Mastectomy - surgery, recovery, breast cancer and risks and complications

What is Mastectomy

A surgical OPERATION to remove the BREAST. Mastectomy is most commonly a treatment for BREAST CANCER. Women who have extraordinarily high risk for breast cancer (such as because of family history or known MUTATION of the BRCA-1/BRCA-2 genes) may choose prophylactic mastectomy, also called risk-reduction mastectomy, to reduce the likelihood that they will develop cancer. Mastectomy is a major surgery that may require two to five days of hospitalization after the operation, depending on the extent of the surgery. Women may choose to have immediate or follow-up breast reconstructive surgery, or no reconstruction.

Mastectomy Surgical Procedure

A woman undergoing mastectomy receives general ANESTHESIA. The operation generally takes two to four hours; mastectomy with reconstruction takes longer than mastectomy alone. There are three types of mastectomy:

• Segmental mastectomy is when the surgeon removes the tumor and the quadrant of breast that contains it. The surgeon may recommend this operation when the breast cancer tumor is small and localized though larger than would be appropriate for lumpectomy (removal of the tumor and a margin of the surrounding breast tissue).
• Subcutaneous mastectomy, also called SKINsparing mastectomy, is removal of the breast tissue with the nipple, areola, and surface skin of the breast remaining. Subcutaneous mastectomy affords the most ideal circumstance for breast reconstruction.
• Total mastectomy, also called simple mastectomy, removes all of the breast tissue including the nipple and areola. The surgeon may recommend total mastectomy when the cancer is diffuse (lacking clear boundaries) or in more than one location within the breast. The surgeon may also perform SENTINEL LYMPH NODE DISSECTION, a method that examines the first LYMPH NODE in the drainage path from the tumor. Whether the sentinel contains cancer cells is an accurate indicator of whether the cancer has spread from the breast.
• Modified radical mastectomy removes all of the breast, including the nipple and areola, as well as the axillary LYMPH nodes (lymph nodes under the arm), called axillary lymph node dissection. This is the operation of choice when the cancer tumor is fairly large or diagnostic scans show the lymph nodes contain cancer.

After removing the breast the surgeon places small tubes to drain fluid from the surgical site during the initial stages of HEALING and then sutures closed the surgical incision. The surgeon removes the drains three to seven days after the operation, usually before the woman leaves the hospital. The nature and extent of scarring and deformity depends on the type of mastectomy. If there are skin sutures, they are usually ready for removal in five to seven days.

Mastectomy Risks and Complications

As with any surgery, the risks of mastectomy include excessive bleeding, INFECTION, and reaction to the anesthesia. These risks are slight. The potential for complications increases with the complexity of the surgery. Women who undergo modified radical mastectomy with axillary lymph node dissection may have significant swelling in the arm on the side of the surgery in the immediate postoperative recovery period as well as intermittently over the long term. Many women undergo adjuvant therapy (follow-up treatment), such as RADIATION THERAPY or CHEMOTHERAPY, after mastectomy for breast cancer. These therapies carry their own risks and do not usually affect the course of healing from the surgery.

Mastectomy - Outlook and Lifestyle Modifications

With early detection and treatment, recovery from both the mastectomy and the breast cancer is complete. Recovery from modified radical mastectomy can take several months, with restrictions on lifting and some physical activities until the area fully heals and swelling (LYMPHEDEMA) is under control. It is difficult to predict who will have ongoing lymphedema; this is a significant longterm risk for any woman whose surgery includes axillary lymph node dissection. Women who choose not to have reconstructive surgery may opt instead for prosthetic bras. Many women have concerns about body image and sexuality; these are potentially significant issues that can affect QUALITY OF LIFE. Some women find SUPPORT GROUPS helpful.

See also CANCER TREATMENT OPTIONS AND DECISIONS; HORMONE-DRIVEN CANCERS; PAGET’S DISEASE OF THE BREAST; PLASTIC SURGERY; SURGERY BENEFIT AND RISK ASSESSMENT.

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