Approximately 30% of women with breast cancer undergo a mastectomy, which involves the complete removal of the mammary gland. The surgery can involve one or both breasts. In any case, it is a procedure that has a significant psychological impact on women, and for this reason, in most cases, it should be accompanied by breast reconstruction. Because after a mastectomy, if there is no immediate reconstruction, women often feel a sense of defeat despite having overcome the disease. This emotional wound is much deeper than the one left by the scalpel. We discuss mastectomy and, in particular, an innovative reconstructive mastectomy procedure with Prof. Lucio Fortunato, breast surgeon at Paideia International Hospital.
What is conservative mastectomy?
The mastectomy procedure involves the removal of the mammary gland and the external part of the breast. However, in the last 15-20 years, conservative techniques have been developed that allow the preservation of the skin and nipple to enable better reconstruction. In these cases, it is called a conservative mastectomy.
At Paideia International Hospital, there is the possibility of performing an innovative conservative mastectomy. What does it entail?
In most women who undergo mastectomy, it is possible, as mentioned, to preserve the areola and nipple. However, particularly in women with very large, significant breasts, it is necessary to perform a procedure to prepare the vascularization of the areola/nipple complex to make it ‘autonomous’. This is because the nipple is nourished by the mammary gland, which will be removed. This type of preparation allows us to extend the mastectomy to a greater number of women with very satisfactory results.
What are the advantages of this type of surgery?
There are many and very important advantages. By preserving the entire breast envelope and not removing the nipple area, there is enough space to insert the implant, thus allowing the woman to undergo immediate breast reconstruction during the same surgical session as the mastectomy. A single procedure, therefore, with the insertion of a definitive implant – which, in most cases today, we place above the muscle – and the possibility of avoiding the trauma of seeing the body so profoundly mutilated.
In cases where a woman discovers a tumor in one breast that requires a mastectomy, is the removal of the other breast indicated as a preventive measure?
No, preventive bilateral mastectomy is not necessary; however, it is highly requested by women when they receive a diagnosis of breast cancer. Nevertheless, it is important to remember that 40 years ago, Umberto Veronesi demonstrated that the cure for breast cancer was not related to the extent of the surgical intervention. Therefore, even in the presence of unilateral mastectomy, there is no indication to remove the other breast because this not only does not increase the chances of recovery but also involves a series of significant complications.
The situation is different for women who discover they have a genetic predisposition to breast cancer, as in the case of Angelina Jolie, for whom preventive mastectomy can be an option. But even in these cases – truthfully a small percentage of women – it is a decision that must be made on a case-by-case basis.
