Mastectomy (Breast Removal Surgery)

Medically Reviewed by Dr. K on 29 March 2021

What Is a Mastectomy?

A mastectomy is a medical operation that removes a breast and often adjacent tissues in order to treat breast cancer. For a long time, the standard treatment for breast cancer was a radical mastectomy, which included the removal of the whole breast, lymph nodes in the underarm, and any of the chest muscles under the breast. Surgical advancements, on the other hand, have provided patients more choices than ever before. Many people will benefit from less intrusive, breast-conserving procedures.

The form of mastectomy that is better for you is determined by a number of factors, including:

  • Age
  • General health
  • Menopause status
  • Tumor size
  • Tumor stage (how far it’s spread)
  • Tumor grade (its aggressiveness)
  • Tumor’s hormone receptor status
  • Lymph nodes and whether they’re involved

 

What Is a Total Mastectomy?

Your doctor will remove your entire breast, including the nipple, during this operation, also known as a simple mastectomy. They can even remove lymph nodes from your underarm, which are tiny glands that are part of your immune system.

If cancer hasn’t spread beyond the breast or if you’re undergoing a preventative mastectomy to lower the chance of breast cancer, you’re more likely to have a complete mastectomy.

 

What Is a Preventive Mastectomy?

Preventive mastectomy, commonly known as prophylactic mastectomy, is an option for women who have a significant chance of breast cancer.

According to studies, people with a potential chance of breast cancer are up to 90% less likely to develop the condition after undergoing a preventive mastectomy.

Doctors typically suggest a complete mastectomy. In certain instances, both breasts are removed. A double mastectomy is the medical term for this procedure.

Some women who have had breast cancer in one breast can have the other removed to minimise the likelihood of the cancer recurring (called recurrence).

Breast reconstruction may be performed either at the time of the preventive mastectomy (immediate reconstruction) or later (delayed reconstruction). The surgeon can create a breast using silicone implants or tissue flaps from another part of your body during breast reconstruction.

What Is a Partial Mastectomy?

This treatment is available to women with stage I or stage II breast cancer. It’s a breast-conserving operation in which the specialist only extracts the tumour and the underlying tissue.

Radiation treatment, which uses strong X-rays to target the breast tissue, is usually accompanied by 6 to 8 weeks of surgery. Radiation destroys cancer cells which prevents them from spreading or returning.

There are two types:

  • Lumpectomy: The tumour and a tiny area of normal tissue around the tumour are removed through a lumpectomy.
  • Quadrantectomy: In comparison to a lumpectomy, a quadrantectomy eliminates the tumour as well as additional breast tissue.

A partial mastectomy may necessitate additional surgery in certain instances. Your doctor may have to remove the whole breast if cancer cells are already present in the tissue.

 

What Is a Radical Mastectomy?

The breast is fully removed during a radical mastectomy. The overlying tissue, muscles under the breast, and lymph nodes are often removed by the surgeon. However, doctors rarely perform radical mastectomy today because it isn’t necessarily more successful than other treatments. But after cancer has progressed to the chest muscle, it is advised.

 

What Is a Modified Radical Mastectomy?

The updated radical mastectomy is a less traumatic and more common treatment (MRM). The skin, breast tissue, areola, and nipple, as well as the majority of lymph nodes under the arm, are removed by the doctor. The lining of a large muscle in the chest is often removed, but the muscle itself remains intact. You won’t get a hollow in your chest as you will following a radical mastectomy.

After that, you may have breast reconstruction.

Your doctor may recommend radiation after your operation, based on the extent of your tumour and if the cancer has spread to your lymph nodes.

What Is a Skin-Sparing Mastectomy?

The doctor removes breast tissue, the nipple, and the areola, but much of the skin around the breast is left intact. It’s only seen where a mastectomy is followed by full breast reconstruction. If the tumours are huge or close the skin’s surface, that might not be the best option.

 

What Is a Nipple-Sparing Mastectomy?

A complete skin-sparing mastectomy is another term for it. All of the breast tissue is removed, including the ducts that extend all the way up to the nipple and areola. The skin of the nipple and areola, though, is spared, and tissues under and around them are ripped off. These places may be saved if they are cancer-free. This procedure also necessitates reconstruction directly after the mastectomy.

 

Mastectomy in Men

The most popular treatment for men with breast cancer is a mastectomy. Since men’s breast tissue is so sparse, surgeons normally extract the whole breast. Your doctor may even remove any lymph nodes in the region. They can even advise you to have the other breast removed to avoid cancer in that region.

Reconstructive surgery with implants is seldom performed on men. That’s because they don’t help with a man’s chest form. However, the specialist will reconstruct the nipple to make the affected breast appear more normal.

