The classical (Halstead) radical mastectomy
The radical mastectomy, devised in the late 19th century by William Halsted, was the most commonly performed operation for breast cancer until the third quarter of the 20th century. As well as removing all of the breast, the surgeon cut away the pectoralis major muscle covering the chest wall. The smaller pectoralis minor muscle was also removed to allow the surgeon easier access to the armpit (axilla) to clear out the lymph nodes and surrounding fat.
Extended radical mastectomies
The belief that ‘more is better’ led radical surgeons to carry out even more extensive operations, in which chains of lymph nodes under the collarbone and the internal mammary nodes under the breastbone were also removed. To get at the internal mammary nodes several ribs were removed and the breastbone was split with a chisel. Not content with that, some surgeons went so far as to remove the arm on the affected side and cut out various glands throughout the body (adrenals, pituitary, ovaries) to suppress the production of hormones that were believed to ‘fuel’ the spread of the tumour.
If a woman survived such operations she was left with a severely mutilated ribcage, which was difficult to conceal under any clothing. If surgery had been carried out on the left side, only a thin layer of skin remained to cover the heart.
Adapted from Lerner BH, The breast cancer wars: hope, fear and the pursuit of a cure in twentieth-century America. New York; Oxford University Press, 2003.
Read more in: Mutilating surgery.