Mastectomy

Definition of Mastectomy

A mastectomy is a surgical procedure in which part, or all, of the breast is removed. Healthy tissue around the breast as well as lymph nodes in the armpit, may also be removed. The most common types of mastectomy are:

• modified radical mastectomy, which involves removal of the whole breast. Most of the lymph nodes under the arm are removed, a procedure called axillary node dissection. The lining of the chest muscles may also be removed.
• radical mastectomy, also known as a Halsted radical mastectomy. This procedure is seldom used today. It involves the removal of the breast, both chest muscles, all lymph nodes in the armpit, and surrounding fat and skin.
• total, or simple, mastectomy. This operation involves the removal of the entire breast and sometimes lymph nodes from the armpit
• segmental, or partial, mastectomy. This procedure involves the removal of the cancer and an area of healthy tissue around it.

Some breast lumps are removed with breast-sparing surgeries, such as a lumpectomy.

Who is a candidate for the procedure?

A mastectomy is generally done in women with a diagnosis of breast cancer. It may occasionally be recommended for a woman with a strong family history of breast cancer but who has not developed it herself, to prevent a cancer from occurring in her breasts Women who are positive for a breast cancer gene, such as BRCA 1 and BRCA 2, may choose mastectomy for the same reason.

How is the procedure performed?

The woman is put to sleep under general anesthesia. The skin over the affected breast, the chest, and the upper arm is cleansed with an antiseptic. An incision is made that may or may not include the nipple and the pigmented skin around the nipple, called the areola.

The incision may be horizontal from the breastbone to the underarm. Occasionally, if the tumor is higher up, the incision is diagonal from the upper part of the armpit down to the breastbone. The surgeon may be able to include any previous biopsy incision, for cosmetic reasons.

The breast tissue is then removed and sent to the laboratory for analysis Some women choose to have a reconstruction with placement of a fluid-filled implant done at this same time. Other women may have that done at a later time, or not at all.

The chest wall incision is closed with sutures or staples. Small tubes are placed through the skin to drain any fluid that might build up in the area. A large bandage is placed over the incision and taped firmly in place. This pressure dressing keeps the skin against the chest wall muscles. This reduces the fluid buildup and promotes drainage.

What happens right after the procedure?

The woman will be kept in the surgery recovery room for a short period of time. She will have an intravenous line (IV) and oxygen tube. The throat may be sore from the breathing tube used during the surgery. She will be asked to cough and breathe deeply to clean out the lungs and prevent pneumonia. Pain medication will be given as needed.

Back in the hospital room, the woman will usually need help getting up the first time. After that, she will be encouraged to get up and move about. If she is able to eat, drink, and urinate, she may be able to go home the next day. The bandages and drains remain in place until they are removed by the surgeon. Home care instructions are given.

What happens later at home?

The woman may need to periodically empty a reservoir attached to the drains. Care must be taken to keep all items clean to prevent infection. Proper hand-washing is very important before and after emptying the drains or changing dressings. A change in color or increase in the amount of drainage should be noted and reported to the surgeon.

Pain medications are given, but the pain is not usually severe. The surgeon will let the woman know what activities are allowed in the first few days after surgery. After healing, the woman will have a flat, normally shaped chest wall if the breast was not reconstructed at the time of the operation. The scar runs diagonally or horizontally from near the breastbone to the edge where the breast tissue was.

Reconstructive surgery can be done at any time to improve the cosmetic results. Many women feel sad or depressed after mastectomy. They may have concerns about body image and sexuality. Any diagnosis of cancer brings with it the fear of death. A woman experiencing these feelings should tell a healthcare professional so that she can be provided with the correct facts and learn about resources that can help. Support groups are available that bring together groups of woman who have had similar disease and treatment experiences.

What are the potential complications after the procedure?

Surgery can be complicated by bleeding, infection, or an allergic reaction to the anesthetic.

Other complications of mastectomy can include:

• Fluid can accumulate under the skin flaps.
• Cell death of the skin edges of the incision is uncommon, but it may occur if the skin flaps are very thin or if there is tension at the incision site.
• Numbness along the skin in the underarm area and upper arm can be caused by damage to the nerves that travel through the area of the lymph nodes that were removed during surgery. Although it might take some time, this complication may go away.
• Some people have severe, sharp, shooting, or burning pain along the chest wall, which is also called postmastectomy pain syndrome. This is frequently caused by nerve damage.
• Swelling of the arm on the side of the surgery, called lymphedema, can occur months or even years after surgery, due to damage to the lymph vessels that drain the area.

The following steps can help prevent lymphedema:

• Do not have blood drawn from the involved arm.
• Avoid getting injections in the involved arm.
• Do not have blood pressure taken in the involved arm.
• Avoid any injury to the involved arm, such as cuts, insect bites, or burns.
• Continue physical activity, within the limits recommended by the healthcare professional.

Any new or worsening symptoms should be reported to the healthcare professional.