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Mastectomy

Mastectomy is the medical term for the surgical removal of one or both breasts,
partially or completely. It is
usually done to treat breast
cancer; in some cases,
women and some men
believed to be at high risk
of breast cancer have the
operation prophylactically,
that is, to prevent cancer
rather than treat it. It is also
the medical procedure
carried out to remove Modified Radical
Radical Mastectomy.
breast cancer tissue in Mastectomy.
males.

Description

Description

General anesthesia is
administered during
mastectomy, and an ECG
monitor (electrocardiogram)
is connected to the patient
to monitor heart rates. Simple (total)
Blood pressure and vital Partial Mastectomy
Mastectomy.
signs are also monitored
throughout the surgery.
• For a subcutaneous mastectomy, the surgeon removes the entire breast
but leaves the nipple and areola (the pigmented circle around the nipple) in
place.
• For a total or simple mastectomy, the surgeon cut breast tissue free from
the skin and muscle and removes it. The nipple and the areola are also
removed. The surgeon may do a biopsybiopsy of nearby lymph nodes to see if
the cancer has spread.
• For a modified radical mastectomy, the surgeon removes the entire breast
along with the lining over some of the muscles. Some of the lymph nodes
underneath the arm are also removed.
• For a radical mastectomy, the surgeon removes the overlying skin, all of the
lymph nodes underneath the arm, and the chest muscles. This surgery is not
done unless breast cancer has spread to your chest wall muscles.
• The skin is closed with sutures (stitches) or tape (Steri-Strips).
The drainage tube placed in the breast or under the arm removes blood and lymph
node fluid accumulated during the healing process. Drainage tubes are usually
removed within two weeks, when the drainage is reduced to less than 30 ccs (1 fluid
oz) per day.
Your surgeon may be able to reconstruct the breast (with artificial implants or tissue
from your own body) during the same operation. You may also choose to have
reconstruction later.
Mastectomy generally takes 1 to 3 hours.
Possible effects of mastectomy include:
• wound infection
• hematoma (blood trapped in the wound)
• seroma (clear fluid trapped in the wound)
• lymphedema: temporary to permanent limitations of arm/shoulder movement
(if lymph nodes are removed during the operation)
• numbness in the upper-arm skin
• phantom breast pain

Mastectomy indications
Despite the increased ability to offer breast-conservation techniques to patients
with breast cancer, there exist certain groups who may be better served by
traditional mastectomy procedures including:
• women who have already had radiation therapy to the affected breast
• women with 2 or more areas of cancer in the same breast that are too far
apart to be removed through 1 surgical incision, while keeping the
appearance of the breast satisfactory
• women whose initial lumpectomy along with (one or more) re-excisions has
not completely removed the cancer
• women with certain serious connective tissue diseases such as scleroderma,
which make them especially sensitive to the side effects of radiation therapy
• pregnant women who would require radiation while still pregnant (risking
harm to the fetus)
• women with a tumor larger than 5 cm (2 inches) that doesn't shrink very
much with neoadjuvant chemotherapy
• women with a cancer that is large relative to her breast size
• Women who have tested positive for a deleterious mutation on the BRCA1 or
BRCA2 gene and opt for prophylactic removal of the breasts
• male breast cancer patients

Why the Procedure is performed?

Why the Procedure is Performed


WOMAN DIAGNOSED WITH BREAST
CANCER
The most common reason for a
mastectomy is breast cancer.
Mastectomy may treat several types of breast cancer: invasive ductal carcinoma,
invasive lobular carcinoma, medullary carcinoma, mucinous and tubular
carcinomas, inflammatory carcinoma, Paget's diseasePaget's disease, ductal
carcinoma in situ (DCIS), and lobular carcinoma in situ (LCIS).
If you are diagnosed with breast cancer, talk to your doctor about your choices:
• Surgery where only the breast cancer and tissue around the cancer are
removed. This is called breast conservation therapy (breast lump
removalbreast lump removal). Part of your breast will be left.
• MastectomyMastectomy: all breast tissue is removed.
You and your doctor must consider:
• The size of your tumor, where in your breast it is located, whether you have
more than one tumor in your breast, how much of your breast the cancer
affects, and the size of your breasts
• Your age, family history, overall health, and whether you have reached
menopause
• Whether the cancer has spread to your lymph nodes or other parts of the
body
• The type of breast cancer you have. This is important because some types of
breast cancer are more likely to spread or come back.
The choice of what is best for you can be difficult. Sometimes, your doctor may
recommend one type of surgery. This is because your doctor can tell you what is
known about the type of cancer you have and your risk factors. Other times, your
doctor will talk with you about two or more surgical treatments that would be good
for your cancer.

