Mastectomy Advancements


Radical mastec­tomies are rarely performed. Progress provides hope for what is the most common type of cancer in the U.S.

Battling Genes

⚠️ Use Discretion: Graphic human anatomy.

Cancer is a group of diseases characterized by the uncontrolled growth and spread of abnormal cells. A personal or family history of breast cancer and inherited BRCA1 or BRCA2 genetic mutations increases risk. BRCA1 germ line mutation is associated with unilateral triple-negative breast cancer. The tumor(s) must be removed or growth halted to preserve life.

Many treat­ments are available, including lumpectomy (partial mastec­tomy), mastec­­tomy, chemo­therapy, radia­tion therapy, targeted hormone therapy, and immuno­therapy (FDA approved March 2019).

Modern Breast Cancer Treatment

As a patient, a breast cancer diag­noses can feel depressing, emotionally and physically exhausting, even devastating. Within the past 150 years, mastec­tomies have advanced from solely radical to more common nipple-and-areola-sparing sur­geries. Early treat­ment yields optimum results.

Prior to, and throughout the beginning of the 20th century, the 5-year survival rate of all breast cancer was zero percent, despite surgical interven­tion. Now the average 10-year survival rate for women with inva­sive breast cancer is 83 percent. The average 5-year survival rate is 90 percent with proper treat­ment.

If located only in the breast, the 5-year survival rate of women with breast cancer is 99 percent. Sixty-two percent of cases are diagnosed at this stage. If the cancer has spread to the regional lymph nodes, the 5-year survival rate is 85 percent. When cancer has spread to a distant part of the body (Stage IV metastasis), the 5-year survival rate is 27 percent.

The history of mastec­tomies reaches beyond the past century and a half. Tales of barbaric sur­geries sans anes­thesia and follow-up treatment are not for the faint of heart. By compari­son, even uncommon bilateral mastec­tomies today are civilized.

Apparent progress in treat­ment methods provides hope for what is, according to American Cancer Society, the most common type of cancer in the United States. The following is a synopsis of the excellent compila­tion by Matthew D. Freeman, Jared M. Gopman, and C. Andrew Salzberg.

Evolution of Mastec­tomies

3000 BCE—According to Egyptian documents likely originat­ing between 3000 BCE and 1500 BCE, breast tumors were generally treated with simple cautery and no post-op management.

1500s—German surgeons made major contributions in the field of surgery. Despite detailed tech­niques and case reports, few mastec­tomies were actually being performed during this time due to the lack of skilled surgeons. Patients were also discouraged by excessive disfigure­ment and morbidity associated with the procedure itself.

1700s—In the 18th century, major contributions in lymph node mapping are attributed to Pieter Camper (b. 1722) and Paolo Mascagni (b. 1752). Le Dran’s colleague, Jean Petit (b. 1674), recommended breast, pectoral muscle, and axillary lymph node removal in the management of breast cancer. However, reconstructive capa­bilities were lacking. Performing these proce­dures without antiseptic, the chest wall was often left disfigured with a large gaping wound. As you might imagine, mortality was high.

1800s—In 1804, Japanese surgeon Seishu Hanaoka performed the world’s first procedure under general anesthesia—a mastectomy. This paved the way for more comfortable sur­geries.

William S. Halsted published his work with radical mastec­tomy from the 50 cases operated at Johns Hopkins between 1889 and 1894. He recommended en bloc resection of all suspected tissues including the pectoralis major muscle and lymph nodes of the axilla, which became known as the “Halsted radical mastectomy”—a popular tech­nique that prevailed for 70 years.

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