 

Before a Mastectomy

Before surgery:

  • You’ll be dressed in a hospital gown.
  • You’ll need to fast prior to your surgery.
  • You’ll be kept in a waiting area prior to surgery. Friends and relatives are welcome to pay you a visit, usually a few at a time.
  • A nurse can use a felt-tip marker to indicate the position of the incision on your breast.
  • You may be sedated. You’ll continue to relax when the nurse places a needle attached to a long tube of medicine in your hand and tapes it in place.

 

During a Mastectomy

During surgery:

  • You’ll be staying for at least 2 hours, and maybe longer if you’re having reconstruction done afterward.
  • A cut is made to isolate the breast tissue to be removed from the skin above and the muscle below it.
  • The protocol for sentinel node dissection or axillary lymph node dissection follows.
  • The cosmetic surgeon takes charge if you’re having reconstructive surgery.
  • If this is not the case, the breast surgeon will insert drains into your breast and armpit to prevent fluid from accumulating where the tumour once was.
  • The incision is stitched up and the wound is covered with a bandage that stretches over your chest.

After a Mastectomy

After surgery:

  • The removed lymph nodes would be sent to a lab to see if the disease has spread to them.
  • You’ll be taken to a treatment room where the heart rate, body temperature, and blood pressure will be monitored.
  • You’ll be admitted to a hospital room when you wake up. You’ll probably stay for one or two days, but if you had reconstruction, it might be longer.
  • Someone from the medical team will discuss the following topics with you:
    • Medications. The discomfort you have following surgery can be treated by drugs prescribed by your doctor. You can usually treat the discomfort with over-the-counter pain relievers within a week or two.
    • How to care for:
      • The incision. The bandage would most likely remain in place until your first follow-up appointment.
      • Drains. They can come out when you leave the hospital, but they may remain in place for up to three weeks.
      • Stitches. Non-dissolving types and staples can be removed during the follow-up appointment.
    • Exercises. They’ll prevent the side that you had surgery from stiffening up. You’ll most likely begin the day after surgery.
    • When you can wear a prosthesis or bra. Your surgical site must first heal. You’ll learn how much longer you have to wait.

 

Mastectomy Risks

A mastectomy is normally safe and effective, although it does carry certain risks, as do all surgical procedures. They are as follows:

  • Bleeding
  • Infection
  • Swelling of the arm (lymphedema)
  • Pockets of fluid under the incision (seromas)
  • Risks from general anesthesia
  • Injury to surrounding tissues

During operation, certain people feel numbness in their upper bodies. Damage to small nerves in the region where the lymph nodes are removed causes it. There’s a fair possibility you’ll recover more of your arm’s sensation over time.

 

Tips for Mastectomy Recovery

Once you’ve been home, make sure you stick to the treatment plan the doctor prescribed. Often, make certain you:

  • Rest. Surgery can be very draining, be sure to get plenty of rest.
  • Take your meds. You will be in pain, so make sure you take your medication as prescribed.
  • Keep the site dry. Avoid baths or showers until your drains and stitches are safe to be removed. In the meantime, you can stay clean by having sponge baths.
  • Do your exercises. They will speed your recovery time.
  • Ask for help. Don’t be afraid to speak out. It takes time to heal. Get as much support as you can for food preparation, shopping, housework, child care, pet care, doctor’s appointments, and everything that you aren’t able to do on your own.

Sources

Referenced on 29.3.2021

  1. American Cancer Society: “Surgery for Breast Cancer." “Mastectomy,” “Surgery for Breast Cancer in Men," “Treatment of Breast Cancer in Men, by Stage."
  2. National Comprehensive Cancer Network: “Breast Cancer: Treatment Guidelines for Patients."
  3. Cancer Net: “Guide to Breast Cancer."
  4. BreastCancer.org: “What is Mastectomy?" “Mastectomy: What to Expect,” “Rates of Preventive Double Mastectomy in Men Nearly Doubles."
  5. John Hopkins Medicine: “Mastectomy.”
  6. Manouras, A. Archives of Surgery, June 2008.
  7. Mayo Clinic: “Modified Radical Mastectomy,” “Male breast cancer: Definition," “Male breast cancer: Treatment and drugs."
  8. Townsend, C. Sabiston Textbook of Surgery, Saunders Elsevier, 2007.
  9. Brunicardi, F. Schwartz’s Manual of Surgery, McGraw-Hill, 2006.
  10. McPhee, S. Lange 2008 Current Medical Diagnosis & Treatment, McGraw-Hill Medical, 2008.
  11. American Cancer Society:
  12. Cancer Research UK: “Breast Cancer in Men."
  13. Memorial Sloan Kettering Cancer Center: “Surgery for Male Breast Cancer."
  14. https://www.webmd.com/breast-cancer/mastectomy

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