Mastectomy
We work closely with Drs. Roy Ashikari and Andrew Ashikari of the Ashikari Comprehensive Breast Center at the Dobbs Ferry Community Hospital to provide you with a coordinated mastectomy and immediate reconstruction. They are expert in the latest procedures for skin-sparing mastectomy.
The availability of genetic testing for BRCA1 and BRCA2 gene mutations reveals that many women have a significantly increased risk for breast cancer. Worried about their risk of developing the disease, many of these women seriously consider prophylactic mastectomy as a near total reduction of their breast cancer risk.
Standard treatment for breast cancer used to involve complete removal of a woman’s breast and most or all of her chest muscle. The result for women who were “cured” of their disease was a scarred and disfigured body, without the possibility of reconstruction.
Current mastectomy techniques are just as effective, while more conservative. Different types of mastectomies are performed, depending on the type and extent of a breast cancer found.
Simple (Total) mastectomy
When non-invasive breast cancer is present with positive margins or is found within two or more quadrants of the breast, the entire breast is removed. No muscle or underarm lymph nodes are removed.
Modified radical mastectomy
When invasive breast cancer occurs in two or more quadrants of the breast or has positive margins, it is treated with modified radical mastectomy. The most commonly-performed type of mastectomy, modified radical mastectomy includes removal of the entire breast and underarm lymph nodes. The number of lymph nodes removed and the technique to remove them depends on the extent of breast cancer found.
Radical mastectomy
The entire breast, chest wall muscle and some underarm lymph nodes are removed. Because the less-invasive simple mastectomy and modified radical mastectomy have proven to be as effective as radical mastectomy, radical mastectomy is rarely performed.
Skin-sparing mastectomy
When immediate reconstruction is performed with mastectomy, the breast tissue is removed, but much of the breast skin remains to hold and shape the reconstructed breast. The areola is typically excised (sometimes it is necessary to make a secondary lateral or vertical incision ). Research shows skin-sparing mastectomies do not increase the risk for breast cancer or recurrence in patients with early stage-breast cancer.
Prophylactic (preventative) mastectomy has been shown to reduce the risk of breast cancer by as much as 95% in women who are at high hereditary risk for the disease. If you are considering prophylactic mastectomy to lower your risk of breast cancer, you should first consider other risk-reducing techniques, and understand the benefits and limitations of this procedure, with or without reconstruction. Discuss this with your healthcare team before making a decision.
A prophylactic mastectomy followed by immediate reconstruction has distinct cosmetic advantages over traditional mastectomy and reconstruction. In many cases, a woman’s reconstructed breasts can look the same after mastectomy and reconstruction as they did before.
Prophylactic mastectomy involves less-invasive procedures:
Subcutaneous mastectomy
During this skin-sparing mastectomy, tissue is removed through an incision under the breast, rather than around the areola. This leaves a woman’s the skin, areola, and nipple intact.
Some women who have prophylactic mastectomies prefer a subcutaneous procedure because it allows them to retain their nipples while producing very good cosmetic results. Performing reconstruction through the incision under the breast produces a new breast without visible scars.
Because a subcutaneous mastectomy leaves more tissue behind-working through the incision under the breast makes it impossible to remove as much tissue as a simple or modified radical mastectomy-this procedure is considered appropriate only as a prophylactic measure. It is inappropriate as treatment for women with large tumors, cancer of the breast skin, or with tumors under or near the nipple or areola.
Nipple-sparing mastectomy
This is another type of skin-sparing mastectomy that allows a woman to retain her own areola and nipple. Unlike the subcutaneous mastectomy, the incision for a nipple-sparing mastectomy is made around the areola.
Although both techniques conserve the nipple, a subcutaneous mastectomy leaves more breast tissue behind. During the surgery, a sample of the patient’s tissue beneath the nipple is tested. If cancer cells are found, the entire nipple-areolar complex is removed. If the tissue is clear of cancerous cells, the nipple and areola are scraped clean of tissue and regrafted back onto the breast. Removing and regrafting the nipple usually causes it to lose most, if not all of its normal sensation and can flatten its shape.
