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Mastectomy


Medical editor Ellen Schlichting MD
Surgeon
Oslo University Hospital
Norway

General

Mastectomy (mammary ablation) is the surgical removal of the mammary gland with or without underlying fascia. Underlying musculature is not removed.

For invasive cancer and DCIS grade 3, a sentinel node biopsy is performed before a mastectomy.

Axillary lymph node dissection is performed when preoperative spreading in the axilla is present, or for locally advanced disease when spreading in the axilla is present before preoperative treatment. In addition axillary lymph node dissection is performed for locally advanced cancer with skin involment. Or for T-3 tumors when there is little or no tumor response after preoperative treatment, regardless of preoperative axillary status.

Indications

  • When breast-conserving surgery is not indicated, or not wanted by the patient.
  • When radiation therapy is not feasible.

  Goal

  • Curation
  • Palliative for local control (with metastases)

Equipment

  • Tray for fine surgery

Preparation

  • Thrombosis prophylaxis.  
  • Shaving of the axilla. 
  • The surgery is performed under general anaesthesia 
  • The patient supine position with ipsilateral arm abducted 70-90 degrees.

Implementation

  • An ellipse-shaped incision including the areola is made through the preoperative outline. 
  • The mammary gland is dissected from the surrounding tissue down to the pectoralis major muscle. 
  • The gland and fascia over the muscle are removed. 
  • Hemostasis is performed. 
  • A vacuum drain is inserted in the wound and fixed with a suture. 
  • The wound is closed with intracuticular sutures. 
  • Local anesthesia is injected in the edges of the wound (20 ml xylocain with or without adrenaline). 
  • Steri-strips and compression bandages are applied.

Follow-up

  • The vacuum drain is removed 1st postoperative day.
  • The compression bandage is removed 1st postoperative day.
  • The patient is discharged the same day or after one night stay.
  • Follow-up by surgeon after 2-3 weeks.
  • The patient is followed up with annual mammograms for 10 years.

Axilla surgery increases the risk for development of late complications such as lymphedema.

Plastic surgery reconstruction

Even if most breast cancer operated patients adapt themselves to the use of external prosthesis, the patient should be informed about the possibilities of reconstruction.

Radiation therapy does usually contraindicate reconstruction. Surgical reconstruction with incorporation of implants or muscular flap (usually pedunculated or free TRAM Flap) does not reduce life expectancy. The reconstruction does not increase difficulties for discovering local relapse.

In large breasts, breast reduction of the remaining breast may be necessary both for cosmetic and functional reasons. The breast must then be checked by mammography before surgery and histological examination of the operated specimen should be especially meticulous.


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