Editing Mastectomy (section)

==Types==
Currently, there are several surgical approaches to mastectomy, and the type that a person decides to undergo (or whether they will decide instead to have a lumpectomy) depends on factors such as the size, location, and behavior of the tumor (if one is present), whether or not the surgery is prophylactic or preventative, and whether the person intends to undergo reconstructive surgery after the mastectomy.<ref name="Breastcancer 2013">{{cite web |date=May 16, 2013 |title=What Is Mastectomy? |url=http://www.breastcancer.org/treatment/surgery/mastectomy/what_is |access-date=September 13, 2014}}</ref> For trans people undergoing a [[Gender-affirming surgery (female-to-male)|gender-affirming mastectomy]], the type of procedure chosen can also vary depending on the desired results, the scarring (or lack thereof), the recovery process, the person's desire for nipple sensation, and other different factors based both on personal preference and input from medical experts.<ref>{{Cite journal |last1=Top |first1=Hüsamettin |last2=Balta |first2=Serkan |date=2017-04-05 |title=Transsexual Mastectomy: Selection of Appropriate Technique According to Breast Characteristics |journal=Balkan Medical Journal |volume=34 |issue=2 |pages=147–155 |doi=10.4274/balkanmedj.2016.0093 |issn=2146-3131 |pmc=5394296 |pmid=28418342}}</ref>

