Does a radical mastectomy involve the removal of both breasts?

Radical Mastectomy Does Not Typically Involve Both Breasts

No, a radical mastectomy does not typically involve the removal of both breasts unless specifically planned as a bilateral procedure. A radical mastectomy refers to a specific surgical technique performed on a single breast, not automatically both breasts 1.

Understanding Mastectomy Types

Mastectomy techniques have evolved significantly over time:

• Radical mastectomy: An older, more extensive procedure that involves removal of the entire breast, pectoral muscles, and axillary lymph nodes
• Modified radical mastectomy: The current standard approach that preserves the pectoralis major muscle while removing the breast tissue and axillary lymph nodes 1, 2
• Total mastectomy: Removes all breast tissue but preserves pectoral muscles and may not include axillary node dissection

Each of these procedures is typically performed on a single breast affected by cancer, not both breasts simultaneously, unless there are specific indications for bilateral surgery.

When Bilateral Mastectomy Is Performed

Bilateral mastectomy (removal of both breasts) is performed in specific circumstances:

• Risk-reducing surgery: For high-risk patients such as BRCA1/2 mutation carriers or those with previous chest wall radiation for lymphoma 1
• Prophylactic approach: For women at very high lifetime risk of developing breast cancer 1
• Patient preference: Some patients with unilateral breast cancer opt for contralateral prophylactic mastectomy 1

Effectiveness of Risk-Reducing Bilateral Mastectomy

For BRCA1/2 mutation carriers, bilateral mastectomy reduces:

• Subsequent breast cancer incidence by 90-95% 1
• Breast cancer-related mortality by 90-95% 1

Important Considerations for Bilateral Procedures

When bilateral mastectomy is planned:

• Preoperative evaluation: Clinical breast examination and bilateral mammogram within 6 months 1
• Complete tissue removal: Bilateral mastectomy for risk reduction should involve removal of all breast tissue (total mastectomy) 1
• Axillary assessment: Limited utility during risk-reducing mastectomy unless breast cancer is identified in the specimen 1
• Reconstruction options: Can be performed with or without immediate breast reconstruction 1

Follow-up After Bilateral Mastectomy

• Women with BRCA1/2 mutations should follow specific high-risk surveillance protocols 1
• For other women, routine health maintenance is appropriate after bilateral risk-reducing mastectomy 1
• Annual examinations of the chest/reconstructed breast area should continue due to small residual risk 1
• Mammograms are not recommended for the reconstructed breasts 1

Common Pitfalls and Caveats

• Patients should understand that early-stage breast cancer may have better outcomes with breast conservation therapy compared to mastectomy in some cases 1
• Careful genetic assessment and psychological counseling are mandatory before undertaking risk-reducing bilateral mastectomy 1
• Despite complete mastectomy, a small risk of developing breast cancer remains due to potential residual breast tissue 1
• Post-surgical complications like hematoma, infection, and seroma formation should be discussed with patients 3

Remember that the decision for bilateral mastectomy requires thorough multidisciplinary consultation and should be based on individual risk factors, genetic testing results, and patient preferences after comprehensive counseling.