The most drastic breast cancer operation turned out to save no extra lives
The first radical mastectomy, performed in 1882, stripped away the breast, the armpit lymph nodes and the chest muscles beneath. Later outcome studies found that for most tumours it offers no survival advantage over gentler operations, and today surgeons keep it for a narrow set of cancers that invade the chest wall.
A mastectomy removes one or both breasts, in part or completely. Most are done to treat breast cancer, but some people at high inherited risk, such as carriers of harmful BRCA1 or BRCA2 mutations, choose one as prevention. The main alternative for cancer is a lumpectomy, or wide local excision, which takes out the tumour with a margin of healthy tissue and keeps the rest of the breast.
Choosing between them depends on breast size, how many lesions there are, how aggressive the cancer is, whether radiotherapy is available, and how willing a patient is to accept the higher recurrence rates that follow lumpectomy. Studies comparing mastectomy with lumpectomy plus radiation suggest routine radical surgery does not always prevent distant spread. Full removal can still suit particular groups: people who have already had radiation to that breast, those with two or more tumours too far apart for one incision, pregnant women who would otherwise need radiation, and those whose tumour exceeds 5 cm and barely shrinks with chemotherapy.
Operations now come in grades. A simple or total mastectomy removes breast tissue but leaves the armpit contents alone, sometimes taking only the sentinel lymph node, the first one cancer would reach; patients often go home after a short stay with a drain attached. A modified radical mastectomy also clears the armpit fat and nodes, helping show whether cancer has spread, but spares the chest muscles. The radical form, also called the Halsted operation, is more disfiguring and now reserved for tumours involving the pectoralis major or recurrent disease on the chest wall.
Beyond cancer, mastectomy is used in cosmetic and reconstructive surgery, by intersex men with gynecomastia, and by transgender men and non-binary people as gender-affirming surgery, often called top surgery. Possible after-effects include soreness, scarring, swelling, infection, fluid build-up and phantom breast pain. Shoulder and arm stiffness is common, and UK research found that exercise begun 7 to 10 days after surgery can reduce those problems.
Source: Mastectomy
