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Risk Reducing Surgery
Mastectomy Overview:
In medicine, mastectomy is the medical term for the surgical removal of one or both breasts, partially or completely. Mastectomy is usually done to treat breast cancer; in some cases, women and some men believed to be at high risk of breast cancer have the operation prophylactically, that is, to prevent cancer rather than treat it. It is also the medical procedure carried out to remove breast cancer tissue in males. Alternatively, certain patients can choose to have a wide local excision, also known as a lumpectomy, an operation in which a small volume of breast tissue containing the tumor and some surrounding healthy tissue is removed to conserve the breast. Both mastectomy and lumpectomy are what are referred to as "local therapies" for breast cancer, targeting the area of the tumor, as opposed to systemic therapies such as chemotherapy, hormonal therapy, or immunotherapy.
Traditionally, in the case of breast cancer, the whole breast was removed. Currently the decision to do the mastectomy is based on various factors including breast size, number of lesions, biologic aggressiveness of a breast cancer, the availability of adjuvant radiation, and the willingness of the patient to accept higher rates of tumor recurrences after lumpectomy and radiation. Outcome studies comparing mastectomy to lumpectomy with radiation have suggested that routine radical mastectomy surgeries will not always prevent later distant secondary tumors arising from micro-metastases prior to discovery, diagnosis, and operation.
Preventive Mastectomy Overview:
Women considering preventive mastectomy information
Preventive mastectomy involves the removal of breast tissue before a breast cancer has occurred in an effort to prevent breast cancer. In a very small percentage of women who undergo this surgery, breast cancer is found at the time of surgery or when the tissue is sent to pathology. When deciding whether preventive mastectomy is right for you, it is important to know what’s involved. Talking to a breast surgeon and plastic surgeon about your particular situation is the best way of finding out what the surgery may involve and what it means for you.
Talking to these surgeons does not mean you have to go ahead with the surgery. Before finding out more about preventive mastectomy, you may find it helpful to review the anatomy of the breast.
Usually organs in the body such as the kidneys and heart are contained in a ‘capsule’ that separates the organ tissue from the rest of the body. This is not the case with the breast. Breast tissue blends into surrounding body tissue, which makes it difficult to distinguish between where the breast ends and the surrounding tissue begins. This is particularly true in the lower part of the breast and in the part of the breast that extends into the armpit (called the axillary tail). It is possible to remove nearly all the breast tissue in most postmenopausal women, because they tend to have a moderate amount of fat between their skin and breast tissue. It is more difficult however, to remove all the breast tissue in younger women where there may not be as much fat between the skin and the breast tissue.
Surgeons use different approaches when performing preventive mastectomy. The amount of breast tissue that is left behind will vary according to the approach.
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