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Mastectomy is the surgical removal of the breast for the treatment or prevention of breast cancer.
Mastectomy is performed as a surgical treatment for breast cancer. The severity of a breast cancer is evaluated according to a complex system called staging. This takes into account the size of the tumor and whether it has spread to the lymph nodes, adjacent tissues, and/or distant parts of the body. A mastectomy is usually the recommended surgery for more advanced breast cancers. Women with earlier stage breast cancers, who might also have breast-conserving surgery (lumpectomy), may choose to have a mastectomy. In the United States, approximately 50, 000 women a year undergo mastectomy.
The size, location, and type of tumor are important considerations when choosing the best surgery to treat breast cancer. The size of the breast is also an important factor. A woman's psychological concerns and lifestyle choices should also be considered when making a decision.
There are many factors that make a mastectomy the treatment of choice for a patient. Large tumors are difficult to remove with good cosmetic results. This is especially true if the woman has small breasts. Sometimes multiple areas of cancer are found in one breast, making removal of the whole breast necessary. The surgeon is sometimes unable to remove the tumor with a sufficient amount, or margin, of normal tissue surrounding it. In this situation, the entire breast needs to be removed. Recurrence of breast cancer after a lumpectomy is another indication for mastectomy.
Radiation therapy is almost always recommended following a lumpectomy. If a woman is unable to have radiation, a mastectomy is the treatment of choice. Pregnant women cannot have radiation therapy for fear of harming the fetus. A woman with certain collagen vascular diseases, such as systemic lupus erythematosus or scleroderma, would experience unacceptable scarring and damage to her connective tissue from radiation exposure. Any woman who has had therapeutic radiation to the chest area for other reasons cannot tolerate additional exposure for breast cancer therapy.
The need for radiation therapy after breast-conserving surgery may make mastectomy more appealing for nonmedical reasons. Some women fear radiation and choose the more extensive surgery so radiation treatment will not be required. The commitment of time, usually five days a week for six weeks, may not be acceptable for other women. This may be due to financial, personal, or job-related factors. In geographically isolated areas, a course of radiation therapy may require lengthy travel and perhaps unacceptable amounts of time away from family or other responsibilities.
Some women choose mastectomy because they strongly fear recurrence of the breast cancer, and lumpectomy seems too risky. Keeping a breast that has contained cancer may feel uncomfortable for some patients. They prefer mastectomy, so the entire breast will be removed.
The issue of prophylactic mastectomy, or removal of the breast to prevent future breast cancer, is controversial. Women with a strong family history of breast cancer and/or who test positive for a known cancer-causing gene may choose to have both breasts removed. Patients who have had certain types of breast cancers that are more likely to recur may elect to have the unaffected breast removed. Although there is some evidence that this procedure can decrease the chances of developing breast cancer, it is not a guarantee. It is not possible to be certain that all breast tissue has been removed. There have been cases where breast cancers have occurred after both breasts have been removed. However, a 1999 survey of over 500 women found that 70% of women who chose prophylactic mastectomy were satisfied with the procedure.
Author Info: Ellen S. Weber, The Gale Group Inc., Gale, Detroit, Gale Encyclopedia of Cancer, 2002
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