Mastectomie

Mastectomie, or mastectomy, is the surgical removal of all or part of the breast tissue. It is most commonly performed to treat breast cancer or to reduce cancer risk in people with a high genetic or familial risk. Depending on the extent of tissue removed and whether nearby muscles or lymph nodes are involved, several surgical approaches exist.

Common types include simple (total) mastectomy, which removes all breast tissue including the nipple-areola complex; modified radical mastectomy, which removes breast tissue and axillary lymph nodes while preserving the chest muscles; and skin-sparing or nipple-sparing mastectomies, which preserve more of the skin or the nipple-areola complex to aid reconstruction. Radical mastectomy, historically used, is now rarely performed. Prophylactic mastectomy may be chosen to lower cancer risk in high-risk individuals such as BRCA mutation carriers.

Reconstruction may be done at the same time as the mastectomy (immediate reconstruction) or later (delayed reconstruction). Options include implants and autologous tissue techniques (such as DIEP or TRAM flap, or latissimus dorsi flap).

Lymph node assessment is common, often with sentinel lymph node biopsy; axillary dissection may be performed if nodes are involved. Postoperative radiotherapy may be recommended in certain high-risk cases after mastectomy.

Risks include infection, bleeding, seroma, numbness, changes in breast shape, lymphedema, and complications related to reconstruction. Outcomes depend on cancer stage and biology, as well as reconstruction choices and patient preferences.