Mastectomy

Mastectomy is a type of surgery that can be done to remove all breast tissue from a breast in order to prevent or treat breast cancer.

Some facts about Mastectomy:

• Mastectomy is one of the treatment option for those with early stage breast cancer.
• Lumpectomy is a type of breast conserving surgery, in which only the tumor is removed from the breast, may be another option.
• Both mastectomy and lumpectomy are equally effective for preventing a recurrence of breast cancer.
• Breast skin can be preserved by new mastectomy techniques, also known as skin sparing mastectomy which allow for a more natural breast appearance following the procedure.
• Breast reconstruction in which surgery is done to restore shape to your breast, can be done at the same time as your mastectomy or during a second operation at a later date.
• Mastectomy can be done to remove one breast, unilateral mastectomy or both breasts known as bilateral mastectomy.
• Ductal carcinoma in situ (DCIS), or noninvasive breast cancer, Stages I and II (early-stage) breast cancer, Stage III (locally advanced) breast cancer after chemotherapy, inflammatory breast cancer after chemotherapy, Paget's disease of the breast and locally recurrent breast cancer can be treated by doing a Mastectomy.
• Mastectomy is recommended if you have two or more tumors in separate areas of the breast.
• It can be done if the breast cancer has recurred in the breast after a radiation treatment to the breast region.
• Mastectomy is recommended if cancer is still present at the edges of the operated area after a lumpectomy and there is a chance of extending the cancer to elsewhere in the breast.
• It is also recommended if you have a large tumor relative to the overall size of your breast and may not have enough healthy tissue left after a lumpectomy.
• A Mastectomy will be performed in case you have widespread or malignant-appearing calcium deposits (microcalcifications) throughout the breast which are determined as cancer after a breast biopsy.
• Mastectomy is a better option if you are pregnant as radiation will create an unacceptable risk to your unborn child.
• You may not tolerate the side effects of radiation to the skin if you have a connective tissue disease, such as scleroderma or lupus.In such cases Mastectomy could be an option.
• Mastectomy can also be considered if you don't have breast cancer, but have a very high risk of developing the disease.
• A preventive or risk reducing mastectomy can be done to remove both of your breasts that significantly reduces the risk of developing breast cancer in the future.
• A very high risk of breast cancer is determined by a strong family history of breast cancer or the presence of certain genetic mutations that increase the risk of breast cancer.
• Bleeding, infection, pain, swelling (lymphedema) in your arm if you have an axillary node dissection, formation of hard scar tissue at the surgical site, shoulder pain and stiffness, numbness, particularly under your arm, from lymph node removal and buildup of blood in the surgical site (hematoma) are some of the possible risk of mastectomy.

Preparation for Mastectomy:

• You will meet with a surgeon and an anesthesiologist to discuss your operation, review your medical history and determine the plan for your anesthesia before your surgery.
• Make sure you understand the procedure, including the reasons for the surgery and risks of the surgery before your mastectomy.
• Discuss with your doctor whether you will have breast reconstruction and when. It can be done immediately after your mastectomy, while you are still anesthetized or later.
• Inform your doctor about any medications, vitamins or supplements you're taking as some substances could interfere with the surgery.
• Aspirin, anti-inflammatory drugs and herbal supplements, which can increase bleeding should be avoided.
• You may have restrictions on eating and drinking and which medications you can take before your procedure.
• Your hospital stay depend on your recovery.

Procedure for Mastectomy:

Simple or total mastectomy, modified radical mastectomy, radical mastectomy, partial mastectomy, and subcutaneous (nipple-sparing) mastectomy are the five different types of mastectomy.

Simple or total mastectomy:

• A simple or total mastectomy can be done for multiple or large areas of ductal carcinoma in situ (DCIS) and for breast removal in order to prevent any possibility of breast cancer occurring, also known as prophylactic mastectomies.
• The entire breast will be removed in a simple or total mastectomy. Axillary lymph node dissection or the removal of lymph nodes in the underarm area will not be performed by the surgeon.
• However, lymph nodes are occasionally removed when they are located within the breast tissue taken during surgery.
• No muscles are removed from the breast.

Modified radical mastectomy:

• Modified radical mastectomy will be done for most people with invasive breast cancer to examine the lymph nodes that helps to identify whether cancer cells may have spread beyond the breast.
• The entire breast will be removed during the procedure.
• Axillary lymph node dissection will be performed to remove levels I and II of underarm lymph nodes.
• No muscles are removed from the breast.

Radical mastectomy:

• Radical mastectomy will be recommended only when the breast cancer has spread to the chest muscles under the breast.
• The entire breast along with levels I, II, and III of the underarm lymph nodes will be removed by the surgeon during the procedure.
• The chest wall muscles under the breast will also be removed by the surgeon.

Partial mastectomy:

• Partial mastectomy involves the removal of the cancerous part of the breast tissue and some normal tissue around it.
• Lumpectomy is a form of partial mastectomy. However, more tissue is removed in partial mastectomy than in lumpectomy.

Nipple-sparing mastectomy:

• All of the breast tissue is removed, sparing the skin, nipple and areola during nipple-sparing mastectomy.
• Breast reconstruction is performed immediately afterward and a sentinel lymph node biopsy also may be done.

The breast tissue and lymph nodes that are removed will be sent to a laboratory for analysis regardless of the type of mastectomy you have. The plastic surgeon will coordinate with the breast surgeon to be available at the time of surgery if you are having breast reconstruction at the same time as a mastectomy. Temporary tissue expanders can be placed in the chest  for breast reconstruction which will form the new breast mound.