What Is Surgery - Mastectomy
Mastectomy is performed as part of the surgical approach in treating patient with breast cancer.
Generally there are a few forms of mastectomy. These include simple mastectomy, Halsted’s radical mastectomy, modified radical mastectomy, subcutaneous mastectomy and skin sparing mastectomy.
Simple mastectomy may involve removal of all the breast tissue while preserving the axilla. Halsted’s radical mastectomy may include removal of the entire breast, the pectoralis major muscle and pectoralis minor muscle as well as the axillary lymph nodes.
Modified radical mastectomy is performed by removing the entire tissue of the breast and the axillary content. Subcutaneous mastectomy may include removal of the breast tissue with nipple -areola complex remain preserved. Skin sparing mastectomy may include circumareolar incision in removing the breast tissue while preserving the skin.
On examination post mastectomy, looks for evidence of recurrence of breast cancer such as ulceration, skin discoloration, skin puckering or lump / nodules detected.
Observe for any evidence of lymphedema on the ipsilateral arm. Inspect for any evidence of hepatomegaly ascites, pleural effusion, lobar or lung collapse and tachypnea due to metastases. Any cachexia or anemic or axillary or supraclavicular lymphadenopathy should raise suspicious of recurrent of breast cancer.
Patient may also present with telangiectasia or ink marking due to radiotherapy or alopecia due to chemotherapy.
The indication of mastectomy may include the present central tumor which involve the nipple, tumor more than 5 cm, or ductal carcinoma in situ more than 3 cm, patient choice of treatment, locally recurrent breast cancer and multifocal cancer.
The reconstruction of the breast can be performed after / post mastectomy. These include autologous reconstruction, implant , tissue expander and muscle flap.
Autologous reconstruction include deep inferior epigastric artery perforator flap, transverse rectus abdominus myocutaneous flap and superior gluteal artery perforator flap.
Subpectoral reconstruction is associated with implant / tissue expander. Latissimus dorsi can be used to contributes for half of the breast while the remaining from the implant.