CHAPTER 21 Mastectomy


Breast cancer is the most common malignancy in women, excluding cancers of the skin. Fortunately, the majority of breast cancers are diagnosed as early-stage lesions and are therefore amenable to surgical intervention with good anticipated outcomes (for current staging, see Box 21-1). The surgical management of breast cancer has undergone a dramatic transformation over the past several decades. Until the mid-1970s, radical mastectomy, a procedure that involved removal of breast tissue, the underlying pectoralis muscles, and regional axillary nodes, was the procedure of choice for the treatment of breast cancers. This operation was subsequently replaced by the modified radical mastectomy (which spares the pectoralis muscles) and the total or simple mastectomy (a pectoralis-sparing mastectomy without axillary lymphadenectomy). Over the past 2 decades, breast-conserving therapy, consisting of partial mastectomy (lumpectomy) and radiation therapy, has assumed a prominent role in the treatment paradigm for increasing numbers of breast cancers. More recently, sentinel lymph node biopsy has greatly reduced the number of axillary lymph node dissections performed on patients without clinically evident nodal metastases.

BOX 21-1

Joint Committee on Cancer Staging System for Breast Cancer

From Singletary SE, Allred C, Ashley P, et al: Revision of the American Joint Committee on Cancer staging system for breast cancer. J Clin Oncol 20:3628–3636, 2002. Reprinted with permission from the American Society of Clinical Oncology.

This chapter focuses on partial mastectomy and total mastectomy, which remain important components of the management of in situ and invasive breast cancers. Sentinel lymph node biopsy is addressed in detail in Chapter 23, as is axillary lymphadenectomy, which is sometimes performed in conjunction with total mastectomy.


I. Invasive Breast Cancer: Most early breast cancers are treated with partial mastectomy and radiation (breast-conserving therapy) (Fig. 21-2). Contraindications to this approach include: large tumor burden relative to small breast size, previous radiation therapy or other contraindications to radiation therapy (e.g., pregnancy), and multicentric disease (cancer foci in multiple quadrants of the breast). Sentinel lymph node biopsy is performed in conjunction with partial or total mastectomy for most invasive and some in situ cancers. Axillary lymphadenectomy is indicated in patients with sentinel lymph nodes containing metastases or clinically positive axillary nodes.

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May 26, 2018 | Posted by in GENERAL SURGERY | Comments Off on Mastectomy

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