التعريف والنظرة العامة
A radical mastectomy is the surgical process of removing the entire breast as treatment for breast cancer or large-sized tumours. It also involves the removal of the underlying chest muscles as well as the lymph nodes of the axilla or the armpit.
Up until the mid-1970s, this procedure was commonly performed on women suspected of having a malignant lump of tissues in their breasts. Removing the entire breasts and its associated parts are said to help prevent the spread of cancer to other parts of the body. However, due to the advent of newer surgical techniques and increasing awareness on the nature of this particular disease, radical mastectomy is offered only in extreme cases. This procedure is also known as the Halsted radical mastectomy, named after William Stewart Halsted, the surgeon who performed it for the first time in the United States and advocated its efficacy.
من يجب أن يخضع للنتائج المتوقعة
A radical mastectomy can be recommended for patients diagnosed with:
- Advanced stages of carcinoma or cancer of the breast – This procedure is especially indicated if cancer cells have spread beyond the breast tissue and has affected the underlying chest wall. Because the disease is not contained or localised in just one part of the breast, patients do not qualify for skin-sparing or tissue-sparing surgical procedures.
- Tumours that are more than 5cm in diametre and are located deep within the breast and adjacent to the chest wall.
- Tumours that are less than 5cm in diametre but are located in the outer parts of the breast, with indications of spreading to nearby lymph nodes.
A radical mastectomy is considered a major surgical procedure and is performed in a hospital setting. Patients would need to rest for several weeks after the surgery. The affected arm is placed on a sling to minimise movement and reduce the chances of reopening the wound. Patients are also advised to participate in a physical rehabilitation programme to encourage healing and avoid muscle atrophy. Since the procedure grossly alters the chest anatomy, patients are also encouraged to attend support groups or seek professional help to address ensuing psychological and mental ضغط عصبى.
A radical mastectomy has a high success rate in removing identified diseased cells. As in any type of cancer, the survival rate of patients also depends on the stage of cancer when the procedure was performed. Patients may also need to undergo adjuvant cancer treatments like chemotherapy or radiation therapy following this procedure to increase their chances of being cancer-free.
كيف يتم إجراء العملية؟
The patient is placed in a supine position with arms outstretched and elevated. General anaesthesia is then administered. The patient’s chest area is cleansed in preparation for the procedure. Using a scalpel, the surgeon then makes an elliptical incision in the breast, cutting around the nipple and areola area. The surgeon then proceeds to evaluate and assess the underlying breast tissue. The breast tissue is then dissected through the pectoralis muscle and the tissue is separated from underlying musculature, the skin, and lymph vessels. The whole breast tissue is then removed and samples are sent to the pathology laboratory for evaluation.
The surgeon then makes an incision into the fascia, separating the pectoralis major and pectoralis minor muscles in the process. Any remaining breast tissue is then removed. The surgeon dissects the pectoralis major muscle and also exposes the pectoralis minor muscle. By removing the attachment of this muscle from its tendons, the axilla is exposed. The lymph nodes and its associated fat tissues are excised and removed. Throughout the process, the nerves and blood vessels are carefully identified and preserved, as much as possible. Blood vessels that need to be cut are ligated or sutured shut. Gauze soaked with sterile saline solution is then placed within the axilla. The surgeon proceeds to remove the pectoral muscles completely. Once all the necessary tissues are completely removed and the surgeon is certain that no bleeding will occur, the surgical site is irrigated with sterile saline solution.
If indicated, a breast reconstruction procedure can be performed after the removal of diseased tissue. A sterile tissue expander is placed in the pocket or space left behind by the procedure. The expander is filled with saline solution to inflate the area and reduce the hollow appearance.
Since the procedure entails the removal of the entire breast, the surgeon may need to cover the surgical site with grafted skin. Typically, the graft is harvested from other parts of the body, like the abdomen or the back, to cover the extensive wound.
The surgeon will then place drain tubes before covering the wound. One tube is placed in the axilla and the other on the chest wall. Sterile dressings are then placed over the surgical site.
المخاطر والمضاعفات المحتملة
As a major surgical procedure requiring general anaesthesia and a huge incision, a radical mastectomy is commonly associated with the following risks and complications:
- Excessive bleeding – This can occur during and after surgery and is a major concern in this procedure.
