The mastectomy is necessary in approximately a third of breast cancers.
Mastectomy is breast surgery, carried out as part of certain breast cancers. This operation is generally decided when the conservative breast treatment includes a significant risk of local recurrence or incomplete treatment at the level of the breast. These situations correspond precisely to the cases where the tumor exceeds a certain size or a certain proportion compared to the size of the breast:
- An infiltrating breast cancer whose volume represents more than a third or half of the breast. The surgeon judges whether the remaining volume of the breast is sufficient or not to be able to have a satisfactory form. If this is not the case, it is better to make a breast removal with a reconstruction.
- Infiltrating cancer that has not decreased in volume after chemotherapy
- Extended in situ cancer whose size does not make it possible to obtain a satisfactory aesthetic or carcinological result. In this case an immediate reconstruction is almost always possible.
- Multifocal tumors (several tumors in different quadrants in the same breast).
- The recurrences of breast cancer already treated by a conservative treatment.
- Prophylactic surgery in certain situations.
Definition: What is a mastectomy?
Non -conservative or “mastectomy” breast surgery is a surgical intervention carried out under general anesthesia which consists in removing the mammary gland in full with more or less skin. We can in some cases keep the areola and the nipple. It is necessary in approximately a third of breast cancers.
What is a partial mastectomy?
A partial mastectomy is to remove the tumor and part of the healthy fabric that surrounds it.
What is a total mastectomy?
The total mastectomy, or simple consists in removing all the breast and the fabric that covers the muscles of the chest (fascia pectoral).
Who should make a preventive mastectomy?
Preventive mastectomy can be done when there is a high risk of developing breast cancer. These are women carrying a strong genetic predisposition on the BRCA 1 and BRCA 2. genes. Their probability of declaring breast cancer can be 80 %. It is currently estimated that 8% of breast cancers are linked to a genetic anomaly.
In the general population, almost one in 9 women in France has had, or will have breast cancer before the age of 70.
In the general population, almost one in 9 women in France has had, or will have breast cancer before the age of 70. But in the event of the alteration of the BRCA1 gene, 65 % of women will have been treated for breast cancer before the age of 70 and 40 % before 50 years. Even if these figures are high, it means, however, that a woman can be genetically predisposed and never have breast cancer. In prevention, two options are offered to predisposed women: regular surveillance and mastectomy.
The patient is received by the surgeon who will operate it, so that the intervention is explained (preparation, the course and the operating follow -up) and that he can ask all the questions that concern him. “”A consultation is also planned with an anesthesiologist, explains Dr. Françoise Rimareix, head of the breast oncological surgery at Gustave Roussy. The patient is questioned about his medico-surgical history, notably allergic, heart, respiratory, kidney, thrombo-evil as well as the treatments followed. He is also asked about his smoking consumption which has a great impact on complications that can occur after surgery“. A certain number of examinations can be prescribed (electrocardiogram, blood tests). If the patient suffers from dental problems (especially unhealthy teeth), he is invited to consult a dentist before the intervention, if the deadlines allow.
► During the intervention, the lymph nodes in the armpit (axillary region) are taken and then analyzed, to see if the cancer has remained located or if it has spread. Either we just remove the sentinel node which is the first lymph node relay which can be reached by cancer or it is made an axillary cleaning where one removes between 10 and 20 lymph nodes.
► Depending on the case, mastectomy should be followed by chemotherapy or radiotherapy. The mastectomy is practiced under general anesthesia, by a Senologist surgeon. It requires a few days of hospitalization. During the operation, the surgeon removes the whole mammary gland. The amount of skin has removed depends on the type of cancer.
“Immediate reconstruction is compulsory when keeping the areola and the nipple”
► With immediate reconstruction. In some cases, the areola and the nipple are left in place and it is practiced at the same time an immediate reconstruction of the breast by implant. “”This immediate reconstruction is compulsory when keeping the areola and the nipple. It can be done even if treatments such as chemotherapy or radiotherapy are providedrecalls the doctor. These surgeries are carried out in expert centers after decision in a multidisciplinary consultation meeting and in concerted choice with the patient“.
Is the mastectomy painful?
The anesthesiologist performs loco-regional anesthesia by a nervous block before or during general anesthesia, this makes it possible to considerably decrease analgesic drugs in post-operatively which are systematically prescribed and adapted to the intensity of the pain. Pain of neurological origin at the level of the chest wall and at the level of the hollow of the armpit may persist in the event of associated lymph node cleaning. “It is necessary to make a rehabilitation of the arm the day after the surgery, continues the specialist. An edema of the arm called lymphedema can appear in 10% of cases in the event of axillary cleaning and then requires a long short care“.
Breast reconstruction
Any woman, whatever her age or the degree of progress of her breast cancer can, if she wishes, be a candidate for a reconstruction subject to her general health state and in particular her risk factors for complications after surgery (smoking, significant overweight).
“”Different types of reconstruction are possible: installation of silicone prostheses under the muscle or under the skin, installation of shreds of skin with fat with or without muscle taken on the belly (diep) or in the back (large dorsal) or on another part of the body (thigh, buttock)details Dr. Rimareix. There is also the lipofilling or lipomodeling technique where we only use the fat of the thighs or belly that is taken by liposuction and which is reinjected to redo all or part of the breast“. The technique is chosen by the surgeon according to the choice of the patient and according to her risk factors for complications. It is chosen a technique where the benefit of reconstruction is always higher than the risk of complications.
Thank you to Dr Françoise Rimareix, head of the breast oncological surgery in Gustave Roussy
