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Mastectomy

Mastectomy

A mastectomy is an operation to remove the whole breast. It can often be combined with a simultaneous reconstructionBreast cancer treatment is the most common reason people undergo a mastectomy. Women with strong family histories or gene mutations such as BRCA1, BRCA2 or TP53 often choose to undergo a double mastectomy (aka bilateral mastectomy) for “risk reduction”. Occasionally women who have had a previous mastectomy without reconstruction choose to have a mastectomy to remove their healthy breast, simply for symmetry and to resolve issues they are experiencing with the uneven weight distribution, living with one breast.

Types of mastectomy and jargon used:

  • Simple mastectomy: all the breast tissue, the nipple area and some surrounding skin is removed with the breast tissue. The remaining skin sits flat on the chest wall with a scar that runs horizontally or diagonally across the chest. This method is used when there is no simultaneous reconstruction being performed. Patients often wear a silicone prosthesis in their bra to match the volume of their other breast, filling out their bra cup and enabling them to look symmetrical when clothed. With the prosthesis in place, it is not possible to tell that they have undergone surgery when clothed. The prosthesis is supplied for free within the NHS.
  • Skin and nipple sparing mastectomy: the breast tissue is ‘shelled out’ from underneath the skin and then replaced with the reconstruction material, for example a silicone implant or some of the patient’s tissue that has been harvested from a different site (i.e. an autologous reconstruction). 
  • Skin sparing mastectomy: the nipple has breast tissue right up to the skin surface (i.e. the ducts that carry milk). It is therefore possible to have breast cancer in the nipple. So if the cancer appears very close to the back of the nipple area on scans, it is sometimes necessary to remove it to ensure all of the cancer is excised. A nipple reconstruction can be performed as part of the breast reconstruction or at a later date.
  • Radical mastectomy: similar to the simple mastectomy but with removal of more skin and/or removal of the pec muscle under the breast tissue. This is performed if cancer has affected a large area of the skin or invaded into the muscle under the breast. Due to breast awareness It is rarely performed in the UK nowadays due to the fact that patients tend to be diagnosed and treated prior to the cancer reaching this situation.

Although not always the case, the majority of patients that have breast cancer can undergo some form of breast conserving surgery (i.e. a lumpectomy), even with some larger tumours in smaller breasts. This is due to the practice of breast surgery evolving to incorporate plastic surgery techniques in order to remove more tissue and re-shape the remaining breast tissue to give a good cosmetic result. 

If you wish to discuss your treatment options for breast cancer or if you have been deemed to be high risk of developing breast cancer from a genetic point of view, book an appointment to discuss your situation with Mr Pieri.

It is important to make sure that you get your information from reputable sources when doing your own research on breast cancer and treatments.

For more detailed information about mastectomy surgery, here are some excellent resources: