A mastectomy is the surgical removal of one or both breasts. Usually performed as part of a treatment plan for breast cancer, the procedure may be a partial or total mastectomy. Partial mastectomy is also known as a lumpectomy. Although medicine has developed breast-conserving surgeries, sometimes the extent of the condition requires a mastectomy. Other times, after consulting with her doctor a woman may elect mastectomy as her best option. The decision to undergo a mastectomy should involve these considerations:
- The size and location of a tumor
- If there are multiple tumors in the breast
- The amount of the breast that is affected
- If the cancer has spread to the lymph nodes or into the chest
- The size of the breast
- The woman’s age, general health and family history
In some cases, a preventive or prophylactic mastectomy is done to reduce the risk for tumors in women considered at high risk for breast cancer. These are women with a close relative with breast cancer, who have the genes BRCA1 or BRCA2, have dense breast tissue or have undergone radiation therapy to the chest. However, these factors do not always lead to breast cancer. In addition, while a mastectomy can reduce the risk of cancer by more than 90 percent, it does not eliminate it. The decision to have a prophylactic mastectomy should be based on a consultation with the woman’s doctor and very careful consideration of the benefits and risks involved.
The three most common types of mastectomy are:
- Subcutaneous or simple mastectomy – removal of the breast, but leaving the nipple and areola in place. This is also known as a “nipple sparing” mastectomy. No lymph nodes are sampled or removed.
- Modified radical mastectomy – removal of the entire breast including the nipple and areola and a sampling of the lymph nodes under the arm.
- Radical mastectomy – removal of the entire breast, nipple and areola, overlying skin, lymph nodes under the arm and some chest muscle; due to improvements in early detection, this once common procedure is now needed less often
If surgery is done as a treatment for breast cancer, blood and imaging tests, such as CT scans, PET scans, bone scans and X-rays may be used to find out if the tumors have spread. That helps the oncologic surgeon determine the best procedure to use and what other treatments may be needed. It is important to note if the woman is pregnant, has any bleeding disorders or allergies, and if she is taking any prescription medications or non-prescription supplements. For a week prior to surgery, it may be necessary to stop taking anticoagulant drugs such as aspirin, ibuprofen (Advil), naproxen (Aleve), vitamin E, Plavix, and Coumadin. Fasting for eight hours prior to surgery may be necessary.
A mastectomy is performed in the hospital under general anesthesia. The procedure usually involves a stay of one or two days depending on the type of surgery. A woman receiving a simple mastectomy may be able to return home on the same day. Further treatment will depend on the size and type of cancer, and whether the lymph nodes were involved. If the tissue is healthy enough, a plastic surgeon can reconstruct the breast during the same surgery using implants or natural tissue. In most other cases, the breast can be rebuilt during a later operation.
During the surgery, drains, or tubes are placed at the incision to remove fluid that accumulates where the breast was located. The surgeon removes the drains in a later office visit.
Prognosis of Mastectomy
The prognosis for a mastectomy is generally positive with most women experiencing very good outcomes. Like any surgery, the procedure comes with some risks such as blood loss, blood clots that could travel to the lungs, breathing problems, reactions to anesthesia, heart attach and stroke, but these are rare. A doctor can determine a woman’s risk during his examinations.
With proper follow-up care for a mastectomy, full recovery usually takes about three to six weeks. Some activities a woman can use at home include:
- Keeping the arm at shoulder height while sitting to help prevent swelling
- Following the doctor’s instructions on bathing and caring for the wound
- Exercises recommended by the doctor to relieve stiffness
- Avoiding strenuous activity for at least two weeks
- Wearing a loose-fitting bra when sleeping
The removal of lymph nodes may restrict fluid drainage and increase risk for infection and blood clots in the surgical area. Some additional precautions that should be followed include:
- No injections, intravenous insertions or blood pressure measurements on the affected arm
- Avoiding injury to the affected arm
- Preventing sunburn
- Using an electric shaver under the arm instead of a razor
- Not wearing tight clothing of restrictive jewelry on the affected arm
- Using insect repellent and long sleeves to reduce injury from stings or bites