Mastectomy

What is Mastectomy?

Mastectomy is a surgical procedure to remove one or both breasts, partially or completely. This procedure is performed as a breast cancer treatment or preventive measure of breast cancer.

Is the Mastectomy Procedure an elective or an emergency Procedure?

Mastectomy is an elective procedure.

Types

There are different types of mastectomies. The type chosen depends upon the tumour's size, location, severity, number of tumours, and recurrence rate. Types of this procedure are listed below.

• Simple or Total Mastectomy: This refers to removing breast tissues, areola, nipple, and skin, but not the lymph nodes. This procedure is done in the treatment of breast cancer.
• Modified Radical Mastectomy (MRM): This is a standard surgical procedure for breast cancer in which the entire breast and fatty tissue and lymph nodes are removed.
• Radical Mastectomy: This refers to removing the entire breasts, chest wall muscles, and lymph nodes in the armpits.
• Skin-Sparing Mastectomy: In this procedure, the breast skin is preserved following a mastectomy procedure. The preserved skin facilitates breast reconstruction surgery and gives the breast a natural appearance following the surgery.
• Nipple-Sparing Mastectomy: In this procedure, breast tissue is removed, but the nipple-areola complex is preserved.
• Extended Radical Mastectomy: Extended radical Mastectomy refers to a radical Mastectomy with resectioning of the internal mammary lymph nodes.
• Prophylactic Mastectomy for High-Risk Women (BRCA gene): This is a surgical procedure to remove one or both breasts to prevent breast cancer.

Indications

It is performed in the following cases:

• Having any breast cancers like noninvasive breast cancer, Paget’s disease of the breast, or inflammatory breast cancer
• Having an early stage of breast cancer
• Having a high suspicion of developing breast cancer, such as ductal carcinoma in situ (DCIS)
• Having two or more tumours in the breasts
• Having a tumour that involves more than one area in the breast
• Having a large tumour in the breast that could not be reduced with chemotherapy
• Having a large tumour that exceeds the size of the breast
• Having recurrent breast cancers
• Having a connective tissue disease such as scleroderma or lupus can cause side effects to radiation therapy
• It is also performed in men with gynecomastia

Contraindications and Risk Factors

• It is not performed in the following ways:
• Individuals having distant metastatic disease
• Individuals who have locally advanced breast cancer that is inoperable
• Individuals having other medical conditions that can impact their overall health after undergoing surgery
• Individuals who cannot receive general anaesthesia
• Elderly aged individuals

Investigations Before The Procedure

Examinations and tests done before a Mastectomy procedure are:

• Complete physical examination including past medical history, family history, social history, and medications are reviewed
• Mammograms and other imaging tests like ultrasound and MRI
• Blood tests
• Chest x-ray
• EKG
• Breast biopsy
• Bone scans, and PET scans, are also recommended to check for metastasis

Preoperative Advice

Preoperative instructions before this procedure:

• Discontinue any blood thinners medications two weeks before the surgery
• Avoid oral intake after midnight on the night before the surgery
• Breast reconstruction surgery is discussed whether to be performed immediately following a Mastectomy or later in the future

Intraoperative details

Anaesthesia: It is performed under general anaesthesia (the patient will be asleep during the surgery).
Duration: The duration depends upon the type of Mastectomy performed.

Description of the procedure

An IV line is placed for adequate hydration. Heart rate, blood pressure, breathing, and oxygen levels are monitored throughout the surgery. The patient is placed in a supine position (lying on the back) on the operating table. The surgical site is cleansed with an antiseptic solution. A cut is made on the breast. The type of cut depends upon the type of Mastectomy performed.
The incision is opened to remove the underlying breast and other affected tissues. Drainage tubes are placed into the breast area or the armpit. These drains collect the excess fluid that accumulates in the space of the tumour. The incision is closed with stitches, and a sterile bandage is applied over the surgical site.

Postoperative details

Postoperative instructions after Mastectomy are:

• Pain medications as prescribed by the physician for pain and discomfort
• Apply ice packs to the surgical area to reduce swelling
• Gentle arm exercises are performed to prevent arm and shoulder stiffness and also to prevent scar tissue formation
• The surgical site should be clean and dry
• Follow-up as scheduled by the physician

Role of Diet/ Exercise/ Lifestyle Changes

Aftercare instructions include:

• Drink plenty of water to stay hydrated
• Pain medications should be taken as prescribed by the physician
• Shower only after the removal of sutures and drains
• Gentle arm exercises should be continued
• Diet as prescribed by the physician
• Avoid tight-fitting clothes
• Avoid heavy lifting for a few weeks
• Breast reconstruction surgery can be chosen to reshape the breast after a Mastectomy. Otherwise, breast prostheses are also available to maintain the shape of the breast. They can be fitted into the bra or attached to the chest with a special adhesive. Breast prostheses are available in different sizes, shapes, and colours.

Complications

Complications after a Mastectomy include:

• Wound infection
• A buildup of blood or clear fluid in the wound
• Breast swelling and pain
• Formation of scar tissue at the site of the incision
• Swelling of the arm if lymph nodes are also removed
• Depression due to loss of breast and defects in body structure and appearance

Prognosis

The overall prognosis of a Mastectomy procedure is good. It is a standard treatment option for treating breast cancer and preventing breast cancer.

Indications for hospitalization if required

A Mastectomy procedure requires hospitalization, lasting anywhere from 1 to 3 days. The hospital stay can extend if radiation or chemotherapy is required after the surgery.

Suggested clinical specialist/ Department to consult for the procedure

Surgical oncologist.