Origins of the Mastectomy
The origin of the word mastectomy is from the Greek words for cutting out – ektomia and breast – mastos. Even though the origin of this word can be traced to early 20th century, there have been historical anecdotes about the removal of breast tissue being performed in the 6th century and in certain sections of society in Tsarist Russia. The first documented case of the removal of breast tissue performed by a doctor was in 18th century France. A century later, an operation named radical mastectomy was performed in by Dr. Halsted, a renowned surgeon, one of the Big Four Founding fathers of the Johns Hopkins School of Medicine in the US. The method propagated by Dr. Halsted was named radical mastectomy as he advocated an extreme removal of breast tissue and surrounding muscles to prevent the recurrence of cancer.
His method has evolved to the modern mastectomy, which we will attempt to explain in this article.
The mastectomy has evolved considerably from its origins – currently there are many forms of this procedure. To understand the differences between these procedures, it is important to familiarize oneself with the basic anatomy of the breast tissue. The bulk of the breast is made up of fat and fibrous tissue, with glands – structures which produce milk while breastfeeding, located in between the fat and the fibrous tissue. To differentiate between the various types of mastectomies, it is important to understand the nipple and the areola. They are frequently confused for one another: the nipple is the raised bit of tissue in the middle of the dark region which is the areola. So, yes, the areola contains the nipple and that’s why it’s medically the entire darker region of the breast is referred to as the nipple-areolar complex. In addition to these, we have to be aware of lymph nodes present in the underarm area. When the cancer spreads, it most commonly spreads to the lymph nodes in the underarms first which is why they are removed in certain forms of mastectomy. Now that we have the anatomy lesson out of the way, here are the different types of mastectomy:
- Simple mastectomy – the entire breast tissue is removed in this procedure; however, the axillary lymph nodes are retained.
- Modified radical mastectomy – in this procedure both the breast tissue as well as the axillary lymph nodes are removed
- Radical mastectomy – here the breast tissue, axillary lymph nodes, and the muscles of the chest wall are also removed. This surgery is rarely performed now as there is a medical shift to conserving as much breast tissue as possible.
- Partial mastectomy – this refers to the removal of the cancerous breast tissue (keeping a margin of healthy tissue around it) only.
- Nipple sparing mastectomy – in this surgery, the breast tissue is completely removed, but the nipple and the areola are left alone.
- Lumpectomy – only a portion of the breast tissue is removed here, this type of surgery is also considered to fall under partial mastectomy. However, the amount of breast tissue removed in a lumpectomy is much smaller than that removed in a partial mastectomy.
Common Catalysts of the Mastectomy
Breast cancer is by and large the most common reason for having a mastectomy. However, prophylactic removal of breast tissue is becoming increasingly common. Women are being increasingly aware of the BRCA1 and BRCA2 genes. The widespread availability of genetic testing has made it easier to determine whether they carry these genes. While the 12% of women of the general population develop breast cancer at some point in their lives, for women who carry the BRCA1 or the BRCA2 gene, this risk shoots all the way up to 60%. This is why some women, on discovering their BRCA gene status, choose to have their breast tissue removed.
Mastectomy in the Current Era
There has been a shift to conserving as much breast tissue as possible, using chemotherapy and radiation therapy along with surgery for the best possible outcome. In view of this shift, there have been multiple studies comparing the survival of women who had mastectomies with women who had breast-conservation surgery. The largest of these studies follow almost 2000 women for 20 years! These multiple studies have found that there really is no difference in survival rates between the two approaches. However, when breast conservation surgery is supported by radiation therapy, it drastically reduced the chance of recurrence in such women.
Life After a Mastectomy
Mastectomies can be a harrowing procedure for some women – they feel as if they’ve lost a part of their identity. However, it is important for breast cancer survivors to still continue to give time to grooming, looking good – there are bras which are specifically made to cater to women who have undergone mastectomy, dressing up if they feel like it, and planning romantic evenings or a girls’ night out. Moreover, since it is a surgery after all, mastectomy is not without some post-operative discomfort. Pain after the surgery is common as there is a risk of the formation of scar tissue over time – these can be reduced by the use of scar gels.
In addition to the physical care that a breast cancer survivor has to take with regard to her body, giving due to mental healthcare is just as essential. Taking some personal time to meditate, take a bath with aromatherapy oils – depending on the aromatherapy oil you use it can help reduce nausea, insomnia, pain, and anxiety, and allow yourself some me-time. The journey to recovery from cancer doesn’t stop with the end of treatment. It is a lifelong commitment to your physical and mental well-being, and there is no time like the present to begin!
- Williams textbook of Gynaecology
- Sabiston Textbook of Surgery