Worldwide, breast cancer is the most common cancer and the second leading cause of death in women. Though rare, it can also occur in men.Surgery is the mainstay of cancer therapy in most cases of breast cancer. The surgical options for breast cancer are mastectomy or lumpectomy (breast-conserving surgery).
Mastectomy is a surgical procedure in which an entire breast is removed. It is done when the breast tumoris extensive and cannot be removed by lumpectomy. Women who are at high risk of having cancers in both breasts need to undergo a double mastectomy.
Mastectomy is the preferred treatment option for several types of breast cancer, such as:
- Locally advanced breast cancer(after chemotherapy)
- Ductal carcinoma in situ(DCIS)
- Inflammatory breast cancer (after chemotherapy)
- Early-stage breast cancer
- Paget disease of the breast (breast cancer around the nipple)
- Recurrent breast cancer
Mastectomy may be recommended in the following cases:
- Two or more tumors at different location of the breast
- Recurrence ofbreast cancer after radiation treatment
- Pregnant women with breast cancer who cannot undergo radiation therapy
- The cancerous marginsstill remainafter lumpectomy
- High risk of developing cancer due to gene mutation
- Tumor is too large and has covered almost whole breast
- Widespread microcalcification (calcium deposits) that are identified to be cancer after abiopsy test
- Not fit to bear the side effects of radiation
PREPARATION BEFORE PROCEDURE
During your first appointment with the surgeon, yourmedical, family and medication history will be obtained.Inform your surgeon if you also want to undergo a breast reconstruction surgery.
You may be asked to discontinue blood-thinning medication or painkillersfor a few weeks before surgery, as they increase the risk of bleeding.
You will have toavoid eating and drinking before 8-12 hours of the surgery.
Mastectomy is of various types:
- Total or simple mastectomy: This surgery involves removal of the whole breast, including the nipple, areola, and breast tissue. If required, the sentinel lymph node(the first lymph node where the cancer is likely to spread) may also be removed during the procedure.
- Skin-sparing mastectomy: In this method, the whole breast tissue is removed, including the areola and nipple, leaving the skin intact. Immediately after this procedure, a breast reconstruction can be done by using the tissue from other parts of the body. This procedure is preferred by many women, as it leaves less scar tissue and provides a reconstructed breast that appears natural. However, it can be done in case of large tumor or tumors near to the skin surface.
- Nipple-sparing mastectomy:In this procedure, the breast tissue is removed, but the skin, areola, and nipple are left intact. It is mostly recommended in women who have early-stage, small cancer near the outer surface of the breast with no signs of cancer near the nipple or skin. Breast reconstruction can be done immediately after the procedure. Sometimes, sentinel lymph node biopsy may also be done during the procedure.
- Modified radical mastectomy: It is a combination of simple mastectomy along with the removal of lymph nodes in the armpit (axillary lymph nodes). In patients with invasive breast cancer who plan to undergo mastectomy, a radical mastectomy is done to removethe lymph and evaluate whether the cancer cells have spread to the lymph nodes.
- Radical mastectomy: It is an extensive procedure in which the entire breast, axillary lymph nodes and the chest wall muscle (pectorals) are removed. Nowadays, this procedure is rarely done, as modified radical mastectomy, which is a less extensive procedure with fewer complications is more preferable. However, when there are large tumors that grow into the pectorals, a radical mastectomy is done.
- Double mastectomy: In this method, mastectomy is performed on both breasts. Usually, the mastectomy performed is a total mastectomy, but sometimes it may be a nipple-sparing mastectomy. It can also be performed as a risk-reducing surgery in women with a BRCA gene mutation who have an increased risk of developingbreast cancer.
Mastectomy is performed under general anesthesia. Once the anesthesia is effective, an elliptical incision is made around the breast. Based on the type of procedure, the breast tissues, along with other tissues, are removed. The breast tissue and/or lymph node are sent to the laboratory for test. If planned, breast reconstruction surgery can also bedone after mastectomy.
If the patient has to undergo radiation therapy after surgery, a temporary tissue expander is placed inside the chest. These temporary tissue expanders hold the breast skin in place until the final reconstruction surgery is done.
After completing the procedure, the incision is closed with sutures (stitches). The sutures can be absorbable (get absorbed) or non-absorbable (has to be removed). One or two small tubes are positioned and sewn in the incision area to drain any fluids that accumulatein the chest. These tubes are attached toa small drainage bag.
The patient is shifted to the ward after the surgery. Based on the type of surgery, you may be discharged on the same day or stay for a few days in the hospital.
There can be some pain, pinching sensation, and numbness in the treated area. Some painkillers and antibiotics may be prescribed.
Consult a doctor before wearing a bra or breast prosthesis.
Following measures aid in speedy recovery after mastectomy:
- Avoid lifting heavy weights or doing housework until the doctor permits
- Perform some arm exercises to encourage the movement of shoulder and arm
- Keep the surgical area clean and dry
- Take care of the drainage tube until it is removed
- Consult the doctor if you notice any signs or symptoms of infection in the incision site.