Mastectomy Overview
Mastectomy is surgery to remove breast tissue, often done to treat breast cancer. It can be
classified into several types, including total (or simple) mastectomy, modified radical
mastectomy, radical mastectomy, skin-sparing mastectomy, and nipple-sparing mastectomy.
The type performed depends on factors such as tumor size and location and the extent of
cancer spread. Women at high risk may also consider prophylactic mastectomy, which aims to
reduce the risk of developing breast cancer.
Mastectomy is a critical surgical procedure primarily performed to treat breast cancer. It
involves the removal of breast tissue, which can vary in extent depending on the type of
mastectomy being conducted. Knowledge of the procedure, the instruments required, the
principles of aseptic technique, and the necessary operating room setup are vital for successful
outcomes.
Anatomy and Physiology
The breast, located on the anterior thoracic wall and overlying the pectoralis major muscle, has
a superior border that aligns near the second or third rib and extends to the inframammary
crease. It is demarcated medially by the sternal border and laterally by the mid-axillary line, with
approximately two-thirds of the breast tissue resting on the pectoralis major muscle. The breast
is divided into four quadrants for consistent documentation, with the upper outer quadrant,
including the axillary tail of Spence, being the most common site for breast cancer. Structurally,
the breast contains mammary tissue enveloped in subcutaneous fat and supported by
superficial and deep fascial layers. Suspensory ligaments of Cooper provide structural integrity,
and the breast comprises 10-15% epithelial elements and 85-90% stromal components
organized into lobes and lobules that connect to lactiferous ducts. Blood supply is primarily from
the internal mammary and lateral thoracic arteries, while venous drainage follows similar
pathways towards the axilla. Lymphatic drainage occurs mainly through the axilla, involving
various levels of axillary lymph nodes characterized by their relationship to the pectoralis minor
muscle. Understanding this intricate anatomy is critical for both clinical assessment and cancer
management, as lymphatic channels represent routes for potential cancer metastasis.
Types of mastectomy procedures
-Total (simple) mastectomy. This method removes the whole breast, including the
nipple, the colored ring around the nipple (called the areola), and most of the overlying
skin.
-Modified radical mastectomy. The entire breast is removed. This includes the nipple,
the areola, the overlying skin, and the lining over the chest muscles. Some of the lymph
nodes under the arm are also removed. Breast cancer often spreads to these lymph
nodes. It can then spread to other parts of the body. In some cases, part of the chest
wall muscle is also removed.
-Radical mastectomy. The entire breast is removed, including the nipple, the areola, the
overlying skin, the lymph nodes under the arm, and the chest muscles under the breast.
For many years, this was the standard surgery. But today it is rarely done.
- Some newer mastectomy methods may offer more surgery options. But more studies are
needed to see if these methods work as well to fully remove breast cancer or stop from
starting or coming back after treatment. Newer methods include:
-Skin-sparing mastectomy. The breast tissue, nipple, and areola are removed. But most
of the skin over the breast is saved. This type of surgery seems to work as well as
