A mastectomy is a way to treat breast cancer by surgically removing a breast and sometimes nearby tissues while breast-conserving surgery (also known as a lumpectomy) is the removal of the cancer and some of the surrounding tissue while leaving healthy breast tissue behind. Studies have shown that both a mastectomy and a lumpectomy with radiation have similar survival rates. Both options have their own pros and cons and your doctor will discuss all treatment options with you so you can make the decision that is best for you. Mastectomies are divided into different types and procedures depending on the extent of the cancer and whether how much adjacent tissue needs to be removed. Your doctor will decide on the best approach and discuss your options with you. These procedures may include: -Total or simple mastectomy is the removal of the breast tissue, nipple, areola and skin but not all the lymph nodes. During this procedure the doctor will examine the lymph nodes and remove any necessary to test for metastasis. -Modified radical mastectomy is the removal of the whole breast, including the breast tissue, skin, areola, nipple, and most of the axillary lymph nodes. The lining over the chest muscles may be also removed. -Radical mastectomy is the removal of the whole breast, the underlying chest muscle, and the axillary lymph nodes. This procedure is done if the cancer has spread into the chest muscle.
A mastectomy is used to remove all breast tissue if you have breast cancer or are at very high risk of developing it. You may have a mastectomy to remove one breast (unilateral mastectomy) or both breasts (bilateral mastectomy).
- According to the National Cancer Institute, this surgery has been shown to reduce the risk of breast cancer by at least 95 percent in women who have a disease-causing mutation in the BRCA1 or the BRCA2 gene. Provided there are no cancer metastases, this procedure is the best approach to help prevent you from developing breast cancer.
-There will be no more further need for follow-up mammograms or breast MRIs.
-This will have no effect on the risk of cancer that has already spread to somewhere else in your body.
-The procedure is more complex than a lumpectomy. It takes longer to recover. And there's a higher risk of problems, such as infection.
-Causes a loss of feeling in the chest. Usually the feeling doesn't come back.
-Surgery will also leave scars that are permanent.
-This may mean that you need one or more other surgeries if you want breast reconstruction. Each surgery has risks and requires recovery time.
-If the woman has the operation while she is still of child-bearing age, she will not be able to breastfeed any future babies.
-There’s a risk for anxiety or depression about body image after a mastectomy or breast reconstruction.
A mastectomy is usually performed under general anesthesia, so you're not aware during the surgery. Your surgeon starts by making an elliptical incision around your breast. The breast tissue is removed and, depending on your procedure, other parts of the breast also may be removed. Regardless of the type of mastectomy you have, the breast tissue and lymph nodes that are removed will be sent to a laboratory for analysis. If you're having breast reconstruction at the same time as a mastectomy, the plastic surgeon will coordinate with the breast surgeon to be available at the time of surgery. One option for breast reconstruction involves placing temporary tissue expanders in the chest. These temporary expanders will form the new breast mound. For women who will have radiation therapy after surgery, one option is to place temporary tissue expanders in the chest to hold the breast skin in place. This allows you to delay final breast reconstruction until after radiation therapy. If you're planning to have radiation therapy after surgery, meet with a radiation oncologist before surgery to discuss benefits and risks, as well as how radiation will impact your breast reconstruction options. As the surgery is completed, the incision is closed with stitches (sutures), which either dissolve or are removed later. You might also have one or two small plastic tubes placed where your breast was removed. The tubes will drain any fluids that accumulate after surgery. The tubes are sewn into place, and the ends are attached to a small drainage bag.
Mastectomy is done using general anesthesia so your doctor will carry out a thorough physical examination as well as order further tests, including blood tests, chest x-ray, and an electrocardiogram (EKG). You will likely undergo imaging studies that may include mammogram, breast ultrasound, and breast magnetic resonance imaging (MRI) Please let your doctor know about all medication that you are taking as some will need to be stopped before the procedure. You will need to avoid food and water for six to eight hours before the procedure or as recommended by the doctor.
After the surgery, you will be moved to a recovery room until the effects of anesthesia have worn off. You will likely stay in the hospital for at least two to three nights, depending on the extent of the procedure. If you experience any side effects from the anesthesia, such as headache, nausea, and/or vomiting, please let the nurses know so they can give you medication to manage your symptoms. Incision. To close the surgical incision the doctor may use dissolvable or regular stitches or both together. Depending on the type of surgery you will likely have one or two drains (per side) to remove blood and fluid from the area. These drains are usually removed three to four days after the procedure. You will receive instructions on caring for the incision, which will normally be covered until your next appointment. Exercise. It is normal to feel tired after the procedure. Resume normal activities are you are comfortable doing so. Do not drive for one to two weeks after the procedure and not until you have a reasonable range of motion in your arm and shoulder. You will be given instructions on exercises to help maintain and/or restore range of motion in the affected arm. If lymph nodes are removed or radiation is administered to the axillary nodes you must be very careful with the arm on that side due to the risk of lymphedema. Avoid having blood pressure taken on that arm. Avoid blood draws and other medical procedures on that arm. Do not carry excessive weight or wear tight clothing or jewelry on that arm. To the best of your ability, avoid cuts, burns, and insect bites on that arm. Sexuality and self-esteem. It is normal to experience self-esteem and sexuality issues after a mastectomy and some patients can benefit from therapy before and after the procedure as well as counselling for both partners.
Infection at the incision, causing pain, swelling, and leakage of discharge. Collection of fluid or blood under the skin. Poor healing can occur, caused by lack of blood supply to the wound. Due to nerves being severed, numbness of the arm and the chest may occur. Weakness of the arm on the affected side may also occur. This can be temporary or permanent. Stiffness in the shoulder or arm on the affected side can limit range of motion. This is usually resolved by performing physical therapy soon after the surgery. Abnormal healing, causing adhesions and/or pain, which are often permanent. Lymphedema occurs in one in four patients who have axillary nodes removed. This risk increases with the number of nodes removed and how well the affected arm is cared for. It is important to avoid injury and infection as well as weight gain. Lymphedema generally develops about 20 months after surgery. Compression sleeves and massage can help manage the condition, but it is permanent. A local, regional, or distant recurrence, all of which will require additional treatment, whether surgery, chemotherapy, radiation therapy, and/or hormone therapy. Pain after surgery occurs in two out of three patients between the ages of 30-49 and one out of four patients older than 70. Post-mastectomy pain may be chronic or may improve with time, depending on the patient. Pain medication can be taken to manage this symptom. Anxiety and/or depression is experienced by one in three patients after a mastectomy. Therapy can help. Risks are more likely in patients who are obese and who smoke. These patients are more likely to experience infection at the incision site, lung infection, cardiac and pulmonary complications, and blood clots.
What are the recommendations for travel for this procedure?
If you are taking any blood-thinning medication/anticoagulant, please let your doctor know as some may need to be stopped before you travel for the procedure. Travelers to Thailand should plan to stay in the country for at least two weeks or for the entire duration of treatment. If you plan to return home after the procedure, please speak to your doctor before making travel arrangements. During your follow-up appointment your medical team will assess your health and your incision and you will receive documents detailing your medical and treatment history and your "Fit to Fly" certificate (if needed).
Can men get breast cancer and need a mastectomy?
Yes, men can absolutely get a mastectomy. Depending on the size of the man’s breast, the scar pattern will vary, but the goal is to create a flat chest with aesthetically acceptable scar patterns that are hopefully hidden in the creases of the male pectoral muscles, if it all possible.
When is bilateral mastectomy recommended?
Having both breasts removed is recommended for women at very high risk of breast cancer. For example, those who have tested positive for the breast cancer marker known as BRCA are at very high risk. These high-risk women often have their breasts removed before they get breast cancer. This is called a preventive or prophylactic mastectomy. It can greatly lower their risk of cancer. Having cancer in one breast does not put a woman in this very high-risk group. Your doctor can help you understand your own personal risk of a new cancer and the best way to manage that risk.