The evolution of mastectomy surgical technique: from mutilation to medicine

Abstract

Breast surgeries for cancer and tumors were first described approximately 3,000 years ago, and since that time the standard of management has changed dramatically. From Egyptian papyri to Hippocratic theory, from Galen's dissections to Halsted's radical mastectomy, and from sentinel lymph node mapping to the development of nipple-sparing mastectomies, this review starts at the beginning and highlights breakthroughs and innovation in technique and medicine that have fundamentally changed the way breast cancer is managed. The progression depicted in this review acts as a proxy to the management of other complex diseases. Breast cancer was initially managed with operative extirpation alone, but now requires a multidisciplinary team across various surgical, medical, psychological, and social specialties in order to produce the best outcomes for our patients.

Keywords: Radical mastectomy; breast neoplasms; segmental mastectomy; sentinel lymph node biopsy; subcutaneous mastectomy.

Figure 1

Instruments used by William Fabry to perform mastectomies in the 16th century (6).

Figure 2

The Japanese surgeon, pharmacist, and anesthesiologist Seishu Hanaoka [1760–1835] (10).

Figure 3

The en bloc resection performed by Joseph Pancoast in the 19th century (14).

Figure 4

William S. Halsted [1852–1922], one of the great surgeons of the early 20th century (6).

Figure 5

Illustrations from William S. Halsted depicting the radical mastectomy technique. (A) Halsted mastectomy skin incision with triangular flap of fat; (B) mastectomy specimen prior to final amputation (21).