Mastectomy is a surgical procedure that involves the removal of one or both breasts, usually to treat or prevent breast cancer. As a breast oncoplastic surgeon, I have witnessed firsthand the impact that mastectomy can have on patients' lives. In this comprehensive guide, we will delve into the various aspects of mastectomy, including its types, indications, surgical techniques, recovery and emotional considerations.

Types of Mastectomy:

• Simple (Total) Mastectomy: In this procedure, the entire breast tissue, including the nipple and areola, is removed. It is often performed when the cancer is widespread within the breast or as a preventive measure for individuals at high risk of developing breast cancer.

• Modified Radical: It is recommended for invasive breast cancer with nearby lymph node involvement or when lumpectomy isn't feasible. It involves removing the breast tissue, nipple, areola, and some axillary lymph nodes, but unlike radical mastectomy, it preserves the chest wall muscles. This preserves the chest shape and function, potentially offering better cosmetic outcomes and mobility. It balances effective cancer treatment with preserving quality of life, making it valuable for certain cases.

• Radical: This extensive procedure involves removal of the entire breast, underlying chest muscles, and lymph nodes in the armpit. However, it is rarely performed today due to advances in surgical techniques and better understanding of cancer biology.

Indications for Mastectomy:

Mastectomy may be recommended for various reasons, including:

• Treatment of breast cancer - particularly in cases of large tumors or multiple affected areas within the breast.

• Prevention of breast cancer - in individuals with a high genetic risk, such as those with BRCA gene mutations.

• Recurrence of breast cancer - following previous lumpectomy and radiation therapy.

• Presence of certain pre-cancerous conditions - such as ductal carcinoma in situ (DCIS) that cannot be adequately treated with less invasive options.

Surgical Techniques:

• Traditional Mastectomy: The surgeon makes an incision either around the areola (for total mastectomy) or along the natural crease of the breast. The breast tissue is then carefully dissected and removed.

• Skin-Sparing Mastectomy: This technique preserves as much of the breast skin as possible, which can improve cosmetic outcomes, especially in combination with breast reconstruction.

• Nipple-Sparing Mastectomy: In this approach, the nipple and areola complex are preserved, resulting in a more natural-looking breast mound. It requires meticulous surgical planning to ensure complete removal of underlying breast tissue while preserving blood supply to the nipple. This is usually combined with breast reconstruction.

Recovery and Rehabilitation:

The recovery process following mastectomy can vary depending on the extent of surgery and individual factors. Patients may experience discomfort, swelling and limited arm mobility in the initial weeks post-surgery. Physical therapy exercises and proper wound care aid in recovery and minimize complications such as lymphedema (arm swelling due to lymph fluid buildup).

Emotional Considerations:

Mastectomy can have profound emotional effects on patients, impacting body image, self-esteem and sexuality. We offer comprehensive support, including counselling, support groups and resources for breast reconstruction options. We believe empowering patients with information and involving them in decision-making can help alleviate anxiety and facilitate coping strategies.

Mastectomy is a significant surgical intervention with far-reaching physical, emotional, and psychological implications. We provide holistic care, addressing not only the medical aspects but also the emotional needs of our patients.