Mastectomy

A third of localised breast tumours are unsuitable for treatment by breast conservation. A number of procedures may be performed:

• simple mastectomy:
  • removal of breast, nipple, areola and skin. Nodes may be removed separately. Chest wall muscles left intact
  • enables later reconstruction
    
    
• modified radical mastectomy (Patey's operation):
  • removal of breast, nipple, areola, skin and level I and II axillary nodes plus pectoralis minor; pectoralis major muscle is preserved

Mutilating operations now rarely performed:

• Halsted radical mastectomy - removal of breast, nipple, areola, major and minor pectoralis muscles, axillary nodes
  
  
• Urban extended radical mastectomy - as above plus removal of internal mammary nodes, medial costal cartilages and part of sternum

The last two procedures are used only in advanced disease where their associated morbidity is less than that from radiotherapy.