Mastectomy

Mastectomy Methods

Mastectomy refers to several methods for removing tissue from one or both breasts. Mastectomy procedures are usually performed if the cancer cells have spread beyond the breast to other regions of the body.

Bilateral and Unilateral Mastectomy

A mastectomy is used to remove all breast tissue if you have breast cancer or are at a very high risk of developing it. You may have a mastectomy to remove one breast (unilateral) or both breasts (bilateral).

A bilateral or double mastectomy is the surgical removal of both breasts to treat or prevent breast cancer. There are several reasons why a patient might need or choose to undergo this procedure. While a bilateral mastectomy is an option for some women with a diagnosis of breast cancer, it can also be used as a risk-reducing operation for those who have been identified as having a high risk of developing breast cancer.

Skin-Sparing Mastectomy

This involves the removal of all breast tissue but not the removal of the skin. This newer method can preserve a more natural appearance after surgery. Breast reconstruction may also be carried out alongside or subsequent to mastectomy.

In a skin-sparing mastectomy, the breast tissue is removed while most of the healthy breast skin is left. This method is used only if the patient will have immediate breast reconstruction or reconstructive surgery. If surgery to rebuild the breast will happen later, more breast skin will be removed.

Skin sparing is possible as part of simple mastectomies, as well as those that involve the removal of lymph nodes under the arm if cancer has spread to these areas. Most people with breast cancer are potential candidates for a skin-sparing mastectomy.

Nipple-Sparing Mastectomy

Nipple-sparing mastectomy or NSM combines a skin-sparing mastectomy with preservation of the nipple-areolar complex (NAC), intraoperative pathological assessment of the nipple tissue core, and immediate breast reconstruction, thereby permitting better cosmoses for patients undergoing total mastectomy. However, in cases where tumours are very large, these targeted procedures may not be possible.

A surgeon may also remove lymph nodes from around the breast or breasts to assess whether cancer cells has spread. Axillary node dissection or sentinel lymph node biopsy can be used to make this assessment. If cancer is detected in the surrounding nodes radiation may be used in the impacted area and to treat breast cancer. Modified radical mastectomy as a support for current breast cancer treatment involves removing most of the lymph node and all of the breast tissue in the impacted areas.

Mastectomy & Reconstruction

In some cases, reconstructive surgery can be performed after mastectomy. Reconstruction can sometimes be performed in the same session as mastectomy. It usually uses silicone implants, the body’s own tissue, or a combination of the two.

An elliptical incision is made around the breast or breasts. Breast tissue and lymph nodes will be sent to a laboratory for analysis. Temporary tissue expanders may be used to help the new breast shape form successfully. The surgeon has the option to place a drain in the surgical site. Surgeons may remove other tissues that surround the breast, such as fat and skin. While performing a mastectomy, surgeons take extreme care to ensure that they do not injure any of the patient’s blood vessels, because it can cause severe bleeding.

Afterwards, reconstruction surgery (also referred to as reconstruction of the breast) can be performed to restore the appearance and shape of the woman’s breasts. Procedures employed during breast reconstruction may include those that employ implants, autologous tissue transfer, or a flap procedure. A common method of post-mastectomy breast reconstruction is the TRAM flap. A new breast can be constructed by using skin and fat from another part of the body to create the shape of a breast. Breast reconstruction after a mastectomy is usually performed by plastic surgeons.

If you are interested in reconstructive surgery, your doctor will be able to give you further information about the procedure and what results you can expect from it. Your doctor may also be able to recommend a qualified specialist in this field of medicine.

Duration

Mastectomy without reconstruction usually takes one to three hours. It can generally be performed on an outpatient basis. Bilateral mastectomy will naturally take longer and may require an overnight inpatient stay. Ask your doctor how long you are likely to stay in hospital after the procedure so that you can prepare properly.

Post-Operation

After the procedure, the incision is closed either with stitches that will dissolve naturally or ones that will be removed later. Plastic drainage tubes may also be placed where the breast was removed.

You will spend time in the recovery room where you will be monitored by your medical team. A dressing will be applied to the site of the surgery. Comprehensive instructions will be provided including restrictions on certain activities and any necessary treatment of the surgical area. Your doctor will provide prescriptions for pain medication and may prescribe an antibiotic.

Your pathology results should be available within two weeks of your mastectomy. Your doctor will explain the report in detail. They may refer you to a radiation oncologist if necessary. They will also discuss reconstruction possibilities and options for support.

