Mastectomy is the surgical removal of the breast; this is usually done to treat breast cancer which is one of the leading causes of death in women. Breast cancer usually begins with a lump in the breast, and in early stages treatment has a good chance of success.

Biopsy: If a lump or other sign of breast cancer is detected, the first step is to perform a biopsy to obtain a sample of the suspicious breast-lump tissue. The tissue is then examined under a microscope to determine whether the lump is benign or cancerous. A biopsy is required when doubt exists regarding the nature of a persistent lump, nipple discharge, certain types of breast rashes, and skin or nipple retraction. Sometimes a biopsy may be advised if there are any abnormalities seen on breast X-rays, even though a lump is not felt.

Two types of Biopsy procedure:

• One-step procedure - a tissue sample is taken and examined under the microscope while the patient remains under anesthesia. If cancer cells are found, a mastectomy is performed immediately; if not, the incision is closed. The patient does not know until she awakens whether her breast has been removed.
• Two-step procedure - this procedure removes the source of anxiety by scheduling the biopsy and the mastectomy, if needed, as two separate operations.

For a long time no matter what stage of breast cancer you had, a procedure called a radical mastectomy was the only option for women with breast cancer. Things have changed greatly since then; mastectomy no longer has to be as extensive and disfiguring. After years of research it has shown that more extensive surgery is not necessarily better. There are several types of mastectomy, the size and type of tumor, cancer stage, lymph node involvement, age and overall health condition of the patient are factors that are commonly considered to determine which procedure is most appropriate.

Basic Types of Mastectomy:

• Standard radical mastectomy, also called Halstead mastectomy - in this operation the breast, the underlying chest-wall muscles, and the lymph nodes of the armpit are removed. It is a time tested method that yields a good chance of success, but it results in chest-wall deformity and possible limitation of shoulder and arm motion, and may cause swelling of the arm and hand. Although it was common in the past, radical mastectomy is rarely performed nowadays because modified radical mastectomy has proven to be just as effective and less disfiguring. Today radical mastectomy is recommended only in cases where a large tumor extends into the muscles of the chest wall.
• Modified radical mastectomy - this is one of the most common surgical procedures performed for breast cancer, this procedure the breast and axillary lymph nodes are removed, but the chest-wall muscles are left intact. There is little deformity of the chest wall, and swelling of the arm and hand is rare. The cure rate is equal to that of the standard radical operation.

• Simple or Total mastectomy - thisprocedure removes the entire breast but leaves both the axillary lymph nodes (nodes in the underarm area, also called the axilla)and the chest-wall muscle undisturbed. Less disfiguring than the modified radical procedure, it has a lower cure rate than either of the two preceding operations, but it is often preferred for certain types of tumors and for elderly patients. A total mastectomy is appropriate for women with ductal carcinoma in situ or DCIS, and for women seeking breast removal in order to prevent any possibility of breast cancer occurring.

• Partial mastectomy also called lumpectomy - this procedure only the lump and surrounding suspicious tissue are removed, usually followed by radiation therapy to destroy any remaining cancer cells. A partial mastectomy leaves most of the breast intact, but its ten-year cure rate is less than that of more extensive operations, and some deformity of skin or breast may be caused by the radiation treatments. Partial mastectomies are now used chiefly for elderly patients, for patients who have a poor chance of survival in any case, and for patients who are willing to assume responsibility for any increased risk of recurrence of the cancer. This surgery is usually performed for Stage 1 and 2 tumors.

• Skin-sparing mastectomy - is another option to some patients, which is a relatively new surgical technique. In this procedure, the surgeon makes a much smaller incision, sometimes called a "keyhole" incision, circling the areola. Even though the opening is smaller, the same amount of breast tissue is removed. Scarring is negligible and 90% of the skin is preserved. Reconstruction is performed at the same time as the procedure by a plastic surgeon, using tissue from the patient's abdomen or latissimus dorsi (a muscle in the back).

Artificial Breasts and Breast Reconstruction: To minimize the disfigurement resulting from a mastectomy, most women prefer to wear an artificial breast. This is a breast-shaped prosthesis usually made of silicone plastic, which can be worn inside the brassiere. For women who don't want to wear artificial breast, the breast may be restored to a remarkable degree by plastic surgery.