Mastectomy

Mastectomy

Procedure Overview

What is a mastectomy?

A mastectomy is a surgical procedure in which all or a portion of a breast is removed as a part of a treatment plan for breast cancer. In some cases, mastectomy is performed prophylactically (to prevent cancer from occurring) in women with a high risk for developing breast cancer.

Surgical treatment for breast cancer is generally divided into two categories: breast-conserving therapy (BCT) or mastectomy. BCT involves removing the least possible amount of breast tissue when removing breast cancer, and usually includes adjuvant (additional) therapy after surgery, most often radiation therapy.

There are several types of mastectomy procedures:

Some newer mastectomy procedures may offer additional options for surgery. However, further studies are needed to learn whether these procedures are as effective as more standard types of surgery in completely removing or preventing the return of breast cancer.

When all or most of the breast tissue is removed, breast reconstruction surgery may be performed to rebuild the breast. Reconstruction may be performed at the time of the mastectomy or at a later time.

Anatomy of the Breast:

Illustration of the anatomy of the female breast, front
Click Image to Enlarge

Each breast has 15 to 20 sections, called lobes, that are arranged like the petals of a daisy. Each lobe has many smaller lobules, which end in dozens of tiny bulbs that can produce milk.

The lobes, lobules, and bulbs are all linked by thin tubes called ducts. These ducts lead to the nipple in the center of a dark area of skin called the areola. Fat fills the spaces between lobules and ducts.

There are no muscles in the breast, but muscles lie under each breast and cover the ribs.

Each breast also contains blood vessels and vessels that carry lymph. The lymph vessels lead to small bean-shaped organs called lymph nodes, clusters of which are found under the arm, above the collarbone, and in the chest, as well as in many other parts of the body.

Reasons for the Procedure

A mastectomy may be performed as part of a treatment plan for breast cancer.

Women with a high risk for developing breast cancer, such as those with the BRCA1 or BRCA2 gene (tumor suppressor genes associated with breast cancer) along with other increased risks, may choose to undergo prophylactic mastectomy.

The type of surgical procedure performed for breast cancer depends on the type and extent of cancer involved. If the cancerous lump is small and localized, a lumpectomy, a type of BCT, may be performed, rather than a mastectomy. However, if the cancer has spread to other parts of the breast tissue and/or has spread to the lymph nodes under the arm, the physician most likely will choose to perform a mastectomy. The size of the breast involved may also influence the choice of procedure.

There may be other reasons for your physician to recommend a mastectomy.

Risks of the Procedure

As with any surgical procedure, complications may occur. Some possible complications of mastectomy include, but are not limited to, the following:

Seroma (clear fluid trapped in a wound) is normally present after a mastectomy. Troublesome seromas can be drained in a surgeon's office and treated with compression or an injection that helps to harden the space in the breast if necessary.

A linear scar is likely to result at the site of the mastectomy, and many patients experience a pulling sensation near or under their arm after mastectomy.

Depression and feelings of loss of sexual identity may occur after a mastectomy.

There may be other risks depending upon your specific medical condition. Be sure to discuss any concerns with your physician prior to the procedure.

Cosmetic concerns after mastectomy:

Patients undergoing mastectomy may have concerns about the appearance of their breast(s) after the procedure. Fortunately, breast reconstruction is possible for the majority of patients after mastectomy. Often, patients undergoing modified radical mastectomy may undergo breast reconstruction surgery during the same procedure.

The advantages to immediate breast reconstruction include not waking up to the trauma of losing a breast and eliminating the need for additional surgery. Disadvantages include having to consider reconstruction options during an already stressful time prior to surgery for cancer. In addition, complications, though rare, may result during the healing process from reconstruction surgery that may interfere with radiation or chemotherapy treatment.

Your physician will discuss with you your options regarding reconstructive surgery. Alternative solutions after mastectomy include the use of an external prosthesis or a special mastectomy bra.

Before the Procedure

During the Procedure

Illustration of a total mastectomy

A mastectomy requires a stay in the hospital. Procedures may vary depending on your condition and your physician's practices.

