Mastectomy, radical

Radical mastectomy is a surgical procedure involving the removal of breast, underlying chest muscle (including pectoralis major and pectoralis minor), and lymph nodes of the axilla as a treatment for breast cancer. Breast cancer is the most common cancer among women today, and is primarily treated by surgery, particularly during the early twentieth century when the mastectomy was developed with success. However, with the advancement of technology and surgical skills, the extent of mastectomies has been reduced. Less invasive mastectomies are employed today in comparison to those in the past. Nowadays, a combination of radiotherapy and breast conserving mastectomy are employed to optimize treatment.

Halsted and Meyer were the first to achieve successful results with the radical mastectomy, thus ushering in the modern era of surgical treatment for breast cancer. In 1894, William Halsted published his work with radical mastectomy from the 50 cases operated at Johns Hopkins between 1889 and 1894. Willy Meyer also published research on radical mastectomy from his interactions with New York patients in December 1894. The en bloc removal of the breast tissue became known as the Halsted mastectomy before adopting the title "the complete operation" and eventually, "the radical mastectomy" as it is known today.

Radical mastectomy was based on the scientific belief at the time that breast cancer spread locally at first, invading nearby tissue and then spreading to surrounding lymph ducts where the cells were "trapped". It was thought that hematic spread of tumor cells occurred at a much later stage.

Radical mastectomy involves removing all the breast tissue, overlying skin, the pectoralis muscles, and all the axillary lymph nodes. Skin was removed because the disease involved the skin, which was often ulcerated. The pectoralis muscles were removed not only because the chest wall was involved, but also because it was thought that removal of the transpectoral lymphatic pathways were necessary. It was also thought, at that time, that it was anatomically impossible to do a complete axillary dissection without removing the pectoralis muscle.

William Halsted accomplished a three-year recurrence rate of 3% and a locoregional recurrence rate of 20% with no perioperative mortality. The five-year survival rate was 40%, which was twice that of untreated patients. However, post-operation morbidity rates were high as the large wounds were left to heal by granulation, lymphedema was  ubiquitous, and arm movement was highly restricted. Thus, chronic pain became a prevalent sequela. Because surgeons were faced with such large breast cancers that seemed to need drastic treatment methods, the quality of patient life was not taken into consideration.

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Wikipedia