Before you leave the hospital, your surgeon or nurse will give you information about recovering at home. You should take note of the following:

• Remember to take pain medications.
• Ask your surgeon or nurse how to take care of the mastectomy bandage.
• If you have a drain in your breast area or armpit, the drain might be removed before you leave the hospital.
• Recognise signs of infection.
• Follow an exercise routine to prevent arm and shoulder stiffness on the side where you had surgery.
• Be aware of signs of lymphedema, or swelling due to the build-up of fluid from the lymph nodes.

FAQs

Is mastectomy considered major surgery?

Mastectomy is a common but major surgery with serious risks and potential complications. You may have less invasive treatment options. Consider getting a second opinion about all of your treatment choices before having a mastectomy. The type of mastectomy you receive depends on the stage and type of your breast cancer.

Who is a candidate for a mastectomy?

Total mastectomy is most appropriate for patients who have ductal carcinoma in situ (DCIS), Paget disease of the breast with DCIS or other underlying non-invasive breast cancer, invasive breast cancer or those who have a breast cancer recurrence.

Should I get a single or double mastectomy?

There are reasons both for and against having a double mastectomy, but the bottom line is that it is a personal choice. Some people prefer preserving a healthy breast by having a single mastectomy, and others wish to reduce their risk of a second breast cancer, even if that risk is small.

What is radical mastectomy surgery?

A modified radical mastectomy is a procedure in which the entire breast is removed, including the skin, areola, nipple, and most axillary lymph nodes, but the pectoralis major muscle is spared. Historically, a modified radical mastectomy was the primary method of breast cancer treatment.

At what stage of breast cancer the breast is removed?

Women with stage I or stage II breast cancer may have this procedure. It’s a breast-conserving method in which the doctor removes only the tumour and the tissue around it. The surgery is often followed by 6 to 8 weeks of radiation therapy, with powerful X-rays that target the breast tissue to eradicate any lingering cancer cells.

What is removed during a mastectomy?

Mastectomy is breast cancer surgery that removes the affected breast. A mastectomy may be done: When a woman cannot be treated with breast-conserving surgery (lumpectomy), which spares most of the breast. If a woman chooses mastectomy over breast-conserving surgery for personal reasons.

Is mastectomy necessary for breast cancer?

The mastectomy provides the most peace of mind. Removing the entire breast has a greater chance in preventing recurrent breast cancer, and lowers the risk of needing additional surgeries. In addition, people who have a mastectomy typically don’t need radiation therapy, which can be time consuming and painful.

Do all breast cancer patients have mastectomy?

45.0% had total mastectomy (the entire breast is removed, but no muscle beneath the breast is removed and lymph nodes usually aren’t removed) 34.7% had modified radical mastectomy (the entire breast and underarm lymph nodes are removed, but no muscle beneath the breast is removed) 19.5% had double mastectomy.

How much breast tissue is removed in a mastectomy?

The surgeon removes the entire breast. The surgeon does not perform axillary lymph node dissection (removal of lymph nodes in the underarm area). Sometimes, however, lymph nodes are occasionally removed because they happen to be located within the breast tissue taken during surgery.

What is the recovery time for breast reconstruction after mastectomy?

Average recovery time after mastectomy and reconstruction are about 3-4 weeks, but maybe up to 6-8 weeks.

How painful is a mastectomy?

You will have some pain after breast surgery (lumpectomy, mastectomy or breast reconstruction). For most people, this pain is temporary and goes away after you heal from the surgery. About 20% of people have pain that lasts longer [240]. Pain right after surgery is usually due to injury to the skin or muscles.

How long are you in hospital after a mastectomy?

Mastectomies are very safe procedures, with minimal complications. Most people make a good recovery and only need to stay in hospital for one night. However, some people will need to spend a few days in the hospital. Generally, it takes 3 to 6 weeks to fully recover.

What can you not do after a mastectomy?

Avoid strenuous activity, heavy lifting and vigorous exercise until the stitches are removed. Tell your caregiver what you do and he or she will help you make a personal plan for “what you can do when” after surgery. Walking is a normal activity that can be restarted right away. Driving

What are the possible complications of mastectomy?

Some people may experience numbness in the area where the surgery was performed. Pain and swelling at the site of the surgery. Bleeding under the skin flap or around a chest tube (the tube that drains fluid from the chest).