A mastectomy is a surgical procedure in which all or a portion of a breast is removed as a part of treatment 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.
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.
A mastectomy may be performed as part of treatment 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 doctor 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 doctor to recommend a mastectomy.
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 on your specific medical condition. Be sure to discuss any concerns with your doctor prior to the procedure.
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 doctor 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.
A mastectomy requires a stay in the hospital. Procedures may vary depending on your condition and your doctor's practices.
Generally, a mastectomy follows this process:
After the procedure, you will be taken to the recovery room for observation. Your recovery process will vary depending on 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 doctor. 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 doctor will advise you about this depending on your particular situation.
Once you are home, it is important to keep the surgical area clean and dry. Your doctor 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 doctor 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 doctor 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 doctor may refer you to a volunteer agency or group for support.
Notify your doctor if you have any of the following:
Your doctor may give you additional or alternate instructions after the procedure, depending on your particular situation.
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 veins of the armpit because of surgical trauma in the area.
Lifelong precautions to help prevent problems in the affected arm after lymph node dissection include, but are not limited to, the following:
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 doctor. Please consult your health care provider with any questions or concerns you may have regarding your condition.
This page contains links to other websites 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 websites, nor do these sites endorse the information contained here.