What is Mastectomy?
Mastectomy is a surgical procedure performed to remove one or both breasts. It is done either partially or completely. A Mastectomy is performed as a treatment of breast cancer or as a preventive measure of breast cancer.
Is the Mastectomy procedure an elective or an emergency procedure?
Mastectomy is an elective procedure.
There are different types of mastectomies. The type of Mastectomy chosen depends upon the size, location, and severity of the tumor, number of tumors, and rate of recurrence of the tumor. Types of Mastectomy procedures are listed below.
- Simple or Total Mastectomy: Simple Mastectomy refers to the removal of 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 is removed along with fatty tissue and lymph nodes.
- Radical Mastectomy: Radical Mastectomy refers to removing the entire breasts, chest wall muscles, and also 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 a natural appearance of the breast 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 resection 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 in a hope of preventing breast cancer in the future.
It is performed in the following cases:
- Having any kind of 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 tumors in the breasts
- Having a tumor that involves more than one area in the breast
- Having a large tumor in the breast that could not be reduced with chemotherapy
- Having a large tumor 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:
- 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
- Mammogram and other imaging tests like ultrasound and MRI
- Blood tests
- Chest x-ray
- Breast biopsy
- Bone scan, PET scan are also recommended to check for metastasis
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
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 blood oxygen levels are continuously 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 tissue and all other tissues that are affected. Drainage tubes are placed into the breast area or the armpit. These drains collect the excess fluid that accumulates in the space of the tumor. The incision is closed with stitches and a sterile bandage is applied over the surgical site.
Postoperative instructions after Mastectomy are:
- Pain medications as prescribed by the physician for pain and discomfort
- Apply ice packs to the surgical area for reducing 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 either fitted into the bra or can be attached to the chest with a special adhesive. Breast prostheses are available in different size, shapes, and colours.
Complications after a Mastectomy includes:
- 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
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 and the duration of the stay is anywhere from 1 to 3 days. If radiation or chemotherapy is required after the surgery, the hospital stay can extend.
Suggested clinical specialist/ Department to consult for the procedure