* Simple mastectomy (or "total mastectomy"):  In this procedure, the entire breast tissue is removed, but axillary contents are undisturbed. Sometimes the "[[sentinel lymph node]]"—that is, the first axillary lymph node that the [[metastasis|metastasizing]] [[cancer]] [[cell (biology)|cell]]s would be expected to drain into—is removed. People who undergo a simple mastectomy can usually leave the hospital after a brief stay. Frequently, a drainage tube is inserted during surgery in their chest and attached to a small suction device to remove subcutaneous fluid. These are usually removed several days after surgery as drainage decrease to less than 20-30 ml per day.{{Citation needed|date=January 2025}} People that are more likely to have the procedure of a simple or total mastectomy are those who have large areas of ductal carcinoma ''[[in situ]]'', who are removing the breast because of the possibility of breast cancer occurring in the future (prophylactic mastectomies), or who have a mastectomy as a [[Gender-affirming surgery (female-to-male)|gender-affirming surgery]]. When this procedure is done on a cancerous breast, it is sometimes also done on the healthy breast to forestall the appearance of cancer there, or as a 'balancing' or 'symmetrizing' surgery resulting in a flat chest.{{Citation needed|date=January 2025}} The choice of this "contra-lateral prophylactic" option has become more typical in recent years in California, most notable in people younger than 40, climbing from just 4 percent to 33 percent from 1998 to 2011.  However, the possible benefits appear to be marginal at best in the absence of genetic indicators, according to a large-scale study published in 2014.<ref name="ContralateralQuestionedAP">{{cite news|url=http://bigstory.ap.org/article/double-mastectomy-doesnt-boost-survival-most|author=Lindsey Tanner|title=Double mastectomy doesn't boost survival for most|publisher=AP|date=September 2, 2014|access-date=September 13, 2014|archive-date=September 14, 2014|archive-url=https://web.archive.org/web/20140914001755/http://bigstory.ap.org/article/double-mastectomy-doesnt-boost-survival-most|url-status=dead}}</ref><ref name="ContralateralQuestioned">{{cite journal |author=Lisa A. Newman|title=Contralateral Prophylactic Mastectomy—Is It a Reasonable Option?|journal=JAMA |volume=312 |issue=9 |pages=895–897 |year=2014 |doi=10.1001/jama.2014.11308|pmid=25182096}}</ref><ref name="ContralateralStudy">{{cite journal |author=Allison W. Kurian with five others|title=Use of and Mortality After Bilateral Mastectomy Compared With Other Surgical Treatments for Breast Cancer in California, 1998-2011|journal=JAMA |volume=312 |issue=9 |pages=902–914 |year=2014 |doi=10.1001/jama.2014.10707 |pmid=25182099|pmc=5747359 }}</ref> For healthy people known to be at high risk for breast cancer, this surgery is sometimes done bilaterally (on both breasts) as a cancer-preventive measure. A systematic review found that women who had both breasts removed in this circumstance were, overall, satisfied with their decision.<ref name=":14" /> They had fewer complications than women who had breast reconstruction but had slightly more complications than women who had one breast removed.<ref name=":14">{{Cite journal |last1=Griffin |first1=Cora |last2=Fairhurst |first2=Katherine |last3=Stables |first3=Imogen |last4=Brunsden |first4=Sam |last5=Potter |first5=Shelley |date=2024-01-01 |title=Outcomes of Women Undergoing Mastectomy for Unilateral Breast Cancer Who Elect to Undergo Contralateral Mastectomy for Symmetry: A Systematic Review |url=https://doi.org/10.1245/s10434-023-14294-6 |journal=Annals of Surgical Oncology |language=en |volume=31 |issue=1 |pages=303–315 |doi=10.1245/s10434-023-14294-6 |issn=1534-4681 |pmc=10695874 |pmid=37749407}}</ref><ref>{{Cite journal |date=29 February 2024 |title=Women with cancer in one breast who opt to have both removed report satisfaction with their decision |url=https://evidence.nihr.ac.uk/alert/women-cancer-one-breast-have-both-breasts-removed-satisfaction-with-decision/ |journal=NIHR Evidence|doi=10.3310/nihrevidence_62228 }}</ref>
* Modified radical mastectomy:  The entire breast tissue is removed along with the axillary contents (fatty tissue and lymph nodes). In contrast to a radical mastectomy, the pectoral muscles are spared.  This type of mastectomy is used for cancer patients to examine the lymph nodes because this helps to identify whether the cancer cells have spread beyond the breasts.<ref name="Breastcancer 2013"/>
* [[Radical mastectomy]] (or "Halsted mastectomy"): First performed in 1882, this procedure involves removing the entire breast, the axillary lymph nodes, and the pectoralis major and minor muscles behind the breast. This procedure is more disfiguring than a modified radical mastectomy and provides no survival benefit for most tumors. This operation is now reserved for tumors involving the pectoralis major muscle or recurrent breast cancer involving the chest wall. It is only recommended for breast cancer that has spread to the chest muscles. Radical mastectomies have been reserved for only those cases because they can be disfiguring and modified radical mastectomies have been proven to be just as effective.<ref name="Breastcancer 2013"/>
* Skin-sparing mastectomy: In this surgery, the breast tissue is removed through a conservative incision made around the [[areola]] (the dark part surrounding the nipple). The increased amount of [[skin]] preserved as compared to traditional mastectomy resections serves to facilitate [[breast reconstruction]] procedures. People with cancers that involve the skin, such as inflammatory cancer, are not candidates for skin-sparing mastectomy. The effectiveness and safety profile of skin-sparing mastectomy procedures have also not been well studied.<ref>{{Cite journal |last1=Mota |first1=Bruna S |last2=Bevilacqua |first2=Jose Luiz B |last3=Barrett |first3=Jessica |last4=Ricci |first4=Marcos Desidério |last5=Munhoz |first5=Alexandre M |last6=Filassi |first6=José Roberto |last7=Baracat |first7=Edmund Chada |last8=Riera |first8=Rachel |date=2023-03-27 |editor-last=Cochrane Breast Cancer Group |title=Skin-sparing mastectomy for the treatment of breast cancer |journal=Cochrane Database of Systematic Reviews |language=en |volume=2023 |issue=3 |pages=CD010993 |doi=10.1002/14651858.CD010993.pub2 |pmc=10042433 |pmid=36972145 }}</ref> In a skin-sparing mastectomy, the skin flap may be [[Perfusion|perfused]] with fluids and [[indocyanine green angiography]] is sometimes suggested to help prevent the skin that has been saved from dying to improve reconstruction if the person wishes to do so.<ref name=":12">{{Cite journal |last1=Pruimboom |first1=Tim |last2=Schols |first2=Rutger M |last3=Van Kuijk |first3=Sander MJ |last4=Van der Hulst |first4=René RWJ |last5=Qiu |first5=Shan S |date=2020-04-22 |editor-last=Cochrane Breast Cancer Group |title=Indocyanine green angiography for preventing postoperative mastectomy skin flap necrosis in immediate breast reconstruction |journal=Cochrane Database of Systematic Reviews |language=en |volume=2020 |issue=4 |pages=CD013280 |doi=10.1002/14651858.CD013280.pub2 |pmc=7175780 |pmid=32320056}}</ref> There is no clear evidence on the effectiveness of this approach.<ref name=":12" />
*[[Nipple-sparing mastectomy]] (or ''subcutaneous mastectomy''): Breast tissue is removed, but the nipple-areola complex is preserved. This procedure was historically done only prophylactically or with mastectomy for the benign disease over the fear of increased cancer development in retained areolar ductal tissue. Recent series suggest that it may be an oncologically sound procedure for tumors not in the subareolar position.<ref name="pmid12832974">{{cite journal  |vauthors=Gerber B, Krause A, Reimer T, etal |title=Skin-sparing mastectomy with conservation of the nipple-areola complex and autologous reconstruction is an oncologically safe procedure |journal=Ann. Surg. |volume=238 |issue=1 |pages=120–7 |year=2003 |pmid=12832974 |doi= 10.1097/01.SLA.0000077922.38307.cd|pmc=1422651}}</ref><ref name="pmid17269590">{{cite journal |vauthors=Mokbel R, Mokbel K |title=Is it safe to preserve the nipple areola complex during skin-sparing mastectomy for breast cancer? |journal=Int J Fertil Female's Med |volume=51 |issue=5 |pages=230–2 |year=2006 |pmid=17269590 }}</ref><ref name="pmid17084333">{{cite journal  |vauthors=Sacchini V, Pinotti JA, Barros AC, etal |title=Nipple-sparing mastectomy for breast cancer and risk reduction: oncologic or technical problem? |journal=J. Am. Coll. Surg. |volume=203 |issue=5 |pages=704–14 |year=2006 |pmid=17084333 |doi=10.1016/j.jamcollsurg.2006.07.015 }}</ref>