Generally, a mastectomy follows this process:

  1. You will be asked to remove clothing and will be given a gown to wear.
  2. An intravenous (IV) line may be started in your arm or hand.
  3. You will be positioned on the operating table lying on your back.
  4. The anesthesiologist will continuously monitor your heart rate, blood pressure, breathing, and blood oxygen level during the surgery.
  5. The skin over the surgical site will be cleansed with an antiseptic solution.
    Illustration of a modified radical mastectomy
  6. An incision will be made in the breast. The type of mastectomy to be performed will determine the type of incision(s) made. (The areas removed during surgery are shaded in green in the illustrations.)
  7. The underlying tissue will be gently cut free and removed.
  8. Lymph nodes may be removed after the breast or breast tissue has been removed.
  9. If breast reconstruction is to be performed along with the mastectomy, a plastic surgeon will perform the procedure after the mastectomy has been completed.
  10. Breast tissue and any other tissues that are removed will be sent to the lab for examination.
    Illustration of a radical mastectomy
  11. One or more drainage tubes may be inserted into the affected area.
  12. The skin will be closed with sutures or adhesive strips.
  13. A sterile bandage/dressing will be placed over the site.

After the Procedure

In the hospital:

After the procedure, you will be taken to the recovery room for observation. Your recovery process will vary depending upon the type of procedure performed and the type of anesthesia that is given. Once your blood pressure, pulse, and breathing are stable and you are alert, you will be taken to your hospital room.

After a mastectomy, patients generally stay two to three days or longer in the hospital, depending on the extent of the surgery and if reconstruction surgery was also performed.

The extent of pain depends on the amount and location of tissue removed during surgery. Most soreness may last about two to three days, although many mastectomy patients do not experience soreness after surgery. Take a pain reliever for soreness as recommended by your physician. Aspirin or certain other pain medications may increase the chance of bleeding. Be sure to take only recommended medications.

Radiation therapy or chemotherapy may or may not be necessary after a mastectomy. Your physician will advise you about this depending on your particular situation.

At home:

Once you are home, it is important to keep the surgical area clean and dry. Your physician will give you specific bathing instructions. Unless instructed otherwise, the narrow strips of tape across the incision can become wet during a shower. You may be instructed to replace a wet dressing with a clean, dry one.

You will be instructed about how to take care of the drainage tube, which should be removed after about two weeks at the first followup examination.

If lymph node dissection (removal) was performed with your mastectomy, your physician may recommend that you do exercises to help limber up the shoulder and arm area. Soreness after lymph node dissection may cause you to keep your arm and shoulder as still as possible, leading to arm and shoulder stiffness. Overdoing the exercises could result in injury so they should be started gradually and performed consistently, progressing a little each day. You may be advised to perform these exercises even if lymph node dissection was not a part of your procedure.

Normal activities can usually be resumed within two weeks. Meanwhile, you should avoid strenuous activities, particularly those that involve extensive use of the arm, such as cleaning windows or vacuuming for long periods. Your physician will advise you about when you can start driving again and when you can return to work.

Wearing a loose-fitting bra at bedtime may help make you more comfortable.

If you have problems dealing with your recovery, your physician may refer you to a volunteer agency or group for support.

Notify your physician to report any of the following:

Your physician may give you additional or alternate instructions after the procedure, depending on your particular situation.

Arm care after lymph node removal:

Removal of lymph nodes may affect the drainage of lymphatic fluid from the arm on the surgical side. Problems with lymphatic drainage may result in arm swelling and an increased risk for infection from trauma to the arm. In addition, there is an increased risk for blood clots in the blood veins of the armpit because of surgical trauma in the area.

Life-long precautions to help prevent problems in the affected arm after lymph node dissection include, but are not limited to, the following:

Online Resources

The content provided here is for informational purposes only, and was not designed to diagnose or treat a health problem or disease, or replace the professional medical advice you receive from your physician. Please consult your physician with any questions or concerns you may have regarding your condition.

This page contains links to other Web sites with information about this procedure and related health conditions. We hope you find these sites helpful, but please remember we do not control or endorse the information presented on these Web sites, nor do these sites endorse the information contained here.

American Cancer Society

American Cancer Society

American Society of Clinical Oncology

American Society of Clinical Oncology

National Breast Cancer Foundation

National Breast Cancer Foundation

National Cancer Institute (NCI)

National Cancer Institute (NCI)

National Institutes of Health (NIH)

National Institutes of Health (NIH)

National Library of Medicine

National Library of Medicine

National Women's Health Information Center

National Women's Health Information Center

 

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