Mastectomy means the unilateral or bilateral removal of the mammary gland. This can are necessary in breast cancer if a breast-conserving surgery is not possible with the woman. There are several criteria that can force your doctor to recommended you a mastectomy. He does this for your own good and knows about your fears and pain associated with this measure.
Criteria for giving mastectomy
The most common indication for a mastectomy is breast cancer. Although about 70 percent of breast cancers are nowadays treated with breast conserving surgery but complete mastectomy cannot always be avoided.
Since the mastectomy for many women is a psychological burden therefore it is especially important to carefully consider whether the complete removal is necessary. In men with breast cancer a mastectomy is always performed, a breast conserving surgery is not useful in this case. The following circumstances with a malignant neoplasm in the breast require a mastectomy:
- Large tumors
- Invasive breast cancer – with unfavorable tumor breast size ratio
- Multicentric carcinoma: occurrence of multiple cancer foci in different quadrants of the breast (multicentricity)
- Inflammatory breast cancer
- Comorbidities that do not allow a chemotherapy or radiotherapy
- Likely not satisfactory cosmetic results in breast conserving therapy
- If after breast conserving therapy radiotherapy may not take place
- Prophylactic indications – due to genetic predisposition
- The patient’s request
Besides cancer, there are other situations that require a mastectomy. These include large and possibly shape changing benign tumors or the desire for a sex change operation in patients with transsexualism.
Types of Mastectomy
- Simple mastectomy
- Radical mastectomy (surgery to rotter and halsted)
- Modified radical mastectomy
- Subcutaneous mastectomy
- Skin sparing mastectomy
Before surgery, a detailed medical history should be check and physical examination and the preparation should be done by an anesthetist (anesthesiologist). Because it is an invasive procedure, the patient must be informed of the risks and complications and it is necessary to obtain their consent in writing. Before the operation, the patient receives a general anesthetic, so she spends the pain free engagement sleep.
In simple mastectomy the surgeon sets a spindle-shaped transverse cut around the nipple, involves the removal of the breast, the mammillae-Areoles (nipple and areola) complex, the surrounding fatty tissue, the fascia of the pectoralis major muscle (connective tissue sheath of the large pectoral muscle) and skin. The lymph nodes in the armpit are left. After this operation creates an oblique scar that extends towards the axilla (armpit). Also this operation is suitable for the preventive mastectomy.
Radical Mastectomy (Rotter-Halsted operation)
Rradical mastectomy is an older type of surgery , which is also known under the name of Rotter-Halsted operation and today is no longer applicable. In this surgery, the doctor removes all lymph nodes in addition to the breast in the axilla and sternum and the large and small chest muscle. Since the cosmetic result is very distressing for the patient and the radical mastectomy compared with other methods has not proven to be better, this extreme procedure is now rarely performed.
Modified Radical Mastectomy
The modified radical mastectomy is the most common form of mastectomy nowadays. Here the breast tissue including mammillaen Areoles complex and the pectoral fascia and the axillary lymph nodes and the axillary fatty tissue are removed. Depending on the location of the tumor may also changes the flow of operation.
Subcutaneous Mastectomy and Skin Sparing Mastectomy
In the subcutaneous mastectomy, the breast tissue is removed through an incision in the crease below the breast. The skin of the breast and the nipple are preserved. A variation of this technique is the skin sparing mastectomy: In this case, the doctor removes Although the nipple, but not the breast skin covering. Advantage of both methods is that with a planned reconstruction of the breast adequately cover skin is left. However, a disadvantage is the increased risk of remaining tumor cells in the tissue .
Subcutaneous mastectomy is used to treat high-risk patients, have a genetic predisposition for breast cancer. The responsible genes are called BRCA1 and BRCA2.
After the operation, the surgeon places a wound drainage system into the wound cavity via a rubber hose. This allows the outflow of blood and wound secretions after surgery. The wound margins are now placed together without tension and carefully stitched. Subsequently, the physician connects the wound sterile and the patient is brought into the recovery room, in order to recover from the anesthesia.
- wound healing
- Inflammation caused by infection
- Haemorrhage (bleeding)
- Hematoma (bruising)
- Nerve or vascular damage
- Paresthesia (sensory disturbances in the wound area) by nerve damage
- Seroma (accumulation of wound exudate)
- Lymphedema (fluid retention by disruption of lymphatic drainage)
- Tumor recurrence (tumor recurrence)
- Anastomotic (resolution of the seam)
The complications mentioned may occur in varying frequency in all forms of mastectomy. For many women, the loss of the breast is a sense of loss of femininity and sexual identity associated as a woman. This may be especially the case if a breast reconstruction has not been possible with the mastectomy.