* Sensation-preserving mastectomy: This technique aims to preserve or restore sensation to the chest wall and, in some cases, the nipple–areolar complex following mastectomy. It involves identifying and sparing key sensory nerves or reconnecting them using microsurgical nerve grafting. Dr. Anne Peled and Dr. Ziv Peled published one of the first techniques combining nerve preservation with nipple-sparing mastectomy and implant-based reconstruction.<ref name="Peled2019">{{Cite journal |last1=Peled |first1=Anne Warren |last2=Peled |first2=Ziv M. |date=December 2019 |title=Nerve Preservation and Allografting for Sensory Innervation Following Mastectomy and Implant-Based Reconstruction: Early Results |journal=Plastic and Reconstructive Surgery Global Open |volume=7 |issue=12 |pages=e2332 |doi=10.1097/GOX.0000000000002332 |pmid=31942359 |pmc=6952160 |url=https://journals.lww.com/prsgo/fulltext/2019/07000/nerve_preservation_and_allografting_for_sensory.30.aspx}}</ref>

* Extended Radical Mastectomy: Radical mastectomy with intrapleural en bloc resection of internal mammary lymph node by sternal splitting.<ref name=PMID_6887660>{{ cite journal |last1 = Noguchi |first1 = M |last2 = Sakuma |first2 = H |last3 = Matsuba |first3 = A |last4 = Kinoshita |first4 = H |last5 = Miwa |first5 = K |last6 = Miyazaki |first6 = I |title = Radical mastectomy with intrapleural en bloc resection of internal mammary lymph node by sternal splitting. |journal = The Japanese Journal of Surgery |pmid = 6887660 |pages = 6–15 |issue = 1 |volume = 13 |year = 1983 |doi=10.1007/bf02469683|s2cid = 29706323 }}</ref>
* [[Prophylactic mastectomy]]: This procedure is used as a preventive measure against breast cancer. The surgery is aimed to remove all breast tissue that could potentially develop into breast cancer. The surgery is generally considered when a woman has ''BRCA1'' or ''BRCA2'' genetic mutations. The tissue from just beneath the skin to the chest wall and around the borders of the breast needs to be removed from both breasts during this procedure. Because breast cancer develops in the glandular tissue, the milk ducts and milk lobules must be removed also. Because the region is so large-ranging, from the collarbone to the lower rib margin and from the middle of the chest around the side and under the arm, it is very difficult to remove all of the tissue. This genetic mutation is a high-risk factor for the development of breast cancer, family history, or atypical lobular hyperplasia (when irregular cells line the milk lobes.) This type of procedure is said to reduce the risk of breast cancer by 100%. However, other circumstances may affect the outcome. Studies have shown that pre-menopausal women have had a higher survival rate after this procedure had been done.<ref>"Preventive Mastectomy for Breast Cancer." WebMD. WebMD, n.d. Web. 4 August 2014.</ref>
<gallery class="center">
File: Examples of Custom Nipple Prostheses.jpg|Examples of custom [[Nipple prosthesis|nipple prostheses]]
File: Discrene Breast forms.JPG|[[Breast prostheses]] used by some women after mastectomy
File:BreastCancer.jpg|Mastectomy specimen containing a very large cancer of the breast (in this case, an invasive ductal carcinoma)
File: Breast cancer gross appearance.jpg|Typical macroscopic ([[gross examination]]) appearance of the cut surface of a mastectomy specimen containing cancer, in this case, an invasive ductal carcinoma of the breast, pale area at the center
</gallery>

