The most common indication for mastectomy is breast cancer.
Breast cancer is usually discovered when a lump, a change in the appearance of the breast (such as dimpling or puckering), or a suspicious mammogram is investigated. There are two main types of breast cancer surgery:
- The first is breast conservation, where only the tumor and a rim of surrounding tissue is removed. Breast conservation surgery, also known as lumpectomy or partial mastectomy, is usually followed by radiation therapy to the breast.
- The alternative to breast conservation surgery is removal of the entire breast, or mastectomy, which is the topic of this article.
Which type of surgery is best for which patients is a complex decision, taking many factors into account. If you are diagnosed with breast cancer, discuss with your doctor the relevant issues for your circumstances thoroughly and in as much detail as you need.
Important issues include the size of the tumor in relation to the size of your breast, whether there is more than one tumor in your breast, the side effects of radiation therapy, and your personal preferences.
Another indication for mastectomy is when a breast contains widespread DCIS, or Ductal Carcinoma in Situ.
DCIS is a pre-cancerous condition, and has the potential to become invasive cancer if left in place. It is typically discovered when a suspicious mammogram alerts your doctor to perform a biopsy.
DCIS present in a small area can be removed with a lumpectomy, but when spread throughout the entire breast, might require a mastectomy. When mastectomy is done for DCIS, it usually does not require removal of the lymph nodes under the arm.
Preventive, or prophylactic mastectomy is the surgical removal of one or both breasts that do not contain cancer or DCIS, in an effort to prevent or reduce the risk of breast cancer.
A subcutaneous or a total mastectomy can be done. This surgery is an option to reduce the risk of breast cancer for women at extremely high risk of developing breast cancer.
Prophylactic (preventative) mastectomy is an alternative to intensive screening, and is undertaken only after very careful consideration, often including genetic testing and a psychiatric evaluation.
Women who might consider propylactic mastectomy include those with a strong family history of breast cancer, especially if relatives are diagnosed at a very early age.
Some families have a known genetic mutation that predisposes to breast cancer (BRCA1 or BRCA 2), and individuals can be tested for these genes. Inherited mutations in these genes increase the lifetime risk of developing breast cancer. It is important to note that prophylactic mastectomy greatly reduces, but DOES NOT ELIMINATE the risk of breast cancer.
