Mastectomy (Breast Removal Surgery)

A mastectomy is a procedure in which all breast tissue is removed from a breast to treat or prevent breast cancer. It may be an option for patients with early-stage breast cancer. Another alternative is breast-conserving surgery (lumpectomy), in which only the tumor is removed from the breast. It can be tough to choose between a mastectomy and a lumpectomy. For preventing a recurrence of breast cancer, both procedures are equally beneficial. However, not everyone with breast cancer can have a lumpectomy, and other people would rather have a mastectomy. Breast skin can be preserved and a more natural breast appearance can be achieved using newer mastectomy procedures. This type of mastectomy is also known as a skin-sparing mastectomy. Breast reconstruction surgery, which restores the contour of your breasts, can be done at the same time as your mastectomy or as a separate procedure.

If you get a mastectomy, your doctor will most likely recommend it to you if:

• • You have a large tumor.
  • More than one area of your breast is affected by the tumor.
  • It is not recommended to use radiation therapy.

The size of your breast could also determine the nature of mastectomy you get. Women at high risk for breast cancer may wish to get a mastectomy before the disease starts. It includes women who have BRCA1 or BRCA2 genes, which have been related to breast cancer. In some circumstances, a mastectomy is performed to prevent breast cancer. 

Types of mastectomy procedures

The following are some types of mastectomy procedures:

1. 1. Total (simple) mastectomy.
   2. Modified radical mastectomy.
   3. Radical mastectomy.
   4. Nipple-sparing mastectomy.
   5. Skin-sparing mastectomy.

1) Total mastectomy 

A total mastectomy is a surgical technique that removes the entire breast, including the breast tissue, nipple, areola, and skin to treat breast cancer. This procedure is also known as a simple mastectomy. It may be acceptable for a patient with advanced cancer who does not respond well to a lumpectomy or partial mastectomy. Some patients choose a total mastectomy over breast-conserving surgeries like lumpectomy. Others choose to have the surgery done as a preventive step, even though they have not been diagnosed with breast cancer since they have a genetic predisposition or are otherwise at high risk of getting the disease.

2) Modified radical mastectomy

The modified radical mastectomy is a less traumatic and more common operation. Your breast, comprising the skin, breast tissue, areola, and nipple, as well as the majority of lymph nodes beneath your arm, are removed by the doctor. The lining of a major muscle in the chest is also removed, but the muscle itself remains intact. You won’t have a hollow space in your chest like you would if you had a radical mastectomy.

After that, you might need breast reconstruction. Your doctor may recommend radiation after surgery depending on the size of your tumor or whether cancer has spread to your lymph nodes.

3) Radical mastectomy

The breast is completely removed during a radical mastectomy. The overlying skin, muscles beneath the breast, and lymph nodes are also removed by the surgeon. However, surgeons rarely perform radical mastectomy nowadays since it isn’t always more beneficial than alternative procedures. It is advised only when cancer has gone to the chest muscle.

4) Nipple-sparing mastectomy

The skin-sparing mastectomy is similar to this. A total skin-sparing mastectomy is another name for it. The whole breast tissue is removed, including the ducts that run-up to the nipple and areola. The skin of the nipple and areola, however, has been retained.

A pathologist delicately cuts away the tissues under and around the nipple and areola and examines them. These parts can be spared if no breast cancer cells are discovered near the nipple and areola. This procedure is not recommended in any other case. The mastectomy is followed by reconstruction.

5) Skin-sparing mastectomy 

The doctor removes breast tissue, the nipple, and the areola, but most of the skin over the breast is left intact. It is only used when a mastectomy is followed by quick breast reconstruction. If your tumors are large or near the skin’s surface, it may not be the best option. 

Mastectomy, the most common treatment for Men

The most common therapy for males with breast cancer is a mastectomy. Because men’s breast tissue is so sparse, physicians frequently remove the entire breast. Your doctor may also remove some lymph nodes in the area. They may also advise you to have the other breast removed to prevent cancer in that area.

Reconstructive surgery using implants is rarely performed on men. That’s because they don’t help with a man’s chest form. However, your doctor can repair your nipple and make the afflicted breast look more natural.

Risk factors of Mastectomy 

Every method involves some level of risk. The following are some of the possible side effects of a mastectomy:

• • Breast swelling is just temporary.
  • Breast discomfort.
  • Scar tissue that forms at the cut location can cause hardness (incision)
  • Infection or bleeding in the wound.
  • If lymph nodes are removed, the arm would swell (lymphedema).
  • You may experience discomfort in the breast after it’s been removed (phantom breast pain). Medicines, exercise, and massage may help with this.

After a mastectomy, a clear fluid (seroma) is commonly found in the breast. It can be drained in the surgeon’s office if this bothers you. It can then be treated using compression if necessary. Alternatively, you could receive an injection that helps to strengthen the area in the breast, preventing fluid from accumulating there. The mastectomy location will almost certainly leave a scar. After surgery, you may have a pulling sensation near or under your arm.

After a mastectomy, depression, and feelings of sexual identity loss are common. Breast reconstruction surgery seldom results in problems. However, difficulties may arise while you heal. Radiation or chemotherapy treatments may interfere with these issues. Other dangers may exist, depending on your medical condition. Before the procedure, make sure to express any concerns with your doctor.

Is mastectomy a good choice for you?

