  • Tumor size: An MRM is usually recommended if the tumor is large and cancer has already spread to the lymph nodes.
  • The spread of cancer: Women who have invasive breast cancer and decide to have mastectomies will receive an MRM so their lymph nodes can be examined. This lymph node examination allows identification of cancer cells that may have spread beyond the breast called metastasis.
  • Exposure to the armpit: A slightly more favorable group of women with breast cancer may be treated with an MRM rather than a radical mastectomy. However, doctors may recommend women with advanced breast cancer (stage III) have a radical mastectomy for better exposure to the armpit as an alternative surgical option.
  • Menopause status: In menopausal women, an MRM is more preferable.

What are the other mastectomy surgeries?

  • Simple or total mastectomy: In this surgery, the entire breasts will be removed. However, the underlying chest wall muscles and sometimes armpit lymph nodes are secured. 
  • Partial mastectomy: This is removal of the cancerous part of the breast tissue and some normal tissue around it.
  • Nipple-sparing mastectomy: In this surgery, the entire breast tissue is removed, but the nipples are kept intact.

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Medically Reviewed on 11/11/2020
References
Medscape Medical Reference

BreastCancer.org


Mayo Clinic


Annals of Surgery