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Types of mastectomy: Preventive, partial and radical

A mastectomy is an operation to remove a breast. When part of a breast is removed, this is called a partial mastectomy. Radical mastectomy describes removing the whole breast.

Preventive mastectomy may be recommended to help prevent breast cancer in women who are at a high genetic risk of developing cancer.

The appropriate type of mastectomy and treatment for breast cancer depends on several key factors including:

  • Age
  • General health
  • Menopause status
  • Tumour size
  • Tumour stage (how far it has spread)
  • Tumour grade (aggressiveness)
  • Tumour hormone receptor status
  • Whether or not lymph nodes are involved

Various types of mastectomy are available today.

What is preventive mastectomy?

Women who have a high genetic or familial risk of breast cancer may choose to have preventive mastectomy surgery. Preventive mastectomy is also called prophylactic mastectomy. It may be a total mastectomy with the removal of the entire breast and nipple. Or it may be a subcutaneous mastectomy, where the breast is removed but the nipple is left intact.

Studies show that the occurrence of breast cancer may be reduced by 90% or more after preventive mastectomy in women with a high risk of this disease. Sometimes, women who have had breast cancer in one breast will decide to have a preventive mastectomy to remove the other breast. This can reduce the chance of the cancer recurring. In some cases both breasts are removed. This is called a double mastectomy.

Breast reconstruction can be done at the time of the preventive mastectomy. When this happens it is called an immediate reconstruction. Breast reconstruction can also be scheduled for a later time. When it is, it is known as delayed reconstruction. During breast reconstruction the surgeon may use synthetic implants or tissue flaps from another part of your body.

What is a partial mastectomy?

Doctors may perform a partial mastectomy on women with stage 1 or stage 2 breast cancer. The partial mastectomy is breast-conserving therapy where the part of the breast containing the tumour is removed. This procedure is then followed by radiotherapy to the remaining breast tissue. With radiotherapy, powerful X-rays target some of the breast tissue. The radiotherapy kills cancer cells and prevents them spreading.

A lumpectomy removes just the tumour and a small cancer-free area of tissue surrounding the tumour. This is also called a wide local excision. If cancer cells are found later, the surgeon may remove more of the tissue. This procedure is called re-excision.

Another type of partial mastectomy is called a quadrantectomy. For this procedure the surgeon removes the tumour and more of the breast tissue than is removed with a lumpectomy.

In some cases more surgery is required after a partial mastectomy. Sometimes, if cancer cells are still in breast tissue, it may be necessary to remove the entire breast.

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