Definition – What is a mastectomy?
The term mastectomy refers to a surgical removal of the entire mammary gland on one or both sides. There are various forms of mastectomy, which differ in their radicality and the structures of the breast to be removed. The most common reason for a mastectomy is female breast cancer, but there are also a number of other indications. Following the mastectomy, surgical reconstruction of the breast is usually performed.
Indications for a mastectomy
The most common reason for mastectomy (removal of the mammary gland) in women is breast cancer. Depending on the size, aggressiveness and malignancy of the tumor, it is not sufficient to remove the tumor area in order to preserve the breast. In these cases the affected breast is removed.
Depending on the case, different surgical techniques are used. More rarely, benign tumors of the breast are so large that only the removal of the breast can be considered as surgical therapy. Another reason for a mastectomy may be an excessively enlarged breast (mammary hypertrophy, hypermasty).
The affected women often suffer from severe back and neck pain, postural deformities and skin changes in the area of the breasts, so that ultimately only a surgical reduction of the breast is an option. In this so-called reduction mastectomy, the volume and weight of the breast is reduced to a reasonable level. If both breasts are affected, two operations are often performed at intervals of several months.
An enlargement of the mammary gland in men (gynecomastia) can also be an indication for mastectomy. In this case, a hormonal imbalance (testosterone deficiency, excess oestrogen) leads to gland growth in the male breast, which is often perceived as cosmetically very disturbing. A so-called prophylactic bilateral mastectomy is recommended in certain cases where the risk of breast cancer in the family is greatly increased.
What forms of mastectomy are there?
There are various forms of mastectomy, which differ in their radicality, i.e. the degree of tissue removal. Thus, the different forms are used for different indications. In subcutaneous mastectomy, the entire mammary gland is removed, leaving the skin and nipples including the areola.
After the operation, the image of a male breast is created, which can be reconstructed to its original shape. In a simple mastectomy, in addition to the mammary gland, a skin flap, which also contains the nipple, fatty tissue and the fascia of the breast muscle on which the mammary gland rests are removed. The modified radical mastectomy also includes the removal of the axillary lymph nodes.
It is often performed in cases of breast cancer, as there is a risk that tumor cells have already settled in the axillary lymph nodes. It is considered the standard procedure for breast cancers that cannot be operated on while preserving the breast. The radical mastectomy (according to Rotter-Halsted) additionally includes the removal of the large breast muscle (M. pectoralis major) and is rarely used nowadays.