What is mastectomy?
Mastectomy is surgery to remove the affected breast.
A large amount of mastectomies is carried out for treatment of breast cancer in women, although men can develop breast cancer, a mastectomy is also performed. In some cases, in order to remove the affected area another surgical method may be used. Patients with extensive breast cancer may require a bilateral mastectomy, which involves the removal of some or all tissues in both breasts. Mastectomy greatly reduces, but does not eliminate the risk of breast cancer.
You may have a higher risk of developing breast cancer, if one or more family members had breast cancer, especially at young age. Genetic tests can also show that you have a high risk. This operation should be done only after analysis and discussion with your doctor, genetic counselor, family members, and others.
Some men with the disease when breast tissue grows out of control, known as gynecomastia, are recommended a mastectomy for cosmetic purposes.
When is a mastectomy performed?
Breast cancer is the most common reason for a mastectomy.
The surgeon performing an operation and the plastic surgeon performing breast reconstruction should decide what type of mastectomy to choose. Some methods can’t be used, depending on the location and severity of the cancer. The emotional needs of the patient are considered, too.
You and your doctor should pay attention to the following issues:
– The size of the tumor, where it is located, you may have another tumor in your breast, the extent of the affected breast, the size of the breasts.
– Your age, family medical history, general condition of health, whether or not you are menopausal.
– Breast reconstruction is required or not. You should decide whether to have breast reconstruction before a mastectomy. Reconstruction can be carried out immediately or later after a mastectomy.
Different types of mastectomy
Subcutaneous (“nipple-sparing”) mastectomy is surgery where only the affected breast tissue is removed, but the nipple and areola are left. The incision to remove the breast tissue can be made in the crease under the breast, where it can be completely invisible, or the incision may be made around the areola.
Simple mastectomy, also known as total mastectomy, is surgery where the entire breast is removed. The most common form of surgery, called traditionally total mastectomy, involves the removal of the nipple and areola. Nevertheless, the operation can be performed with the conservation of the skin and nipple. It also leaves muscles under the breast unchanged. The main condition for the conservation of the nipple, areola, and skin is the following: the affected area should be at least two centimeters from tissue that must be conserved.
Radical mastectomy is not common. Although this operation was common in the past, it is now performed only in patients who have a common breast cancer that has spread to the wall muscle under the breast tissue. Like other types of mastectomy, the surgeon removes the entire affected breast tissue, but he also removes all the lymph nodes in the armpit area and muscles that are located under the breasts. Only the skin is left in order to close the incision. This procedure is not appropriate for people whose cancer has not invaded the muscle. This operation is the most disfiguring procedure, a small amount of tissue and the skin just above the breastbone are left. The scar left after this operation is from 15 to 20 cm.
Modified radical mastectomy
Modified radical mastectomy is a type of mastectomy, which combines the removal of all breast tissue of the affected area with the removal of lymph nodes from the armpit on the affected side of the body. This operation usually involves the removal of the nipple and areola, but the operation may be performed with the conservation of the skin and nipple. This method conserves the skin of the breast, but the nipple and areola are usually removed. The breast tissue is removed through an incision. It is required to make an additional incision for women with large breasts to remove all breast tissue, but a big amount of the skin is left after surgery. The incision to remove the breast tissue can be made around the areola conserving both the nipple and areola. This procedure can lead to a larger incision than traditional procedure requires, especially if the breast is large.
Partial mastectomy is breast-conserving surgery, where only a part of the affected breast and a small amount of tissue are removed.
Double mastectomy, also known as prophylactic mastectomy, is surgery to remove both breasts as a way to reduce the risk of developing breast cancer.
Before mastectomy surgery
As a rule, you have to go through a preliminary examination, including blood tests, CT scans, bone scans and chest X-rays, which would define the precise location of the tumor. Your doctor should know whether cancer has spread to the lymph nodes, liver, lungs, bones, or somewhere else.
You should inform your doctor or nurse if you are pregnant or if you are taking any medications or herbs on your own initiatives or other doctors prescribed.
Before surgery you may be asked to stop taking aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve, Naprosyn), vitamin E, and any other drugs that interfere with blood clotting.
Ask your doctor what drugs you should still take on the day of surgery. On the day of the operation, you should follow the instructions received from your doctor or nurse about eating or drinking before mastectomy surgery. Your doctor or nurse will tell you when to go to the hospital.
During mastectomy surgery: How does it work?
General anesthesia is made, you sleep during surgery, so this procedure is completely painless for you. Mastectomy surgery usually lasts 2 – 3 hours, though it can require more time if the surgeon removes lymph nodes or reconstructive surgery is performed immediately after a mastectomy.
