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Simple and radical mastectomy are two types of surgical procedures that can be used to treat breast cancer. In this article, we will explain what these procedures involve, how they differ, and what are their benefits and risks.
**What is simple mastectomy?**
A simple mastectomy¹ is the surgical removal of one or both breasts. The adjacent lymph nodes and chest muscles are left intact. If a few lymph nodes are removed, the procedure is called an extended simple mastectomy.
A simple mastectomy involves removing the breast tissue, nipple, areola, and most of the overlying skin². Unlike a radical mastectomy, it does not involve removal of the underlying muscles and uninvolved lymph nodes (see the images below).
Simple mastectomy may be indicated for:
- Locally advanced breast cancer
- Multifocal breast cancer
- Large tumor relative to the size of the breast, excision of which may compromise cosmesis
- Recurrent breast cancer after previous breast-conserving surgery
- Prophylaxis in high-risk individuals
- Patient preference¹
**What is radical mastectomy?**
A radical mastectomy³ (Halstead mastectomy) is a surgical treatment for breast cancer. It is the most complex type of mastectomy, in which the surgeon removes:
- The entire breast including the skin, nipple, and areola
- All axillary lymph nodes
- Major, minor, and fascia pectoral muscles
A radical mastectomy removes a person’s entire breast, along with the underarm (axillary) lymph nodes and chest wall muscles⁴.
For many decades, radical mastectomy was the “gold standard” in breast cancer treatment. With today’s improved imaging techniques and more treatment options, it is rarely necessary. Studies from the 1970s and 1980s showed that breast-conserving surgery followed by radiation treatment was a valid alternative to radical mastectomy in early-stage breast cancer. Other research found that more extensive surgery did not improve overall survival. In addition, less aggressive procedures are associated with better cosmetic outcomes and fewer serious side effects⁴.
Doctors now only recommend radical mastectomy when a tumor spreads into a person’s chest wall. This is because there are newer surgeries with fewer risks that spare the breast and produce similar outcomes to a radical mastectomy³.
**How do simple and radical mastectomy differ?**
The main difference between simple and radical mastectomy is the extent of tissue removal. Both procedures remove the entire breast, but a radical mastectomy also removes all the underarm lymph nodes and the chest wall muscles. A simple mastectomy leaves these structures intact.
Another difference is the cosmetic outcome. A simple mastectomy preserves more skin and muscle tissue, which can facilitate breast reconstruction if desired. A radical mastectomy results in more scarring and deformity of the chest wall, which can affect arm mobility and self-image.
2. Mastectomy
• Definition : Surgical removal of breast tissue partially or
completely.
• In the past, a radical mastectomy with complete removal
of the breast was the standard treatment for breast cancer.
But surgical breakthroughs over the past decades have given
women more options than ever before. Less invasive breast
conserving treatments are available to many women.
3. When is mastectomy
indicated?
• Women with carcinoma breast
• Men with carcinoma breast.
• Extensive benign disease of breast.
• Prophylactic when there is presence of BRCA mutation.
• No/ minimal response to systemic or radiation therapy
to CA breast
5. Simple Mastectomy
• Removal of the entire breast tissue,
i.e, (tumor + entire breast + areola,
nipple + skin over the breast+ including the
axillary tail is removed )
• No dissection of lymph nodes or removal of
muscle.
• Sometime adjacent lymph nodes are removed
along with the breast tissue.
6. Indication
• Stage 1 and stage 2a carcinoma
• Large cancers that persist after adjuvant therapy.
• Multifocal or multicentric CIS
• Risk reducing mastectomy.
Contraindication
• Locally advanced breast cancer
7. Step 1
Horizontal
elliptical incision
at the site of
tumor in the
breast
Step 2
Retraction of the
intervening
tissue
Step 3
Resection of a
tumor along with
some normal
tissue
Step 4
wound irrigation
with sterile water
& Establishment
of drainage
Step 5
Surgical closure
of the wound by
suture
Simple Mastectomy Steps
8.
9. • Disadvantages of simple mastectomy
high chances of reoccurrence,
lymphatic metastasis and malignancy.
10. Radical Mastectomy
• Most extensive type mastectomy.
• Breast tissue, axillary lymph nodes
and pectoral muscles are removed.
11. Radical Mastectomy
Indication
• Advanced stage of Breast carcinoma
(3a, 3b, 3c)
• Fixation to muscle, skin changes
• Advanced locoregional disease
• Prior therapy with total breast irradiation or multimodality
cytotoxic therapy.