===Before surgery===
Prior to undergoing the mastectomy, it is important to meet with the surgeon to discuss the relevant risks and benefits of receiving the surgery. Depending on the indication for mastectomy, there may be other options to address the clinical condition. One important consideration to discuss with the surgeon is whether breast reconstruction will occur and when this procedure will take place. One option is to have the reconstruction immediately after the mastectomy in the same surgery, whereas other patients opt for a subsequent surgery for reconstruction. This breast reconstruction surgery will be conducted by a plastic surgeon. In addition to the surgeon, a meeting with an anesthesiologist is pertinent in order to review the patient's medical history and determine the plan of anesthesia.{{citation needed|date=October 2022}}

Leading up to the day of the surgery, there are various considerations that patients can be cognizant of to facilitate their recovery following surgery. As with other surgeries that may lead to appreciable blood loss, it is advised not to take aspirin or aspirin-containing products for 10 days before the surgery.<ref name=":0">{{Cite web |title=Mastectomy: Instructions Before Surgery |url=https://www.ucsfhealth.org/Education/Mastectomy%20Instructions%20Before%20Surgery |access-date=2022-09-12 |website=ucsfhealth.org |language=en}}</ref> The reason for this is to prevent the anti-coagulative function of aspirin and other blood thinners that would make it difficult to achieve coagulation during the surgery. In addition, it is important for patients to tell the doctor about any medications, vitamins, or supplements that they are taking because some substances could interfere with the surgery.<ref name=":10">{{Cite web |title=Mastectomy - Mayo Clinic |url=https://www.mayoclinic.org/tests-procedures/mastectomy/about/pac-20394670 |access-date=2022-09-12 |website=www.mayoclinic.org}}</ref> It is also pertinent for patients to not eat or drink 8 to 12 hours before surgery, however, there may be specific pre-operative instructions given by each patient's care team.<ref>{{Cite web |date= |title=Preparing for Surgery |url=https://www.acog.org/en/womens-health/faqs/preparing-for-surgery |access-date=2023-03-10 |website=www.acog.org |language=en}}</ref>

Maintaining fitness and proper nutrition is also an important measure to consider prior to receiving a surgery because it has been shown that postoperative outcomes are improved in patients that exercise and maintain a healthy diet prior to surgery. In addition to nutrition and exercise, it is advised to reduce alcohol consumption and smoking. This concept of pre-rehabilitation is beneficial in mitigating post-operative complications and decreasing length of stay in the hospital.<ref>{{Cite journal |last1=Durrand |first1=James |last2=Singh |first2=Sally J |last3=Danjoux |first3=Gerry |date=November 2019 |title=Prehabilitation |journal=Clinical Medicine |volume=19 |issue=6 |pages=458–464 |doi=10.7861/clinmed.2019-0257 |issn=1470-2118 |pmc=6899232 |pmid=31732585}}</ref> The rationale is that increasing a patient's functional status prior to surgery will allow for a smoother and faster recovery in the postoperative setting.<ref>{{Cite web |title=Getting yourself healthy before surgery: MedlinePlus Medical Encyclopedia |url=https://medlineplus.gov/ency/patientinstructions/000433.htm |access-date=2023-10-18 |website=medlineplus.gov |language=en}}</ref>

