Mastectomy

Mastectomy is a surgical treatment for breast cancer in which the entire breast tissue is removed through a surgical procedure as opposed to a wide local excision. Sometimes, adjacent structures, such as lymph nodes, are removed to prevent recurrence or metastasis. In some cases, mastectomy is done for the prevention of breast cancer development.

The following subtypes are distinguished ^1,2:

• simple or total mastectomy

• radical mastectomy

• modified radical mastectomy (MRM): resection of the breast including the skin, nipple-areolar complex, and an axillary dissection with sparing of the ipsilateral pectoralis major muscle ^3,5

• skin-sparing mastectomy

• nipple-sparing mastectomy

• double mastectomy

Indications

Mastectomy has the following indications ^2,3:

• cancers that are not suitable for breast-conserving surgery, including

  • large tumor-versus-breast ratio

  • widespread or multicentric disease, located in more than one quadrant, and cannot be removed through a single incision with achievement of negative margins

  • poor response to neoadjuvant chemotherapy and endocrine therapy

  • inflammatory breast cancer

  • contraindication to radiation therapy (e.g. early pregnancy)

  • diffuse and extensive suspicious or malignant-appearing microcalcifications

  • persistent positive margins after excision

  • local recurrence after breast-conserving therapy and/or radiation therapy

  • active connective tissue disease involving skin (e.g. scleroderma, SLE)

• breast cancer prophylaxis in high-risk patients in the following settings

  • proven genetic susceptibility

  • history of prior mantle radiation

• patient preference

Contraindications

Contraindications include the following:

• distant metastatic disease at presentation

• patients in whom the primary mode of treatment remains systemic therapy

• intolerance to general anesthesia

Radiographic appearance

The following appearances are described here for normal post-operative state.

Plain radiograph

In uncomplicated post-op status, normal breast tissue shadow will be absent on the corresponding side.

CT/MRI

The absence of breast tissues will be seen in the form of an asymmetric anterior chest wall.

Complications

Common complications include the following:

• hematoma

• infection

• wound dehiscence

• seroma

• skin necrosis

Differential diagnosis

For absent tissue on one side on mammography and radiography, consider:

• amazia: absence of breast parenchyma

• amastia: absence of breast tissue

• Poland syndrome