SIMPLE MASTECTOMY

Definition

Mastectomy is the surgical removal of the breast for the treatment or prevention of breast cancer.

Types

There are 4 types of mastectomies

1. 1. Simple,
   2. Partial,
   3. Modified Radical
   4. Radical

Whenever possible the woman will be offered a chance to have breast conserving treatment or partial mastectomy. Just as studies proved that removing more tissue, as in a radical mastectomy, is no more effective than doing a modified radical mastectomy, the surgical trend toward partial mastectomy with radiation treatment is showing equal effectiveness today. Largely due to early detection, the number of breast conserving surgeries performed today has skyrocketed. An earlier diagnosis offers women more options on how to best treat their cancer.

The physician gathers as much information as possible to determine which treatment will offer the best outcome for the patient. When deciding which surgical procedure to choose following a diagnosis of breast cancer, many factors will be addressed. Such as:

• # Tumor size in relation to breast size
  # Type of tumor
  # Stage of cancer
  # Lymph node involvement
  # Histological grade of the tumor
  # Whether the tumor is hormone driven by estrogen or progesterone
  # Prior treatment with radiation in the area
  # Whether the patient has any contraindications for radiation treatment
  # Whether the patient has access to a radiation treatment facility
  # The patient's upper body range of motion (to tolerate the radiation treatment)

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What is Simple or Total Mastectomy?

The entire breast is removed, but no lymph nodes are removed in this procedure. Simple mastectomy is most frequently used for further cancer prevention or when the cancer does not go to the lymph nodes.

Total (Simple) Mastectomy

Woman with total (simple) mastectomy A pink highlighted area indicates tissue removed at mastectomy B axillary lymph nodes: levels I C axillary lymph nodes: levels II D axillary lymph nodes: levels III

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PROCEDURE

This is one of the standard operations for cancer of the breast and involves removal of the entire breast including the overlying skin with nipple and areola. It may be modified into subcutaneous mastectomy which leaves the skin of the breast intact while removing the breast tissue.

Indications
These are for central tumours and further large tumours relative to the patient's breast size for which radiotherapy is relatively contraindicated.

Anaesthetic
General anaesthetic.

Technique
The breast is normally excised using a horizontal incision across the breast to include the whole of the breast tissue. At the end of the procedure drains are normally inserted to prevent accumulation of blood clot. Breast reconstruction may be performed at time of surgery or as a secondary procedure.

Length of Operation
Normally around 60 minutes.

Time in Hospital
Between 5 and 7 days.

Post-Operative Discomfort
There is more discomfort from this operation due to the amount of breast tissue removed. Within the first 5 to 7 days the drains are removed and if non-dissolvable sutures have been used these are normally removed between 10 to 14 days.

Time off Work
This is between 3 to 4 weeks.

Risks and Complications
As with any operation there is a risk of bleeding and infection. Simple mastectomy is chosen for many women as there is a decreased risk of local recurrence compared to wide local excision.

Outcome
This is totally dependent on the stage of the tumour when discovered.