What are the NCCN guidelines for radical mastectomy in the treatment of breast cancer?

Updated: Sep 23, 2020
  • Author: Pavani Chalasani, MD, MPH; Chief Editor: John V Kiluk, MD, FACS  more...
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Answer

According to National Comprehensive Cancer Network (NCCN) guidelines, mastectomy with level I/II axillary lymph node dissection is the recommended procedure in patients who respond to neoadjuvant chemotherapy. Other NCCN indications for mastectomy include the following [77] :

  • Prior radiation therapy to the breast or chest wall

  • Radiation therapy contraindicated by pregnancy (except patients in the third trimester who can receive radiation postpartum)

  • Inflammatory breast cancer

  • Diffuse suspicious or malignant-appearing microcalcifications

  • Widespread disease that is multicentric, located in more than one quadrant, and cannot be removed through a single incision with negative margins

  • A positive pathologic margin after repeat re-excision and suboptimal cosmetic outcome

Relative indications for mastectomy include the following:

  • Active connective tissue disease involving skin (eg, scleroderma, lupus)

  • Tumors greater than 5 cm in diameter

  • Focally positive margin

Patients who are younger than 35 years of age or premenopausal with known BRCA1/2 mutations have an increased risk of local recurrence. Prophylactic bilateral mastectomy may be considered for risk reduction.


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