Mastectomy


Article Context

  1. Overview
  2. Indications of Mastectomy
  3. Procedure
  4. Mastectomy vs lumpectomy
  5. Care at Medicover
  6. Frequently Asked Questions

Overview

A mastectomy is a surgical procedure which involves the removal of all or part of the breast. The surgery is done most often to treat breast cancer. Breast cancer is a major public health problem for women throughout the world. In India, the projected incidence of breast cancer in females is 1in 29 females in their lifetime.

Risk factors for breast cancer include increased age, family history of breast cancer, genetic mutations and radiation exposure.

There are different types of mastectomies based on how the surgery is done and the amount of tissue removed.

Types of Mastectomy

Simple mastectomy: Breast removal without breast reconstruction. The surgeon removes the entire breast, including the nipple, areola and skin. The Oncologist removes the lymph nodes during the procedure unless the surgery is to prevent breast cancer from developing. This surgery is used to treat early forms of breast cancer.

Skin sparing mastectomy: The entire breast tissue, including the nipple and areola, is removed by the oncologist, but the skin is left in place. Breast reconstruction is done right away for patients with this type of surgery.

Nipple-sparing mastectomy: The surgeon can remove the breast tissue while leaving the skin, areola and nipple. This surgery is only an option when the cancer is not detected in the tissue underneath the nipple. A patient who has this type of surgery will have breast reconstruction done immediately.

Modified radical mastectomy: It involves the removal of the breast tissue and all lymph nodes. The surgeon performs this procedure in patients with advanced breast cancer. Removing the lymph nodes allows the doctor to determine whether cancer has spread beyond the breast.

Double mastectomy: The surgeon removes both breasts in this procedure. Patient who has a high risk of breast cancer may undergo this surgery as a part of risk reduction.

Indications of mastectomy:

Patient with new lump in the breast, redness in the nipple area, pain in any area of breast and abnormal discharge from nipple are suggestive of breast cancer. The following are few indications to treat breast cancer through mastectomy.

  • Patients with advanced disease.
  • Tumours which are multicentric and multifocal of size greater than 5 cm.
  • If the primary tumour has insufficient margins and the breast is too small to allow for a more extensive removal.
  • If the breast-conserving surgery is found to be inadequate in controlling the tumour.
  • Prophylactic mastectomy- Some patients who have a high risk of malignancy due to a strong family history of breast cancer.

Procedure:

Before the procedure:

  • The oncologist advises medical tests such as x-rays, CT-scan and other biochemistry reports to study and understand the state of cancer present.
  • The doctor takes into consideration the size and location of the tumour, the number of tumours present and the extent of their margins.
  • The doctor also looks for other general conditions such as age, family history, Allergies before taking the patient for surgery.
  • A week prior to the surgery, blood-thinning medications such as aspirin are withdrawn.
  • The patient will be prepared for the surgery by the caregivers in the hospital.

During the Procedure:

  • The oncologist makes an incision at the accurate area after making the relevant marks on how the surgery should be done.
  • Based on where the tumour is lodged, the surgeon may go in for partial mastectomy, a total or modified radical mastectomy procedure.
  • After the tumour is removed, the surgeon stitches up the incision after which dressing is done.
  • The surgery may take more than 2 hours.

After the procedure:

  • The patient will be kept in the intensive care unit for the first 48 hours. Once the condition has improved, he is shifted to a normal ward.
  • The stay in the hospital will be about 1 week to 10 days.
  • The patient will be encouraged to walk and do his routine activities.
  • Antibiotics are given for the sutures to heal faster.
  • The treatment may be accompanied by radiotherapy and chemotherapy as per the patient condition.
  • Any fluid accumulation near the surgical area will be drained by needle aspiration.
  • Strenuous activity should be avoided during the first three months.
  • A Physiotherapist is required to assist to regain shoulder motion.

Precautions after the surgery:

  • Do not remove the dressing or stitches. If the dressing falls off, do not attempt to replace them.
  • Avoid strenuous activity, heavy lifting and vigorous exercise until the stitches are removed.
  • Avoid taking a bath until the surgical site is completely healed.
  • Removal of lymph nodes may affect the lymphatic fluid drainage from your arm, neck and chest on the affected side and cause swelling, so raise the arm above the elbow level to drain the lymph.
  • If you notice any swelling, redness or warmth in the treated area, immediately inform your doctor.

Mastectomy vs lumpectomy

Mastectomy and lumpectomy are both performed to remove breast cancer. Both are effective but they differ in some features which we will discuss further. Your doctor will help you decide which is best for you.

Mastectomy Lumpectomy
Surgical removal of the entire breast. Breast-conserving surgery in which a portion of the breast containing the cancer tissue is removed.
It is a major surgery done under general anaesthesia. It is a less extensive surgery performed under general anaesthesia.
Recovery ranges from 4-8 weeks depending on whether lymph nodes were removed or if breast reconstruction was performed. Recovery ranges from a few days to 2 weeks depending on whether lymph nodes were removed or not.
There is no chance of recurrence. Chances of recurrence of the lump.

Care at Medicover

Medicover hospital has the top surgical oncologists who diagnose and treat breast cancer bringing highly successful outcomes. Medicover hospital is equipped with advanced technology to perform mastectomy with precision, safety and expertise. Oncologists at Medicover have performed many complex surgeries with successful outcomes.


Frequently Asked Questions:

After a mastectomy without breast reconstruction, it can take three to four weeks to feel mostly normal. If you also have breast reconstruction, recovery can take six to eight weeks. For some procedures, it can take months before you can return to being fully active.

Wound infection or bleeding, swelling of the arm, short term breast swelling, hardness due to scar. This can be treated by medicines, exercise or massage.

Once surgery is completed, you will most likely have drains that are coming out of your body and being held in place with stitches. So, drain lanyard for shower is required.Mastectomy pillow and shower seat.

You can expect moderate amount of pain after the surgery. The pain lasts 3 to 5 days and can be controlled with anti inflammatory drugs.

A breast oncology surgeon removes breast based on the amount of the portion of tissue involved.

References:

  • https://www.cancer.org/cancer/breast-cancer/living-as-a-breast-cancer-survivor/follow-up-care-after-breast-cancer-treatment.html
  • https://www.mskcc.org/cancer-care/patient-education/about-your-mastectomy
  • https://www.breastcancer.org/treatment/surgery/mastectomy-vs-lumpectomy