Mastectomy and its place in modern times
Mastectomy in history
It was first described by the ancient Egyptians to treat breast tumors and has been practiced throughout human history in various ways and with dramatically bad results. It was scientifically described by Halsted in 1894, who proposed a very radical operation, with great trauma to the chest. In addition to the breast all the lymph nodes in the armpit and the pectoral muscles were removed, so women suffered a great reduction in upper limb mobility and a high degree of lymphedema.
Unfortunately, Halsted-type mastectomy remained as the only surgical treatment for breast cancer until the 1970s, when it was shown that such an aggressive surgical approach not only offered women nothing more in terms of survival, but took away from their quality of life. Then modified radical mastectomy, which did not traumatize the chest, but also had an aggressive approach to the lymph node issue, began to be widely practiced.
In the years that followed, everything changed. In the 1980s it was shown that mastectomy was not necessary for all breast cancer patients, but that conservative breast surgery (breastectomy combined with radiotherapy) could be performed with the same oncological results. For patients who could not have breast conservation, mastectomy, so-called simple mastectomy, performed with a single multiple incision, continued to exist. The subject of lymph node surgery was completely separated from breast surgery, with the technique of guardian lymph node biopsy sparing many women from complete lymph node cleansing and its complications. More about underarm surgery can be found here.
Mastectomy in today’s oncoplastic era
When should a mastectomy be performed?
Modern scientists are trying to expand women’s options for avoiding mastectomy. Nevertheless, there are cases in which it should be performed. Such cases are:
- Surgeable locally advanced breast cancer
- Cancer that is very large in relation to the size of the breast where even with complex oncoplasty methods it cannot be removed with breast preservation and an acceptable aesthetic result
- Multicentric cancer (cancer with multiple foci in multiple breast sites)
- Extensive DCIS (non-invasive carcinoma in situ)
- Reversal of cancer after prior conservative surgical treatment
- New breast cancer after previous conservative surgical treatment in the same breast
- Indication to breast radiotherapy, which is an integral part of conservative treatment
- For risk reduction due to family history or genes (bilateral mastectomy)
- For risk reduction after developing cancer in the other breast (previous mastectomy in the other breast)
- Patient who prefers mastectomy to conservative treatment and breast conservation
- Male patient with breast cancer
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Thoracic Mastectomy
In the age of oncoplastic surgery, even the technique of simple mastectomy is subject to variations depending on the ultimate surgical plan and the patient’s wishes. Through discussion with each woman, we will decide the exact approach depending on the future planning of breast reconstruction. The incision and other parameters will depend on the restoration technique we follow. In selected women who will be offered Immediate Breast Rehabilitation (in the first year), the surgical plan is completely changed and in place of a simple mastectomy, a subcutaneous mastectomy with or without nipple preservation will be performed. This is a much more complex surgery available at Patras Breast Care Clinic.
Complications of mastectomy
During the mastectomy, antibiotics are administered in the operating room and a drain is placed for 24 hours. After surgery, antithrombotic therapy is always administered. The pain from the mastectomy is mild and lasts for one to two 24 hours. However, mastectomy as an operation does not have frequent and significant complications. The few that can occur are:
- Aematoma (rarely, within 24 hours, may require evacuation in the operating room)
- Surgical wound infection (within a few days, requires little antibiotics)
- Stool (after days, collection of clear fluid during healing, aspirated in the operating room)
- Skin flap anoxia (rare, in very difficult mastectomy cases)
- Decrease in sensation in the incision area
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For information about Subcutaneous Mastectomy with or without nipple preservation, see the corresponding page for Breast Reconstruction.
This page wants to answer frequently asked questions about mastectomy, including:
Note of the Breast Care Clinic of Patras:
By informing you, we want to protect you from sources of invalid information and dissemination on the internet. We also want to help you get informed before visiting our clinic. The breast surgeon Ioannis Haveles has written all the texts of the website of the Breast Care Clinic of Patras -frontidamastou.gr- and guarantees the scientific correctness of the information provided at the time of writing (2017). However, every woman is different and the treatment is individualized based on many elements. Do not jump to conclusions without asking your doctor. Talking to your qualified breast surgeon is not a substitute for reading informative texts, so address all your questions to your breast surgeon.
