Breast after a mastectomy. Image credit: Flickr
Breast after a mastectomy. Image credit: Flickr

Mastectomy is a surgery that entails total removal of breast(s) in women or men. The surgery is invariably the resort when other breast cancer treatments such as lumpectomy (breast-conserving surgery) cannot treat the cancer. Mastectomy is also performed to treat cancers that have come back post lumpectomy. Some women who currently do not have breast cancer but are extremely likely to develop one in the future could opt for a mastectomy. The surgery is typically carried out under general anesthesia and should not take more than a couple of hours to complete.

Generally, mastectomy is a treatment option for women suffering from breast cancer types such as non-invasive breast cancer (for instance – ductal carcinoma in situ), inflammatory breast cancer, Paget disease of the breast, stage 1 or stage 2 breast cancer (also called early-stage breast cancer), or locally advanced or stage 3 breast cancer. Mastectomy can affect the patient both on a physical and emotional level. Any pre-surgery doubts can be clarified with the surgeon or specialist nurse. The nurse could offer practical advice about breast implants and bras to be used after surgery.

Types

There are different types of mastectomies:

Total Mastectomy

Also called simple mastectomy, total mastectomy means removal of the entire breast. In other words, the focus here is on the breast tissue, and the lymph nodes within the underarm region and muscles beneath the breast aren’t removed. However, at times, the lymph nodes could also be removed if they are situated in the breast tissue. Total mastectomy is performed to ensure there is no likelihood of the breast cancer recurring.

Preventive Mastectomy

This mastectomy type is a preventive measure where one or both the breasts are removed to mitigate breast cancer. The procedure can also be referred to as double mastectomy or bilateral mastectomy. The surgery is carried out in women who have cancer in only one breast but have a higher risk of the other breast getting affected as well in the future.

Partial Mastectomy

Partial mastectomy refers to the removal of the breast tissue’s cancerous part and some surrounding normal tissue. This procedure is similar to lumpectomy, but more tissue is taken out in partial mastectomy compared to lumpectomy.

Radical Mastectomy

Radical mastectomy entails removal of the whole breast, along with lymph nodes and chest wall muscles beneath the breast. This mastectomy variant is performed when the cancer cells have made their presence felt in the chest muscles. After a radical mastectomy, the patient’s chest area may look significantly disfigured. This is why it has been replaced by modified radical mastectomy to a great extent, which does the job as effectively and the results are less disfiguring.

Modified Radical Mastectomy

Modified radical mastectomy entails surgical removal of both the lymph nodes and breast tissue. However, the muscles are left in place. Those keen on examining the lymph nodes would opt for this surgery type since studying the lymph nodes helps determine whether the cancer cells have moved beyond the breast.

Skin-Sparing Mastectomy

A skin-sparing mastectomy entails saving as much breast skin possible to use as cover for the reconstructed breast. It’s usually performed when the patient wants immediate breast reconstruction. The breast is then reconstructed using natural breast tissue or a breast implant. The skin-sparing technique is a comparatively new technique and is not ideal when larger tumors are involved. However, the technique is gaining popularity since there are lesser scars and a natural-looking reconstructed breast.

Nipple-Sparing Mastectomy

The nipple-sparing technique is not a lot different from the skin-sparing method. The only difference is instead of the skin, the nipple and areola are preserved. This procedure is recommended to women who have early-stage, small cancer near the external portion of the breast. Moreover, the tumor should not be more than two centimeters in size, and should be located at least two centimeters off from the nipple. The drawback to this surgery is that the nipple could wither or deform, and may also face blood supply issues leading to numbness. The out-of-place nipple would be more apparent in women with larger breasts.

Generally, the mastectomy type performed would depend on several factors such as patient age and general health, tumor size, tumor grade and stage, menopause status, etc. By the way, irrespective of the mastectomy type performed, some lymph nodes and breast tissue would be forwarded to a lab for examination.

Mastectomy Side Effects

Mastectomy’s side effects could vary based on the type of procedure. In case the surgery was extremely extensive in nature, the list of side effects would increase. The likely side effects are:

  • Breast tenderness or pain
  • Swelling at surgery location
  • Hematoma (blood buildup in the wound)
  • Seroma (clear fluid buildup in the wound)
  • Limited shoulder or arm movement (usually temporary)
  • Numbness in the upper arm or chest
  • Nerve pain in the armpit and chest wall
  • Lymphedema is a possibility if armpit or axillary lymph nodes are removed too

The first two weeks after surgery would be the toughest. Even simple things such as brushing hair or opening a bottle of water would be almost next to impossible.

Likely Mastectomy Candidates

Mastectomy is not the treatment option for all breast cancer patients. The surgery is usually recommended during cases such as:

  • Radiation therapy is not an option (for several reasons mentioned below)
  • Previously performed lumpectomy didn’t completely wipe off all the cancer cells
  • Multiple cancer regions in a breast
  • Larger tumor, especially bigger in relation to the size of the breast – meaning more unhealthy tissue than healthy tissue
  • Factors such as a BRCA mutation, which could increase the possibility of another cancer
  • Inflammatory breast cancer

Radiation therapy is usually not preferred if the patient has had the therapy before to little or no effect; the patient is pregnant (radiation can harm the fetus); a major connective tissue disorder such as lupus or scleroderma, which could make the patient particularly sensitive to radiation therapy’s side effects. At times, a mastectomy could be performed to address non-breast cancer issues such as severe recurring breast pain, dense breast tissue, fibrocystic breast disease (noncancerous condition), or when the individual has breast cancer in the family.

Recovery & Care

Women who’ve had a mastectomy done would invariably stay put in the medical center for a few nights, usually not more than a week. During the hospital stay, the patient would be under observation. Blood pressure, heart rate, feelings of nausea, and pain level would be regularly checked during the phase. Once everything is clear, the patient could head home. However, the recovery thereafter may take several weeks. The actual time taken to recover would vary across individuals and also depend on the procedure performed. For instance, if the mastectomy was accompanied by a breast reconstruction procedure, the recovery period could be longer.

The majority of women get back to normal life within a month, provided only a mastectomy was performed. If breast reconstruction was carried out too, the recovery could take a few months. During recovery, the hospital would provide instructions on how to bathe, take good care of the operated breast(s), recognize infection signs, exercises to perform and not to perform, types of clothes to wear, when to wear a bra again, foods to eat and food items to avoid, follow-up appointment details, etc. During the early recovery stages, tubes could be inserted into the wound to drain away fluids and blood to prevent infection or swelling. The stitches and scars would be dressed up. The tubes come off usually within two weeks.

Is Mastectomy Superior?

Compared to other cancer treatments such as a lumpectomy or radiation therapy, mastectomy doesn’t mean the patient would survive for longer, or the result would be better. As far as the issue of breast recurrence is concerned, a mastectomy would only reduce the risks of another cancer developing in the breast treated. It doesn’t decrease the possibilities of cancer affecting the other breast or any other body part.

Mastectomy and Breast Reconstruction

Some mastectomy patients prefer to undergo a breast reconstruction surgery as well to restore the breast’s original or pre-surgery look as much as possible. Breast reconstruction surgery could be performed right after the mastectomy or could be postponed to a later date. However, not all women prefer reconstruction. In case of no reconstruction surgery to follow, the surgeon would leave the region flat to make room for a breast implant.