- Infection at the surgical site
- Nerve damage – Patients often complain of tingling and numbness in the affected part due to possible nerve damage. The loss of sensation could predispose the patient to accidental cuts and burns.
- Muscle weakening and atrophy, especially if patients do not undergo proper علاج بدني after the procedure.
- Seroma- The interruption of fluid flow in the lymph vessels could lead to seroma or the accumulation of fluid at the surgical site.
- Phantom breast pain – Most patients report phantom breast pain, which is akin to what amputees go through when they lose one or more limbs. This condition is characterised by throbbing pain and pressure, with the sensation of the removed breast still being there.
Depression – The procedure has a considerable impact on the mental status of the patient, often causing كآبة. Adding to the mental stress is the disfigurement that results from the procedure, which some patients may have difficulty overcoming.
Christian MC, McCabe MS, Korn EL, Abrams JS, Kaplan RS, Friedman MA. The National Cancer Institute audit of the National Surgical Adjuvant Breast and Bowel Project Protocol B-06. N Engl J Med. 1995 Nov 30. 333(22):1469-74.
Giuliano AE, Hunt KK, Ballman KV, et al. Axillary dissection vs no axillary dissection in women with invasive breast cancer and sentinel node metastasis: a randomized clinical trial. JAMA. 2011 Feb 9. 305(6):569-75.
What is Radical Mastectomy: Overview, Benefits, and Expected Results
A radical mastectomy is a complex, major surgical procedure typically used to treat cancers of the breast. Developed in the late 19th century, this technique is often employed when cancer cells have spread to the chest wall or beyond the breast area. In most cases, a woman undergoing a radical mastectomy will also have her lymph nodes in the armpit removed as part of her treatment.
What is a Radical Mastectomy?
A radical mastectomy is an aggressive surgery in which the entire affected breast is removed, along with a significant amount of surrounding tissue. Additional steps in the mastectomy may include removal of:
- The breast skin
- The underlying chest muscles
- Nipple and areola
- The lymph nodes in the armpit
- Additional pieces of skin or tissue in the affected area
In cases where a large amount of tissue is removed, reconstructive surgery may be necessary to help reduce disfigurement of the chest area.
When is a Radical Mastectomy Used?
A radical mastectomy is typically only considered when Breast Cancer has advanced to a certain point, and other treatment options, such as lumpectomy, are no longer considered as viable solutions.
A doctor may recommend a radical mastectomy or other aggressive treatments in cases where:
- The tumor is large
- There are multiple tumors
- The cancer is in multiple lymph nodes
- The cancer has spread to other parts of the body
A patient who is considering a radical mastectomy should discuss possible side effects and risks of the procedure with her doctor.
Radical Mastectomy Benefits
The primary benefit of a radical mastectomy is that it effectively removes the cancerous cells and tissue from the breast area. This method is effective at preventing the cancer from spreading further and potentially leading to more serious complications. A radical mastectomy is also often considered the most effective method of treatment for certain types of breast cancer.
A radical mastectomy is not a foolproof solution. While it may offer the best chance for successful treatment, it can, in some cases, still lead to a recurrence of cancer cells in the area surrounding the tumor.
On the other hand, a successful radical mastectomy can be very effective in permanently removing a tumor and monitoring for future growth or recurrence. This form of surgery offers the best chance of removing a cancerous tumor and preventing further spread of the cancer.
When it comes to combatting breast cancer, a radical mastectomy is often considered to be a last resort because of the cost and risks associated with the procedure. However, it is still considered to be an effective and scientifically-supported form of treatment for certain types of advanced cancers.
Recovery from a radical mastectomy is often a slow and tedious process. In some cases, it may take several months or longer to return to normal daily activities. Patients may experience pain or discomfort in the area of the surgery, along with swelling, numbness, and scarring. Doctors may prescribe medications to help control pain, as well as physical therapy or other forms of rehabilitation to promote healing.
A radical mastectomy is an aggressive form of surgery to remove cancerous cells and tissue from the breast area. This form of treatment is typically only recommended when other methods, such as lumpectomies, are no longer effective. The procedure comes with risks and side effects, and recovery can be difficult and prolonged. However, it can also be very effective for eliminating cancer and preventing recurrence. It is important for someone considering a radical mastectomy to discuss the potential risks and benefits with their doctor before making any final decisions.