Modified Radical Mastectomy
This operation is still performed frequently for breast cancer. The success rate of this operation is the "gold standard" by which other operations are measured. When a new operation is tried, we ask "Is it as good as a modified radical mastectomy?"
One of the advantages of mastectomy is that all the breast tissue is removed, so there can be no future regrets that the treatment was not as aggressive as possible. Most mastectomy patients adapt very well to the change in body shape. The scar is usually horizontal (crosswise) and is not visible even with some low cut dresses or bathing suits. The contour of the chest is similar to that of a male but without a nipple. Unless a patient's breast size is unusually large, it is generally a simple matter to be fitted for a pad (breast prosthesis) that will fit in your brassiere and restore normal contour while wearing your clothes.
Breast reconstruction is an option after mastectomy. Breast reconstruction can be done during the same operation as the mastectomy or at any time after the mastectomy is performed. Reconstruction is usually done by a plastic surgeon. There are two basic types of reconstruction: (1) with a prosthetic implant, and (2) with tissue from elsewhere in the body. With either of these types of breast reconstruction nipple reconstruction is also possible.
Reconstruction with a prosthetic implant usually begins with the placement of a tissue expander which is a temporary implant that is slowly inflated with saline over about three months. An injection is made into the implant every week or two to slowly increase its volume. This stretches the remaining skin so that it will accept the permanent implant, and have a more natural shape. Ultimately, a saline (salt water) filled implant will be inserted in place of the tissue expander.
Reconstructive operations using a patient's own tissue are more complex operations but have the advantage that no synthetic materials are used. The most commonly used operation of this type is the TRAM flap. With this operation an oval of skin from the lower abdomen and its attached fat and blood supply is moved and placed over the breast area to form a soft, contoured, mound of normal tissue. This operation gives excellent cosmetic results but does leave scars.