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Mastectomy is the surgical removal of a
breast. Surgery is presently the most common treatment for breast cancer. Following
mastectomy, immediate or delayed breast reconstruction is possible in many instances.
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Types of Mastectomy
There are several different types of surgical procedures used to treat breast cancer.
Depending on the location or surgeon who performs the procedure, different terms may be
used.
Surgical procedures for breast cancer include:
- Simple or total mastectomy: removal of the breast, with its skin and nipple,
but no lymph nodes. In some cases, a separate sentinel node biopsy
is performed to remove only the first one to three axillary (armpit) lymph nodes.
- Modified radical mastectomy: removal of the entire breast, nipple/areolar region,
and often the axillary lymph nodes. This is the most common form of mastectomy performed
today.*
- Radical mastectomy: removal of the entire breast, nipple/areolar region, the
pectoral (chest) major and minor muscles, and lymph nodes. This procedure is rarely
performed today.*
- Quandrantectomy: removal of a quarter of the breast, including the skin and breast
fascia (connective tissues). The surgeon may also perform a separate procedure to remove
some or all of the axillary (armpit) lymph nodes, either an
axillary node dissection
or a sentinel node biopsy.
- Partial or segmental mastectomy: removal of a portion of the breast tissue
and a margin of normal breast tissue. This procedure usually involves removing less tissue
than a quandrantectomy but more than a lumpectomy or wide excision.
- Lumpectomy
or wide excision: removal of the breast cancer tumor and a surrounding margin of
normal breast tissue.
- Excisional biopsy
also the removal of the breast tumor and a surrounding margin of normal breast tissue.
Sometimes further surgery is not needed if an excisional biopsy successfully
removes the entire breast cancer tumor. This is most likely to occur if the
breast tumor is very small. An excisional biopsy may be performed with "needle"
or "wire" localization.
*In the past, radical mastectomy was the frequently performed on women with breast
cancer. However, experts have found that modified radical mastectomy is equally effective
in most cases, and therefore, it has become the most common type procedure for removing
the entire breast.
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| Radical Mastectomy. |
Modified Radical Mastectomy. |
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| Simple (total) Mastectomy. |
Partial Mastectomy |
| Images courtesy of the NIH/NCI. |
Axillary
Node Dissection
Axillary node dissection, the surgical
removal of the axillary (armpit) lymph nodes, is usually
performed on patients with invasive cancers. A radical mastectomy, modified radical
mastectomy, or lumpectomy operation often includes axillary node dissection (this involves
a separate incision for lumpectomy patients). After surgery, the axillary lymph nodes are
examined under a microscope to determine whether the cancer has spread past the breast and
to evaluate treatment options.
The most common side effect of axillary
node dissection is lymphedema: chronic swelling of the arm.
Approximately 10% to 20% of patients typically experience lymphedema when axillary node
dissection is combined with radiation therapy. Patients are encouraged to report any
tightness or swelling of the arm to their physicians as soon as symptoms occur to prevent
possible long-term suffering. Other side effects of axillary node dissection include
temporary to permanent limitations of arm and shoulder movement and numbness in the
upper-arm skin.
Side effects of axillary node
dissection:
- lymphedema (swelling of the arm)
- limitations of arm/shoulder movement
- numbness of upper-arm skin
Sentinel
Lymph Node Biopsy
Sentinel lymph node biopsy is a procedure that involves removing only one to three sentinel lymph
nodes (the first nodes in the lymphatic chain). To perform sentinel node biopsy, a radioactive tracer
and/or blue dye is injected into a region of a tumor. The dye is then carried to the sentinel
node (the lymph node most likely to be cancerous if the disease has spread from its original
origin). If the surgeon determines that the sentinel node contains cancer, more lymph nodes
are removed and examined. Surgeons detect the sentinel lymph node by either spotting the
blue dye or by measuring a node’s radioactivity with a Geiger counter. If the removed
sentinel node is cancer-free, additional lymph node surgery may be avoided. Research
has shown that sentinel lymph node biopsy may safely eliminate the need to remove
many lymph nodes and reduce the chances of lymphedema (chronic arm swelling). However, the
procedure may not be appropriate for all patients. Click here to
learn more about sentinel node biopsy.
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