- Women’s reluctance to undergo radiation treatment following lumpectomy or Wide Local Excision (WLE) of the breast due to the higher cost
- Women’s inability to return to the hospital for the daily radiation treatments
- Women have poor health insurance coverage that will not sustain the additional radiotherapy
- Women’s belief that it is better to remove the diseased breast entirely rather than risk the possibility of recurrence.
Why Some Women Need Mastectomy and Others Do NotWhile most breast surgeons prefer to perform lumpectomy in order to preserve the breast, mastectomy becomes the required procedure for the following reasons…
- Tumour is large so that it occupies much of the breast volume
- More than one area of the breast is involved, such as in locally advanced breast cancer
- Diagnosis of inflammatory breast cancer
- Diagnosis of Paget’s disease of the breast
- Presence of contraindications to radiation therapy following a lumpectomy
- High risk of developing breast cancer due to a strong family history
Types of MastectomyThere are five types of mastectomy procedures. The surgeon will determine which procedure is best for the patient based upon a thorough assessment, including the stage of the breast cancer and/or the patient’s decision to have breast reconstruction surgery immediately after the mastectomy.
1. Total Mastectomy or Simple MastectomyThis procedure involves the total removal of the breast, including the nipple, areola, and overlying skin.
2. Radical MastectomyThis was originally the standard surgical procedure for breast cancer. It involves the removal of the breast, nipple, areola, overlying skin, axillary or armpit lymph nodes, and chest muscles. This surgery is now being performed only when biopsy has determined that there is spread of the breast cancer to the chest muscles.
3. Modified Radical MastectomyThis procedure involves the removal of the whole breast, nipple, areola, overlying skin, the lining covering the chest muscles, and some of the axillary lymph nodes (particularly those in Level I and II).
4. Skin-Sparing MastectomyLike the abovementioned mastectomy procedure, this surgery also removes the breast, nipple, and areola. But it saves most of the overlying skin of the breast particularly for the breast reconstruction surgery to be done immediately after this procedure. Special modifications are needed if breasts are very droopy or tumour involves the skin.
5. Nipple-Sparing MastectomyAlso known as “total skin-sparing mastectomy”, this procedure involves removal of breast tissues, including the ducts going to the nipple and areola. The tissue beneath and around the nipple and areola are first checked for cancer by a pathologist. If no breast cancer cells are found in these tissues, the nipple and areola are spared. All patients are advised to seek consultation with their breast surgeon to determine which type of mastectomy is best of their condition.
Currently, Dr Evan is one of a handful of surgeons in Singapore able to offer both the full range of options in breast cancer removal (lumpectomy / breast conservation surgery / oncoplastic breast surgery), and the full gamut of reconstructive options after both breast removal or breast conservation surgery (including use of perforator flap-free tissue transfer). This ensures a truly integrated and comprehensive breast surgery practice.