Radical mastectomy

Surgical procedure for breast cancer

William Stewart Halsted, the surgeon who developed the radical mastectomy

A radical mastectomy is a surgical procedure for the treatment of breast cancer. It involves the removal of the entire breast, the underlying pectoralis major and pectoralis minor muscles, and the axillary lymph nodes. This procedure was once the standard treatment for breast cancer but has largely been replaced by less extensive surgeries.

History

William Stewart Halsted, pioneer of the radical mastectomy

The radical mastectomy was first developed by William Stewart Halsted in the late 19th century. Halsted's approach was based on the belief that breast cancer spread in a predictable manner, first to the lymph nodes and then to other parts of the body. By removing the breast tissue, muscles, and lymph nodes, Halsted aimed to eliminate all potential sites of cancer spread.

Procedure

The radical mastectomy involves several key steps:

• Anesthesia: The patient is placed under general anesthesia.
• Incision: A large incision is made over the breast to allow access to the underlying tissues.
• Removal of Breast Tissue: The entire breast is removed, including the nipple and areola.
• Excision of Muscles: The pectoralis major and minor muscles are excised to ensure complete removal of cancerous tissue.
• Lymph Node Dissection: The axillary lymph nodes are removed to check for cancer spread.
• Closure: The incision is closed with sutures, and drains may be placed to remove excess fluid.

Indications

Radical mastectomy was traditionally indicated for patients with large tumors or those with cancer that had spread to the chest muscles. However, with advancements in medical imaging and understanding of cancer biology, the indications for radical mastectomy have become more limited.

Complications

The radical mastectomy is associated with several potential complications, including:

• Lymphedema: Swelling of the arm due to lymph node removal.
• Reduced Range of Motion: Loss of muscle tissue can lead to decreased shoulder mobility.
• Chronic Pain: Some patients experience long-term pain at the surgical site.
• Cosmetic Concerns: The extensive nature of the surgery can lead to significant changes in body image.

Alternatives

Today, radical mastectomy has largely been replaced by less invasive procedures such as the modified radical mastectomy, which spares the pectoralis major muscle, and breast-conserving surgery (lumpectomy), which removes only the tumor and a small margin of surrounding tissue.

Current Practice

In modern practice, radical mastectomy is rarely performed. It is reserved for cases where the cancer has invaded the chest wall or when other treatments have failed. The focus has shifted towards breast-conserving therapy and adjuvant therapy to improve outcomes and quality of life for patients.

Related pages

• Breast cancer
• Modified radical mastectomy
• Lumpectomy
• Lymphedema

Diagram of the pectoralis major muscle, which is removed during a radical mastectomy