What is a mastectomy?
A mastectomy is the removal of the mammary gland on one or both sides (unilateral or bilateral mastectomy). Other names for this surgery are mastectomy or ablatio mammae. There are several procedures available for breast removal:
- simple mastectomy
- radical mastectomy (operation according to Rotter and Halsted)
- modified radical mastectomy
- subcutaneous mastectomy
- skin sparing mastectomy
The choice of surgical procedure is made by the attending physician in consultation with the patient depending on the reason for the intervention. If necessary, the removed mammary gland can be reconstructed during the same procedure, for example with silicone implants or with autologous fat.
When is a mastectomy performed?
- unfavorable tumor-to-breast size ratio
- Occurrence of multiple cancer sites in different quadrants of the breast (multicentricity)
- “inflammatory” breast cancer (inflammatory breast carcinoma)
- Concomitant diseases that do not permit chemotherapy or radiation therapy
- Expected unsatisfactory cosmetic outcome with breast-conserving therapy
- if no follow-up radiation is possible after breast-conserving therapy
- wish of the patient
Special case: Prophylactic mastectomy
A precautionary or preventive mastectomy (prophylactic mastectomy) can be useful if women have been shown to carry a genetic predisposition to the disease.
Carriers of such risk genes therefore sometimes decide to have a mastectomy as a precaution – before a tumor can possibly develop. A prominent example of this is the actress Angelina Jolie.
However, a genetic predisposition is responsible for only a few cases of breast cancer: risk genes can be detected in only an estimated five to ten percent of all women with breast cancer.
Mastectomy in men
In men with breast cancer, a total mastectomy is almost always performed; breast-conserving surgery is usually not advisable here.
What do you do during a mastectomy?
Before the operation
The actual surgery
The details of the actual mastectomy depend on the surgical procedure chosen:
Simple mastectomy
In a simple mastectomy, the surgeon makes a spindle-shaped incision transversely around the nipple. Through this, he removes the breast – nipple and skin, the fatty tissue and the connective tissue covering the pectoral muscle. The lymph nodes in the armpit are left in place.
Radical mastectomy (operation according to Rotter and Halsted)
Modified radical mastectomy
Subcutaneous mastectomy and skin-sparing mastectomy
In subcutaneous mastectomy, breast tissue is removed through an incision in the crease of the lower breast. The skin of the breast and the nipple are preserved. A variant of this technique is skin-sparing mastectomy: here, the doctor removes the nipple but not the skin covering the breast.
After the operation
Once the surgery is completed, the surgeon places a wound drainage system in the wound cavity via a rubber tube. This allows blood and wound secretions to drain away after the operation. The wound edges are now placed together without tension and carefully sutured. The doctor then dresses the wound sterilely, and the patient is taken to the recovery room to recover from the anesthesia.
What are the risks of a mastectomy?
- Bleeding and postoperative hemorrhage that may require a blood transfusion or postoperative care
- Bruising and congestion of wound fluid
- Injury to nerves
- Infections and inflammations
- Wound healing disorders
- Lymphatic drainage disturbance due to removal of lymph nodes
- excessive scarring
- cosmetically unfavorable result with retractions/deformations
- Rare: dying skin, especially with skin sparing mastectomy
- psychological stress due to altered body image
What do I need to be aware of after a mastectomy?
Since the lymph nodes in the armpit are often also removed during a mastectomy, there may be drainage problems and thus fluid accumulation in the tissue in the arm (lymphedema). If necessary, your doctor will prescribe lymphatic drainage therapy, in which the flow of lymph is promoted by stroking and massaging the arm.
This is how you can prevent lymphedema yourself after mastectomy:
- If possible, keep arm extended and slightly angled away from upper body
- Avoid tight clothing
- Avoid exposure to great heat (sauna, sunbathing), generally no heat treatment of the affected arm
- Avoiding strain, for example by heavy lifting
To avoid overloading the wound, even if you feel fit, you should have assistance with activities of daily living (such as personal hygiene, dressing) during the first few days after the mastectomy.
