1 What is a Mastectomy?

A surgery to remove all breast tissue from a breast as a way to prevent or treat breast cancer is called mastectomy which is a one treatment option for those with early-stage breast cancer. If the tumor is only removed from the breast, it is called lumpectomy or breast-conserving surgery.

Both procedures are effective for preventing a recurrence of breast cancer but lumpectomy is not an option for everyone with breast cancer so deciding which procedure you will undergo may be difficult.

Skin-sparing mastectomy can preserve breast skin and allow for a more natural breast appearance after the procedure. Breast reconstruction is the restoration of the shape of your breast that can be done during a second operation or along with mastectomy.

2 Reasons for Procedure

To remove all breast tissue if you have breast cancer or at risk of having one is the main reason for mastectomy. You may have a mastectomy to remove one breast also known as unilateral mastectomy or both breasts also known as bilateral mastectomy.

This procedure can be a treatment for types of breast cancer such as:

Your doctor may suggest mastectomy instead of lumpectomy with radiation if:

  • You have a malignant-appearing or widespread calcium deposits or microcalcifications all over the breast that have been determined to be cancer after a breast biopsy.
  • You have two or more tumors in separate areas of the breast.
  • You are pregnant and radiation will create an unacceptable risk to your unborn child.
  • You previously had radiation treatment to the breast region and the breast cancer has recurred in the breast.
  • You are a carrier of a gene mutation that gives you a high risk of developing second cancer in your breast.
  • You had a lumpectomy but the cancer is still present at the margin of the operated area.
  • You have a large tumor similar to the overall size of your breast.
  • You live far away from a radiation facility and it would be very difficult to be there for treatment for five to six weeks.
  • You have a connective tissue disease such as lupus or scleroderma and cannot tolerate the side effects of radiation.

To remove both of your breasts and significantly reduces your risk of developing breast cancer in the future is the main goal of preventive or prophylactic also known as risk-reducing mastectomy.

This is mostly used for women with a very high risk of breast cancer with factors such as the presence of certain genetic mutations or family history of breast cancer.

If you do not have breast cancer but have a very high risk of developing the disease, mastectomy can be an option.

3 Potential Risks

Some of the potential risks of mastectomy include:

  • Infection
  • Bleeding
  • Swelling in your arm or Lymphederma
  • Pain
  • Stiffness and Shoulder pain
  • Formation of hard scar tissue at the surgical area
  • Hematoma or Buildup of blood in the surgical area
  • Numbness from lymph node removal

4 Preparing for your Procedure

In preparing for your mastectomy, you must follow your doctor’s orders

You and your surgeon should discuss first the procedure, review your medical history and determine the plan for your anesthesia, as well as the benefits and risks of procedures.

You can also ask questions about the procedure or if you are bothered by some factors regarding the procedure. You can also discuss whether you'll have breast reconstruction and when.

Breast reconstruction might involve:

  • Using a combination of tissue reconstruction and implants.
  • Using breast expanders with saline or silicone implants.
  • Using your body's own tissue also known as autologous tissue reconstruction.

A reconstructive surgeon will perform the procedure. Your doctor will tell you if you need any restrictions before the surgery:

  • Tell your doctor if you are taking any vitamins, medications and supplements because some may interfere with the surgery.
  • Stop taking blood-thinning medications or aspirin  a week or longer because these can increase your risk of excessive bleeding. Medications include aspirin such as ibuprofen (Advil, Motrin IB) or other pain relievers, and blood-thinning medications (anticoagulants) such as warfarin (Coumadin).
  • You are not allowed to eat or drink 8 to 12 hours before the surgery.
  • Prepare yourself for a hospital stay so you can plan and pack your essentials.

5 What to Expect

Read on to learn more about what to expect before, during, and after your mastectomy.

Mastectomy might include removing lymph nodes in the armpit area to determine whether cancer has spread and this is an umbrella term used for several different procedures.

Your surgeon will remove a number of nodes from your armpit on the side of the tumor for an axillary node dissection. Your surgeon will remove only the first one or two nodes into which a tumor drains in a sentinel lymph node biopsy and will test them for cancer.

Your surgeon will discuss options such as radiation to your armpit if cancer is present, but if there is no cancer, no further lymph nodes need be removed.

The types of mastectomy include:

  • Modified radical mastectomy – this procedure might be suggested for large tumors or if cancer has spread to the lymph nodes and in this procedure, your surgeon will remove the entire breast such as the breast tissue, areola, nipple and most of the underarm lymph nodes.
  • Single or total mastectomy – this might be done immediately after the mastectomy and in this procedure, your surgeon will remove the entire breast including the breast tissue, areola, and nipple.
  • Skin-sparing mastectomy – breast construction will be done immediately after the mastectomy and in this procedure, your surgeon will remove all the breast tissue, nipple, and areola, but not the breast skin but this may not be suitable for larger tumors.
  • Nipple-sparing or subcutaneous mastectomy – breast reconstruction and lymph node biopsy are performed immediately after the procedure and in this procedure your surgeon will remove only breast tissue, sparing the skin, nipple, and areola.

Before the procedure, your doctor will give you instructions. Mastectomy without reconstruction usually takes one to three hours. Some people will stay at the hospital for one day and some will go home that same day as the procedure.

You should expect to spend more time in surgery and possibly more time in the hospital if you are having a double mastectomy. The surgery takes longer and you may stay in the hospital for a few additional days if you are having breast reconstruction after mastectomy.

Before the procedure, a blue dye or a radioactive substance or both will be injected into the area around the tumor or the skin above the tumor if you are having a sentinel node biopsy. Your surgeon will be able to see the nodes and remove them. You will be not aware of what is happening around you because mastectomy is usually performed under general anesthesia. 

After the anesthesia is inserted, he will make an incision around your breast then the breast tissue will be removed and also other parts of the breast and lymph nodes. Your surgeon will send them to the laboratory for analysis.

Your plastic surgeon will coordinate with the breast surgeon to be available at the time of surgery if you are going to have breast reconstruction at the same time as the mastectomy.

You have to meet with the radiation oncologist before surgery to discuss benefits and risks if you are going to have radiation therapy after surgery.

Placing temporary tissue expanders in the chest to hold the breast skin in place is an option for women who will have radiation therapy after surgery. Your surgeon will close the incisions using sutures or stitches that can either be removed later or dissolved.

You might also have one or two small plastic tubes placed where your breast was removed, they will drain the fluids that accumulated after the surgery. The tubes are sewn into place and the ends are attached to a small drainage bag.

After the surgery, you can expect to: 

  • Be taken to the recovery room where you will be monitored by a nurse.
  • Have a bandage over the surgery area.
  • May feel some numbness, pain and a pinching sensation in your underarm area.
  • Given instructions on how to care for yourself at home such as taking good care of your incisions, checking for infections and following activity restrictions.
  • Talk to your doctor and discuss when are you able to wear a bra.
  • Received antibiotics and  prescriptions medicines.

6 Procedure Results

Within a week of two weeks after the mastectomy, you will receive your pathology result and your doctor will explain this to you. 

If you need to follow up treatment, your doctor may refer you to:

  • A medical oncologist to discuss treatment such as chemotherapy or hormone therapy if your cancer is sensitive to hormones.
  • A radiation oncologist to discuss radiation treatments if you had a large tumor, cancer remaining after mastectomy, cancer that had spread to the skin or nipple or many lymph nodes that tested positive for cancer.
  • A support group or counselor so they can help you in coping with breast cancer.
  • A plastic surgeon if you want to have breast reconstruction.

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