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Surgery For Breast Cancer


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© American Cancer Society 2010

Mastectomy involves removing all of the breast tissue, sometimes along with other nearby tissues.

In a simple or total mastectomy, the surgeon removes the entire breast, including the nipple, but does not remove underarm lymph nodes or muscle tissue from beneath the breast. Sometimes this is done for both breasts (a double mastectomy), especially when it is done as preventive surgery in women at very high risk for breast cancer. Most women, if they are hospitalized, can go home the next day.

For some women considering immediate reconstruction, a skin-sparing mastectomy can be done. In this procedure, most of the skin over the breast (other than the nipple and areola) is left intact. This can work as well as a simple mastectomy. The amount of breast tissue removed is the same as with a simple mastectomy.

This approach is only used when immediate breast reconstruction is planned. It may not be suitable for larger tumors or those that are close to the skin. Implants or tissue from other parts of the body are used to reconstruct the breast. Although this approach has not been used for as long as the more standard type of mastectomy, many women prefer it because it offers the advantage of less scar tissue and a reconstructed breast that seems more natural.

Some doctors doing a prophylactic (preventive) mastectomy might consider doing a subcutaneous mastectomy. In this procedure, the incision is made below the breast. The breast tissue is removed, but the breast skin and nipple are left in place. This is followed by breast reconstruction. This procedure leaves less visible scars, but it also leaves behind more breast tissue than other forms of mastectomy, so the chances that cancer may develop in the remaining tissue are higher than for a skin-sparing or simple mastectomy. Because of the higher chance of cancer developing, most doctors do not recommend this procedure for women who opt for a preventative mastectomy.

A modified radical mastectomy is a simple mastectomy plus removal of axillary (underarm) lymph nodes. Surgery to remove these lymph nodes is discussed in further detail later in this section.

A radical mastectomy is an extensive operation where the surgeon removes the entire breast, axillary lymph nodes, and the pectoral (chest wall) muscles under the breast. This surgery was once very common. But a modified radical mastectomy has been proven to be as just as effective without the disfigurement and side effects of a radical mastectomy, so radical mastectomies are rarely done now. This operation may still be done for large tumors that are growing into the pectoral muscles under the breast.

Possible side effects: Aside from post-surgical pain and the obvious change in the shape of the breast(s), possible side effects of mastectomy include wound infection, hematoma (buildup of blood in the wound), and seroma (buildup of clear fluid in the wound). If axillary lymph nodes are also removed, other side effects may occur (see Axillary lymph node dissection).

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