Mastectomy

Overview of Treatment

Breast mastectomy is a surgical procedure used to treat breast cancer or to prevent high-risk individuals from developing breast cancer. Its primary goal is to remove part or all of the breast tissue to eliminate cancer cells and prevent disease spread. This surgery is common after early breast cancer diagnosis or as a prophylactic measure for high-risk groups such as those with BRCA1/2 gene mutations. The surgical approach varies based on the extent of removal and may include lymph node dissection, often combined with reconstruction to restore appearance.

Types of Treatment and Mechanisms

Breast mastectomy mainly falls into four types:

• Total mastectomy: removal of the entire breast tissue and nipple, with skin preservation for reconstruction
• Modified radical mastectomy: removal of the breast and axillary lymph nodes, with preservation of the pectoral muscles
• Radical mastectomy: removal of the breast, lymph nodes, and pectoral muscles (less commonly used now)
• Prophylactic mastectomy: preventive surgery for individuals at high risk who have not yet developed cancer

The procedure is performed using surgical instruments or endoscopy. After tissue removal, pathological examination confirms clear margins to assess whether additional treatment is necessary.

Indications

Mainly applicable to:

• Patients with stage I to III breast cancer, especially those with larger tumors or multiple lesions
• Subtypes with poor response to treatment, such as HER2-positive or triple-negative breast cancer
• Individuals with a family history of BRCA gene mutations and a risk assessment exceeding 20%

In special cases such as locally advanced breast cancer or tumors that do not fully regress after chemotherapy, this surgery may also be considered.

Usage and Dosage

This is a surgical procedure requiring general anesthesia and hospitalization for 1-3 days. The extent of removal varies by type:

• Standard total mastectomy involves removing breast tissue, the nipple, and part of the subcutaneous tissue
• The number of lymph nodes removed depends on the stage, typically 10-15 nodes in early stages

Postoperative pathology reports guide whether chemotherapy, targeted therapy, or radiotherapy is needed.

Benefits and Advantages

Main advantages include:

• Eradication of the primary tumor, reducing local recurrence
• Providing pathological diagnosis to guide subsequent treatment plans
• Prophylactic surgery can reduce the incidence of breast cancer by 85-90% in high-risk individuals

Compared to breast-conserving surgery, this method offers a more thorough treatment for large tumors or multifocal disease.

Risks and Side Effects

Possible complications include:

• Infection, hematoma, or abnormal skin sensation
• Lymphatic fluid accumulation (lymphedema) with an incidence of about 10-20%
• Permanent scars and changes in body image

Serious risks: anesthesia complications, permanent nerve damage, or permanent lymphatic system injury.

Precautions and Contraindications

Contraindications include:

• Uncontrolled systemic conditions that prohibit anesthesia (e.g., severe cardiopulmonary disease)
• Uncontrolled coagulation disorders

Patients should undergo detailed preoperative health assessments. Diabetic patients need blood sugar control, and postoperative monitoring for lymphedema is essential. Pregnant women should evaluate the impact of surgery on the fetus.

Interactions with Other Treatments

Must be combined with chemotherapy, targeted therapy, or hormone therapy:

• Neoadjuvant chemotherapy may shrink tumors to reduce the extent of removal
• Targeted drugs are selected based on pathology results after surgery
• Radiotherapy may be adjusted depending on the extent of resection

Anticoagulants should be discontinued 7 days before surgery, with alternative options evaluated.

Treatment Outcomes and Evidence

According to NCCN guidelines, total mastectomy can achieve an 85-95% 5-year survival rate in early breast cancer patients. Studies show higher local control rates for multifocal or hereditary breast cancers compared to breast-conserving surgery. Long-term follow-up indicates that prophylactic mastectomy can reduce breast cancer incidence by 90%, but psychological impacts and benefits should be carefully weighed.

Alternatives

Other treatment options include:

• Breast-conserving surgery (lumpectomy) + radiotherapy
• Neoadjuvant targeted molecular therapy
• Clinical trials involving gene therapy or immunotherapy

Selection depends on tumor characteristics, patient age, and quality of life considerations, and should be discussed in detail with the physician.

 

Frequently Asked Questions

After a total mastectomy, how can lymphedema be effectively prevented or alleviated?

Postoperative lymphedema can be managed through various methods: first, regular lymphatic drainage massage guided by a physical therapist; second, avoiding heavy objects or blood pressure measurements on the operated arm; daily wearing of elastic compression sleeves can also reduce swelling risk. If limb swelling or pain occurs, promptly notify the medical team for further assessment and treatment.

What are the options for timing and types of breast reconstruction after a total mastectomy?

Reconstruction can be immediate or delayed. Immediate reconstruction occurs simultaneously with mastectomy, reducing the need for a second surgery; delayed reconstruction is performed after the patient has recovered physically and psychologically. Techniques include autologous tissue transfer, implants, or a combination of both. The specific choice depends on residual skin, overall health, and aesthetic preferences, evaluated after thorough consultation.

How to manage skin discomfort caused by postoperative radiotherapy after a total mastectomy?

During radiotherapy, skin may become red, swollen, or itchy. Using fragrance-free moisturizers can help maintain skin barrier function. Avoid excessive cleaning or friction on the treated area. If blisters or skin breakdown occur, treatment should be paused and the physician notified. Dose adjustments or anti-inflammatory medications may be necessary.

How long after surgery can normal activities be resumed? Which movements should be avoided to prevent complications?

Generally, basic daily activities can be resumed within 2-4 weeks. However, lifting objects over 2 kg, raising arms above the head, or vigorous exercise should be delayed for 3-6 months. Sleeping positions should avoid pressure on the operated side. Gentle cleaning of the wound with warm water is recommended, and regular follow-up is essential to monitor healing progress.

Is there a significant difference in 5-year survival rates between total mastectomy and breast-conserving surgery? What factors should be considered when choosing?

Most studies show no significant difference in 5-year survival rates for early breast cancer between the two procedures. The choice depends on tumor location, patient age, tumor size, and psychological factors. If the tumor is multifocal or genetic risk is high, a total mastectomy may be recommended for thorough removal. Final decisions should be based on pathology reports and multidisciplinary team assessments.