Breast Cancer Treatment

Written by : Dr.M.D.Mazumdar, MD

A mastectomy is a surgery in which the entire breast tissue together with the nipple, skin and some of the tissue overlying the chest muscles is removed. Sometimes, if the cancer is vey close to the chest wall or touching it, part of the chest muscles may also need to be removed. Mastectomy is the commonest type of breast surgery for cancer.

There are different types of mastectomy, depending on the degree of tissues excised. Sometimes, a double mastectomy in which both the breasts are removed may also be required.

The scar after a mastectomy may extend across the chest from the breastbone to the armpit.

A Mastectomy is done in :

• Stages I and II (early-stage) breast cancer

• Stage III (locally advanced) breast cancer after chemotherapy

• Inflammatory breast cancer

• Paget's disease of the breast

• Locally recurrent breast cancer

• Gene mutation which carries a high risk of recurrence of the disease.

• A large tumor in a small breast

• Multiple spots of cancerous cells in the breast (multicentric) or a large area affected by cancer.

• A tumour in the middle of the breast which cannot be removed by lumpectomy without gross disfigurement of the breast.

• Previous treatment history of breast cancer, especially radiotherapy

• Where radiation therapy is not possible, for example, in pregnancy and in connective tissue diseases like Lupus.

Which patient needs which type of mastectomy?

• Simple or Total Mastectomy - This is a type of mastectomy in which the entire breast, including the skin and the nipple is removed but the lymph nodes and the tissue over the chest wall is not removed.

  It is appropriate for women with multiple or large areas of ductal carcinoma in situ (DCIS). It is also done for women who need prophylactic mastectomies - that is, breast removal in order to prevent any possibility of breast cancer occurring.

• Modified Radical Mastectomy - In this type of mastectomy, not only the breast but also the lymph nodes in the armpit which drain the breast is removed. The chest wall is not touched. Women with invasive breast cancer are the appropriate candidates for this type of surgery.

• Radical Mastectomy - In this type of mastectomy, the breast, lymph nodes as well as part of the chest wall is removed. This surgery is done when the breast cancer has spread to the chest muscles under the breast. It is not very commonly done nowadays since modified radical hysterectomy followed by radiotherapy is adequate to treat invasive carcinomas.

• Partial Mastectomy - In this surgery, a part of the breast, generally larger than a lumpectomy, is removed. It is done in cases of large tumors in which lumpectomy alone is not sufficient to remove the cancerous cells.

• Nipple Sparing Mastectomy - The nipple may not always be removed during the mastectomy. Presence of the nipple helps make the breast look more normal after breast reconstruction surgery.

• Complete removal of cancer cells is easier.
• Most patients say that they are relieved at getting all the cancer cells out.
• Risks of recurrence are lower than in lumpectomy.

Disadvantages of Mastectomy

• Mastectomy means a permanent loss of the breast.
• Since the surgery is more extensive, it takes a longer time for recovery. Post-operative care is also longer and recovery may be more difficult than in lumpectomy.
• Breast reconstruction or wearing a prosthesis is necessary.