Most mastectomy incisions are in the shape of an oval around the nipple, running across the width of the breast. If you are having a skin-sparing mastectomy, the incision will be smaller, including only the nipple, areola, and the original biopsy scar.
After the incision is made, the breast tissue is separated from the overlying skin and from the chest wall muscle underneath. All of the breast tissue — which lies between the collarbone and ribs, from the side of the body to the breastbone in the center — is removed. If you are having a radical mastectomy, some of your chest muscle may be removed as well. Your breast surgeon will also perform axillary lymph node dissection if it is part of your surgery plan.
After your breast surgeon has removed your breast tissue, if immediate breast reconstruction is part of your plan, your plastic surgeon will perform the reconstruction.
In the final stages of the surgery, your breast surgeon will check the surgery areas for bleeding and insert surgical drains. Drains are long tubes that are inserted into your breast area or armpit to collect excess fluid that can accumulate in the space where the tumor was. The tubes have plastic bulbs on the ends to create suction, which helps the fluid to exit your body. After the drains are inserted, your surgeon will stitch the incision closed. The surgery site will then be covered by a bandage that wraps closely around your chest.
After surgery, the patient is moved to the recovery room, where for 34 – 48 hours after surgery the medical staff monitors condition in order to get rid of potential problems.
– Blood clots in the legs, which can spread to lungs;
– Blood loss;
– Breathing problems;
– Infections in the surgical area, pneumonia, infections of the bladder or kidney;
– Heart attack or stroke during surgery;
– Allergic reactions to medications;
– Inflammation of the skin;
– The risks of more invasive surgery, such as radical mastectomy: pain and stiff shoulder. You may also feel tingling in the chest area and under the arm;
– Swelling of the arm (called lymphedema) on the same side of the breast where the operation was performed;
– Nerve damage in the arms, back and chest.
After mastectomy surgery
Depending on the type of mastectomy surgery you can stay in the hospital for 1 – 3 days. If you have a simple mastectomy you are likely to go home on the same day. Most women go home after 1 – 2 days. Hospitalization can last longer if you have breast reconstruction.
Many women go home with a surgical drain in their breasts. The doctor will remove it later. The nurse will teach you how to care for a surgical drain.
During recovery the first 2 – 3 days will be the most painful, but the pain will subside quickly after that. It is best to avoid any kind of activity that involves running and jumping movements during recovery. It is not recommended to raise your hands above you head and lift heavy things. You may be prescribed painkillers. In addition to surgery, most patients have to undergo radiotherapy, chemotherapy or a combination of both. The treatment option is based on the severity of cancer, the patient’s wishes and the conclusion of the oncologist.
Fluid may accumulate in a surgical area after the removal of a surgical drain. It is called a seroma. It usually goes away on its own, but sometimes it is necessary to remove fluid via a needle (aspiration).
Depression after the diagnosis of breast cancer is a real problem for many patients. Depression can influence on the process of recovery after surgery or take part in decision-making. It can also enhance fatigue that patients experience after surgery as well as after chemotherapy and radiation. It is easy to confuse the symptoms of a normal recovery after surgery, so it’s important to be aware of the symptoms of depression. It is time consuming to learn how to cope with the loss of your breast. Talking with other women who had a mastectomy can help you cope with these feelings. Ask your doctor or nurse about local support groups.
If there will be no complications, you will be able to return to your usual activities after 6 – 8 weeks. Plus it will be possible to return to your sexual life after mastectomy surgery.
Patients who didn’t want breast reconstruction, prosthetics is required to fill the space where the breast was. Also there are many products available after mastectomy, including bras, breast prostheses and swimsuits.
Most women feel much better after mastectomy. In addition to surgery other methods of treatment for breast cancer are required. These procedures may include hormone therapy, radiation therapy and chemotherapy. They all have their own side effects. You should discuss it with your doctor.
Questions to ask your surgeon before mastectomy surgery
Here are some questions to ask your surgeon as you plan mastectomy surgery:
- How many times have you performed mastectomy?
- What are the risks of mastectomy?
- How should I prepare for surgery?
- How long will surgery take?
- Will you remove any underarm lymph nodes (axillary node dissection) along with the breast tissue?
- What kind of anesthesia will I have?
- Will I need blood transfusions? Should I donate my own blood before surgery?
- If I have immediate breast reconstruction, how will my breast look after surgery? What are the risks of having reconstruction surgery?
- If I choose not to have immediate reconstruction, how will my chest look after surgery?
- Will I be at risk for lymphedema after surgery?
- How long will I stay in the hospital?
- How long will it take to recover?
- Are there any precautions I should take as I recover? Will you give me written instructions to follow?
- Are there exercises I need to do after surgery?
- When can I return to my normal routine and activities?