Mastectomy is the removal of the breast. There are several mastectomy procedures, which are distinguished by the amount of breast tissue and other tissues that are removed. Tumor size, cancer stage, and lymph node involvement are factors considered when determining which procedure is most appropriate. Age and overall health are also taken into account.
Simple Mastectomy (SM) [also known as Total Mastectomy (TM)]: The entire breast is removed, including all the breast tissue, nipple-areola complex, and a small portion of the overlying skin, preserving muscle, fascia, and axillary lymph nodes.
Skin-Sparing Mastectomy (SSM): A small (keyhole) incision, circling the areola, is made. Even though the opening is smaller, the same amount of breast tissue is removed. The areola complex cannot be preserved as the breast ductal system travels through this complex. Scarring is negligible and 90% of the skin is preserved. Reconstruction is performed at the same time, using tissue from the patient’s abdomen or latissimus dorsi (back) muscles.
Subcutaneous Mastectomy (SCM): The tumor and breast tissue are removed, sparing the skin, lymphatic drainage system, and nipple-areola complex. The breast can be reconstructed by creating a submuscular or subcutaneous pocket for an implant. The reconstruction may be easier, but if subcutaneous mastectomy is done for cancer, some cancer cells may remain undetected.
Prophylactic Mastectomy (PM) is not a procedure, per se; it is the rationale for the appropriateness to remove the breast tissue in the absence of malignant disease. PM is also known as Preventive Mastectomy and is typically bilateral. PM may be preformed unilaterally in a patient who has previously undergone a mastectomy in the opposite breast for an invasive cancer and is at risk for developing cancer in the remaining breast.
Patients are considered at high risk for developing breast cancer, when due to:
- A family history of breast cancer in two first generations relatives, such as two siblings, or mother and sister, or the
- Presence of a BRCA 1 or BRCA 2 mutation, or the
- Presence of lesions associated with an increased cancer risk.
Such lesions include atypical hyperplasia and lobular carcinoma in situ (LCIS). Although labeled as a cancer, LCIS is thought not to have invasive potential. However, patients diagnosed with LCIS are at increased risk of developing invasive breast cancer elsewhere in either breast. Therefore, bilateral PM is performed not to excise the LCIS lesion itself, but to eliminate the risk of cancer arising elsewhere.