Mastectomy

MASTECTOMY

Mastectomy is a way of treating breast cancer by removing the entire breast through surgery. It’s often done when a woman cannot be treated with breast-conserving surgery (lumpectomy), which spares most of the breast. It can also be done if a woman chooses mastectomy over breast-conserving surgery for personal reasons. Women at very high risk of getting a second cancer sometimes have a double mastectomy, the removal of both breasts.

Simple (or total) mastectomy

In this procedure, the surgeon removes the entire breast, including the nipple, areola, and skin. Some underarm lymph nodes may or may not be removed depending on the situation. Most women, if they are hospitalized, can go home the next day.

Modified radical mastectomy

A modified radical mastectomy combines a simple mastectomy with the removal of the lymph nodes under the arm (called an axillary lymph node dissection).

Double mastectomy

If a mastectomy is done on both breasts, it is called a double (or bilateral) mastectomy. When this is done, it is often a risk-reducing surgery for women at very high risk for getting breast cancer, such as those with a BRCA gene mutation. Most of these mastectomies are simple mastectomies, but some may be nipple-sparing.

Who should get a mastectomy?

Many women with early-stage cancers can choose between partial mastectomy (lumpectomy, breast conserving surgery) and mastectomy. In most cases, mastectomy does not give you any better chance of long-term survival or a better outcome from treatment than a partial mastectomy. Studies following thousands of women for more than 20 years show that when a partial mastectomy is followed by postoperative radiation, the survival is equal to those women that underwent a mastectomy.

Although most women and their doctors prefer partial mastectomy (with radiation therapy) when it’s a reasonable option, there are cases where mastectomy is likely to be the best choice. For example, mastectomy might be recommended if you:

• Are unable to have radiation therapy
• Would prefer a more extensive surgery instead of having radiation therapy
• Have had the breast treated with radiation therapy in the past
• Have already had BCS along with re-excision(s) that did not completely remove the cancer
• Have two or more areas of cancer in the same breast that are not close enough to be removed together without changing the look of the breast too much
• Have a larger tumor (greater than 5 cm [2 inches] across), or a tumor that is large relative to your breast size
• Are pregnant and would need radiation therapy while still pregnant (risking harm to the fetus)
• Have a genetic factor such as a BRCA mutation, which might increase your chance of a second cancer
• Have a serious connective tissue disease such as scleroderma or lupus, which may make you especially sensitive to the side effects of radiation therapy
• Have inflammatory breast cancer

For women who are worried about breast cancer recurrence, it is important to understand that having a mastectomy instead of breast-conserving surgery plus radiation only lowers your risk of developing a second breast cancer in the same breast. It does not lower the chance of the cancer coming back in other parts of the body.

Should I have breast reconstruction surgery after mastectomy?

After having a mastectomy a woman might want to consider having the breast mound rebuilt with the help of a plastic surgeon to restore the breast’s appearance. This is called breast reconstruction. Although each case is different, most mastectomy patients can have reconstruction. Reconstruction can be done at the same time as the mastectomy or sometime later.

If you are thinking about having reconstructive surgery, it’s a good idea to discuss it with your surgeon and a plastic surgeon before your mastectomy. This allows the surgical teams to plan the treatment that’s best for you, even if you wait and have the reconstructive surgery later. Insurance companies typically cover breast reconstruction, but you should check with your insurance company so you know what is covered.

Some women choose not to have reconstructive surgery. Wearing a breast prosthesis (breast form) is an option for women who want to have the contour of a breast under their clothes without having surgery. Some women are also comfortable with just ‘going flat,’ especially if both breasts were removed.

Recovering from a mastectomy: What to expect after surgery

In general, women having a mastectomy stay in the hospital overnight and go home the next morning, but this can vary depending on what procedures were done and the overall health of the patient.

Most women should be fairly functional after going home and can often return to their regular activities within about 4 weeks. Recovery time is longer if breast reconstruction was done as well, and it can take months to return to full activity after some procedures.

Side effects of mastectomy

The side effects of mastectomy depend on the type of mastectomy you have (with more extensive surgeries tending to have more side effects). Side effects can include:

• Pain or tenderness
• Swelling at the surgery site
• Buildup of blood in the wound (hematoma)
• Buildup of clear fluid in the wound (seroma)
• Limited arm or shoulder movement
• Numbness in the chest or upper arm
• Nerve (neuropathic) pain (sometimes described as burning or shooting pain) in the chest wall, armpit, and/or arm that doesn’t go away over time. It is also called post-mastectomy pain syndrome.

As with all operations, bleeding and infection at the surgery site are also possible. If axillary lymph nodes are also removed, other side effects such as lymphedema may occur.

Will more treatment be needed after mastectomy?

Some women might get other treatments after a mastectomy, such as radiation therapy, hormone therapy, chemotherapy, or targeted therapy. Your surgeon and your medical oncologist will be able to help you build your post-operative treatment plan.

References:

American Cancer Society

Susan G Komen