Recent research has indicated that mammograms should not be done with any increased frequency than the normal procedure in women undergoing breast surgery, including breast augmentation, [[mastopexy]], and breast reduction.<ref name=":11">{{Citation|author1=American Society of Plastic Surgeons |author1-link=American Society of Plastic Surgeons |date=24 April 2014 |title=Five Things Physicians and Patients Should Question |publisher=American Society of Plastic Surgeons |work=[[Choosing Wisely]]: an initiative of the [[ABIM Foundation]] |url=http://www.choosingwisely.org/doctor-patient-lists/american-society-of-plastic-surgeons/ |access-date=25 July 2014 |url-status=dead |archive-url=https://web.archive.org/web/20140719103909/http://www.choosingwisely.org/doctor-patient-lists/american-society-of-plastic-surgeons/ |archive-date=19 July 2014 }}</ref>

===After surgery===
Prior to leaving the hospital, people who have had a mastectomy will typically be given a prescription for pain medication to ameliorate any pain or discomfort at the surgery site.<ref name=":0" /><ref name=":1">{{Cite web |title=Mastectomy: What to Expect |url=https://www.breastcancer.org/treatment/surgery/mastectomy/what-to-expect#section-after-mastectomy-surgery |access-date=2022-09-12 |website=www.breastcancer.org}}</ref><ref name=":2">{{Cite web |title=What is a Mastectomy? {{!}} American Cancer Society |url=https://www.cancer.org/cancer/breast-cancer/treatment/surgery-for-breast-cancer/mastectomy.html |access-date=2022-09-12 |website=www.cancer.org |language=en}}</ref> Recognizing signs of a surgical site infection including fever, redness, swelling, or pus is important. Any signs of infection should be reported to and assessed by a medical professional. In addition, signs of [[lymphedema]] due if lymph node removal is performed during mastectomy may be detected by the presence of heaviness, tightness, or fullness in the hand, arm, or axillary area region.<ref name=":1" />

Regarding return to activity, it is advised not to engage in strenuous activity or lift objects above 5 pounds for up to six weeks after a mastectomy at the discretion of the physician.<ref name=":1" /> However, it is common for a member of the medical team to provide home exercises designed to maintain arm and shoulder movement and flexibility. Walking is also highly encouraged and allowed immediately after surgery. Most people who undergo a mastectomy can return to work and other regular physical activities in approximately 4 weeks after surgery.<ref>{{Cite web |title=What is a Mastectomy? |url=https://www.cancer.org/cancer/types/breast-cancer/treatment/surgery-for-breast-cancer/mastectomy.html |access-date=2025-02-11 |website=www.cancer.org |language=en}}</ref>

People who have had a mastectomy will usually have a post-operative follow-up visit with their provider 1–2 weeks after surgery.<ref name=":0" /><ref name=":2" /> The time at which a person can start to wear a bra or reconstructive breast varies and is often at the discretion of the physician.<ref name=":2" />

Some people with breast cancer may require additional [[Radiation therapy|radiotherapy]] after their mastectomy procedure with the goal of reducing the risk of the cancer returning to the lymph nodes and the tissue remaining in the wall of the person's chest.<ref name=":4">{{Cite journal |last1=Verma |first1=Rashmi |last2=Chandarana |first2=Mihir |last3=Barrett |first3=Jessica |last4=Anandadas |first4=Carmel |last5=Sundara Rajan |first5=Sreekumar |date=2023-06-16 |editor-last=Cochrane Breast Cancer Group |title=Post-mastectomy radiotherapy for women with early breast cancer and one to three positive lymph nodes |journal=Cochrane Database of Systematic Reviews |language=en |volume=2023 |issue=6 |pages=CD014463 |doi=10.1002/14651858.CD014463.pub2 |pmc=10275354 |pmid=37327075}}</ref> The decision by the medical team for suggesting radiotherapy may differ between individual professionals.<ref name=":4" /> Most teams recommend radiotherapy after a masectomy for people who are at a higher risk of cancer recurrence including those with large breast tumours (5&nbsp;cm and larger) and people with cancer that has spread to multiple [[axillary lymph nodes]] (4 or more).<ref name=":4" /> The necessity and usefulness of radiotherapy on people at slightly lower risk, for example, the cancer has spread to 1-3 axillary lymph nodes, is not as clear.<ref name=":4" />