What is Mastectomy?
Mastectomy is the removal of all the breast tissue. When the nipple is preserved it is called a Subcutaneous Mastectomy or nipple sparing mastectomy. When all the breast tissue is removed along with a large portion of the skin including the nipple it is called a Simple Mastectomy.
In Radical Mastectomy, along with the breast tissue and the overlying skin and nipple, the pecs (pectoral muscles) are also removed as are all the lymph nodes in the armpit. This is rarely done these days as the cosmetic appearance is awful. This operation is largely responsible for the fearful reputation of mastectomy. Nowadays, a form of modified radical mastectomy is performed where the major pectoral muscle is spared.
What happens to the tissue that is removed?
The pathologist will examine the breast tissue removed and report on:
- the grade of the cancer (grade 1, 2 or 3- grade 1 being slow growing and grade 3 being the more faster growing)
- whether the cancer is of the invasive type or non-invasive
- the type of breast cancer ( ductal or lobular or of a special type)
- the distance of the margins from the cancer and the nearest margin
- many cancer cells were seen in the blood vessels within the tissue removed (‘lymphovascular invasion’)
- whether the cancer is hormone sensitive [Oestrogen Receptor (ER) positive, Progesterone Receptor (PR) positive]
- whether the cancer is HER-2 receptor positive
Based on a combination of these features one can determine the outlook or prognosis and recommend additional treatment. This additional treatment may be further surgery such as a mastectomy &/or radiotherapy, chemotherapy, Herceptin, Tamoxifen/other anti-hormone therapies.