Mastectomy

Mastectomy is the surgical removal of breast tissue to treat or prevent breast cancer. Types include total (simple) mastectomy, modified radical mastectomy, skin-sparing mastectomy, and nipple-sparing mastectomy. Approximately 150,000 mastectomies are performed annually in the US.

Mastectomy is performed to treat breast cancer (invasive or ductal carcinoma in situ), for prophylactic risk reduction in high-risk patients (BRCA1/BRCA2 mutation carriers), for recurrent breast cancer, and when breast-conserving surgery is not appropriate due to tumor size or location.

Pre-operative workup includes mammography, biopsy results, MRI, genetic testing if indicated, and surgical planning with discussion of reconstruction options. If reconstruction is planned, a plastic surgeon is involved in pre-operative planning.

Under general anesthesia, the surgeon removes breast tissue through an incision. Sentinel lymph node biopsy or axillary lymph node dissection may be performed. If immediate reconstruction is planned, it begins during the same surgery. The procedure takes 2-4 hours without reconstruction.

Hospital stay is 1-3 days. Surgical drains remain for 1-2 weeks. Arm mobility exercises start within days. Most patients return to normal activities in 4-6 weeks. Avoid heavy lifting for 6 weeks. Emotional support and counseling are important parts of recovery.

Risks include bleeding, infection, seroma, lymphedema (arm swelling, especially with axillary dissection), nerve damage causing numbness, phantom breast pain, and psychological impact.

Breast-conserving surgery (lumpectomy) with radiation is equally effective as mastectomy for early-stage breast cancer. The choice depends on tumor characteristics, breast size, patient preference, and genetic factors.

Covered by all insurance plans for cancer treatment. The Women's Health and Cancer Rights Act requires insurers to cover breast reconstruction after mastectomy, including surgery on the opposite breast for symmetry.