WOMEN AT HIGH RISK FOR BREAST CANCER


Your doctor may do either a subcutaneous or total mastectomy to reduce your risk
of breast cancer if you are at very high risk of developing breast cancer. This is
called prophylactic mastectomy.
You may have a higher risk of getting breast cancer if one close family relative, or
more, has had breast cancer, especially at an early age. Genetic tests (such as
BRCA1 or BRCA2) may also show you have a high risk. This surgery should be done
only after very careful thought and discussion with your doctor, a genetic counselor,
your family, and others.
Mastectomy greatly reduces, but does not eliminate, the risk of breast cancer.
The risks for breast removal are:
• Skin loss or long-term wounds on the chest wall
• Bleeding into the area where the breast used to be. Sometimes a second
operation is needed to control bleeding.
Before the Procedure

Before the Procedure


You will have many blood and imaging tests (such as CT scansCT scans, bone
scansbone scans, and chest x-raychest x-ray) after your doctor finds breast cancer.
Your surgeon will want to know whether your cancer has spread to the liver, lungs,
bones, or somewhere else.
Always tell your doctor or nurse if:
• You could be pregnant.
• You are taking any drugs or herbs you bought without a prescription.
During the week before the surgery:
• Several days before your surgery, you may be asked to stop taking aspirin,
ibuprofen (Advil, Motrin), naproxen (Aleve, Naprosyn), vitamin E, clopidogrel
(Plavix), warfarin (Coumadin), and any other drugs that make it hard for your
blood to clot.
• Ask your doctor which drugs you should still take on the day of the surgery.
On the day of the surgery:
• Do not eat or drink anything after midnight the night before the surgery.
• Take your drugs your doctor told you to take with a small sip of water.
• Shower the night before or the morning of the procedure.
• Your doctor or nurse will tell you when to arrive at the hospital.

After the Procedure

After the Procedure


You may stay in the hospital for 1 to 3 days, depending on the type of surgery you
had. If you have a simple mastectomy, you may go home on the same day. Most
women go home after 1 to 2 days. You may stay longer if you have breast
reconstruction.
Many women go home with drains still in their chest. The doctor then removes them
later during an office visit.
You may have pain around the site of your incision after surgery.
Fluid may collect in your armpit. This is called a seroma and is relatively common. It
usually goes away on its own, but it may need to be drain.

Outlook (Prognosis)

Outlook (Prognosis)
Most women recover well after mastectomy.
In addition to surgery, you may need other treatments for breast cancer. These
treatments may include hormonal therapyhormonal therapy, radiation
therapyradiation therapy, and chemotherapychemotherapy. All have their own side
effects. Talk to your doctor.
Your breast cancer may respond differently to surgery and other treatments for
many reasons. Talk to your doctor about these reasons.
Support and Counseling
A woman who undergoes a mastectomy has to deal with not only the stress of
coping with the cancer but also the anguish of losing her breast. Interacting with
other women who have undergone mastectomies can help in dealing with these
feelings. If a woman lives in the United States, she can locate the Reach to
Recovery program in her area at the Web site of the American Cancer Society,
Support for Survivors and Patients, Reach to Recovery.

When to Seek Medical Care


• A woman should contact a health-care provider if any of the following occur
after a mastectomy:
• fever,
• signs of an infection (such as excessive redness at the incision site),
• increased drainage of fluid, or
• the stitches come out.