If any of the following apply to you, a mastectomy may be the best option for you:

• You’ll almost certainly need a mastectomy if the tumor is more than 5 centimeters. Some tumors smaller than 5 cm may still require a mastectomy, while others may be treated with lumpectomy, depending on the stage and other circumstances.
• Your doctor may recommend a mastectomy if your breast is small and a lumpectomy would leave you with very little breast tissue.
• You may need a mastectomy if your surgeon has tried multiple times to remove the tumor with a lumpectomy but has not been able to remove cancer and obtain clear margins.
• You may need a mastectomy if lumpectomy plus radiation isn’t an option for your small tumor (under 4 centimeters). It is because you’ve had prior radiation to the same breast, you have a connective tissue disease (lupus, rheumatoid arthritis), you’re pregnant, or you don’t want to commit to daily radiation treatment.
• You may decide to get a mastectomy if you believe it will provide you with more peace of mind than a lumpectomy.

Mastectomy Plus Reconstruction

Some women choose to have their breasts rebuilt, or reconstructed, at the same time as they have their breasts removed. “Immediate rebuilding” is the term for this. Others may have to wait months or even years for breast reconstruction.

Breast reconstruction can be done in a variety of methods. Inserting an implant, utilizing tissue from another region of your body, or using a mix of procedures are all options.

One advantage of rapid reconstruction is that you don’t have to worry about the emotional impact of having a space where your breast used to be when you wake up from surgery. However, with all of the other decisions they must make, making decisions concerning rapid reconstruction can be daunting for some women. Whether you’re considering immediate or delayed breast reconstruction, it’s necessary to schedule your procedure at a time that is convenient for you. Women who require immediate chemotherapy, for example, may experience delays as a result of reconstruction surgery recovery. Radiation to a rebuilt breast, according to several surgeons, can damage the appearance and feel of the reconstruction. As a result, breast reconstruction should be postponed until both chemotherapy and radiation have been completed.

Preparation for Mastectomy Surgery

Before surgery, you’ll get instructions about any restrictions and other important information, such as:

• Any drugs, vitamins, or supplements you’re taking should be disclosed to your doctor. Some chemicals may cause complications during surgery.
• Stop taking aspirin or any other blood thinners. Talk to your doctor a week or more before your operation about which medications you should avoid because they can raise your risk of severe bleeding. Aspirin, ibuprofen (Advil, Motrin IB, and others), and other pain relievers, as well as blood-thinning drugs (anticoagulants) like warfarin, are among them (Coumadin, Jantoven).
• 8 to 12 hours before surgery, don’t eat or drink anything. Your health care staff will provide you with detailed instructions.
• Prepare for a hospital stay. Inquire with your doctor about how long you should expect to be in the hospital. Bring a robe and slippers to the hospital to help you feel more at ease. Pack a bag with your toothbrush and a book to keep you occupied while you wait.

After your mastectomy surgery, you’ll be sent to the recovery room, where nurses will monitor your heart rate, body temperature, and blood pressure. Let someone know if you are in discomfort or sick from the anaesthetic so that you can be given medicine. After that, you’ll be admitted to a hospital room. The usual length of stay in the hospital for a mastectomy is three days or fewer. You may spend a little longer in the hospital if you get a mastectomy and reconstruction at the same time. Your surgeon or nurse will show you an exercise plan the morning after your surgery to help avoid arm and shoulder stiffness on the side where you had the mastectomy, as well as the production of considerable scar tissue. Until the drains are eliminated, some exercises should be avoided. To ensure that the fitness plan is correct for you, ask your surgeon any questions you may have. In addition, your surgeon should provide you with written and graphical instructions on how to perform the exercises.

At-home Recovery

Mastectomy surgery might take a few weeks to recover from, and reconstruction can take even longer. You must take the time you need to recover.

Here are some general tips to follow at home in addition to your surgeon’s instructions:

Rest: You will almost certainly be exhausted when you return home from the hospital. Allow yourself to take it easy in the weeks following surgery. Learn more about how to deal with weariness.

Medication: Around the breast incision and the chest wall, you’ll probably experience a mixture of numbness and pain (and the armpit incision, if you had axillary dissection). Take pain medicine as prescribed by your doctor if you feel the need. Learn how to deal with chest pain, armpit discomfort, and overall discomfort.

Exercise: It’s important to do arm exercises regularly to avoid stiffness and maintain arm flexibility.

Take sponge baths: When your drains and any staples or stitches have been removed, you can take your first shower. Until your doctor approves showers or baths, a sponge bath will suffice.

References:

• • Gieni M, Avram R, Dickson L, et al. Local breast cancer recurrence after mastectomy and immediate breast reconstruction for invasive cancer: a meta-analysis. Breast 2012;21(3):230–236.
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  • Jagsi R, King TA, Lehman C, Morrow M, Harris JR, Burstein HJ. Chapter 79: Malignant Tumors of the Breast. In: DeVita VT, Lawrence TS, Lawrence TS, Rosenberg SA, eds. DeVita, Hellman, and Rosenberg’s Cancer: Principles and Practice of Oncology. 11th ed. Philadelphia, Pa: Lippincott Williams & Wilkins; 2019.
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  • National Cancer Institute. Physician Data Query (PDQ). Breast Cancer Treatment – Patient Version. 2021.
  • National Comprehensive Cancer Network (NCCN). Practice Guidelines in Oncology: Breast Cancer. Version 4.2021.
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