There are various options for surgically removing breast carcinoma these days: radical, modified radical or simple mastectomies, or conservative breast surgery. The latter include quadrantectomy, tumorectomy or segmental mastectomy.
Conservative breast surgery
Nowadays, most breast cancer patients can undergo conservative breast surgery. The ratio of tumour size to overall mammary tissue plays a key role in determining whether conservative surgery is possible.
In order to indicate the area of change in the mammary gland, the breast is roughly divided up into four quadrants. Most malignant tumours are found in the outer, upper quadrants, i.e. between collarbone and armpit. A quad- rant resection removes both the tumour and – to be on the safe side – the tissue in that quadrant. This type of surgery does, however, frequently produce a cosmetic result that is less than ideal. A tumorectomy or segmental mastectomy removes the tumour and surrounding tissue to a “safe” distance of about two centimetres to healthy tissue. This safe distance around the tumour aims to include any cells that might have invaded the surrounding tissue.
As a rule, some lymph nodes are also removed from the armpit during conservative breast surgery to enable exact diagnostics. The operation usually leaves only small, scarcely visible scars. Conservative breast therapy is often followed by radiotherapy.
A radical mastectomy removes the entire mammary gland including the associated pectoral muscles and lymph nodes. The cut stretches from around the shoulder joint down to the abdomen. The chest usually takes on a very concave shape as a result.
This radical approach to breast surgery was very common, especially in the 1970s. Nowadays, modified radical mastectomies remove the entire mammary gland, together with the associated lymph nodes in the armpits. The pectoral muscles are left, or only removed if also tumour-ridden. A simple mastectomy removes the entire gland tissue but leaves the axillary lymph nodes.