Mastectomy (cont.)

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Medical Author:

Leigh A Neumayer, MD, MS, FACS

Medical Editor:

Melissa Conrad Stöppler, MD, Chief Medical Editor

Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

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Multimedia

Media file 1: Anatomy of the breast.

Media type: Illustration

Media file 2: Types of mastectomy.

Media type: Illustration

Media file 3: The blue highlighted area indicates breast tissue removed during total (simple) mastectomy.

Media type: Illustration

Media file 4: The blue highlighted area indicates breast and lymphatic tissue removed during modified radical mastectomy.

Media type: Illustration

Media file 5: The blue highlighted area indicates breast and lymphatic tissue and the red highlighted area indicates muscle removed during radical mastectomy.

Media type: Illustration

Media file 6: A 62-year-old woman presents with an infiltrating lobular carcinoma of the right breast (T1N0). These photos represent her appearance after a lumpectomy and staging sentinel lymph node procedure. Her lumpectomy was performed through an incision at the juncture of the areola and steri-strips are still in place. Her lymph node biopsy was completed through a separate small incision in her axilla. Once her tumor size and lymph node status were defined, she was provided information regarding her need for chemotherapy and irradiation therapy before proceeding with complete mastectomy. Additionally, the woman was referred to a plastic surgeon in order to provide her with an opportunity to explore her options for breast reconstruction.

Media type: Photo

Media file 7: Postoperative appearance of the woman from Multimedia File 6 after bilateral completion mastectomies without any form of immediate reconstruction. A tradition linear incision was performed at which time all of the breast tissue, the overlying skin, the nipple, and the areola were removed. Care was taken to excise excess soft tissue under her arms to avoid a contour irregularity in her clothing and to facilitate the fitting of an external prosthesis. The choice for a left prophylactic mastectomy was made by the woman with support of her surgical oncologist given a strong family history of breast cancer. She elected not to proceed with any form of immediate breast reconstruction as a personal decision after she had completed an evaluation with a plastic surgeon. She was informed that should she change her mind regarding reconstruction, it could be performed at a later date after the completion of her adjuvant therapy.

Media type: Photo

Media file 8: A 54-year-old woman with a history of previous bilateral silicone breast implant placement for elective breast augmentation presents with a right-sided infiltrating ductal carcinoma (T1NO) diagnosed by core biopsy. These photos represent her preoperative appearance prior to mastectomy and immediate reconstruction.

Media type: Photo

Media file 9: The woman in Multimedia File 8, two years postoperative s/p right skin-sparing mastectomy with immediate right breast reconstruction using a contralateral, rotational transverse rectus abdominus myocutaneous (TRAM) flap with staged nipple reconstruction, areolar tattoo, and delayed lower body lift. These photos represent her appearance two years after the initial treatment of her cancer and immediate staged autologous reconstruction. Her right silicone breast implant was removed at the time of the mastectomy with the reconstruction having been made entirely of her adipose tissue from her abdominal donor site. Her left breast implant was not removed. The lower abdominal incision is longer than that which is typically required for a TRAM flap given her additional lower body lift.