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Mastectomy

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 2 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.

Hospital Stay: Hospital Stay: 2 days
Duration: Duration: 2-3 hrs
Cost Estimate: Cost Estimate: 1820 USD - 2719 USD These are indicative prices in Indian Hospitals

Types of Mastectomy

The types of mastectomy include:

  • Total (or simple) mastectomy: Removal of the entire breast, including the nipple, the areola, and most of the overlying skin.
  • Modified radical mastectomy: Removal of the entire breast, including the nipple, the areola, the overlying skin, and the lining over the chest muscles. In addition, some of the lymph nodes under the arm, also called the axillary lymph nodes, may be removed. The bean-shaped lymph nodes under the arm drain the lymphatic vessels from the upper arms, the majority of the breast, the neck, and the underarm regions. Often, breast cancer spreads to these lymph nodes, thereby entering the lymphatic system and allowing the cancer to spread to other parts of the body. In some cases, part of the chest wall muscle is also removed.
  • Radical mastectomy: Removal of the entire breast, including the nipple, the areola, the overlying skin, the lymph nodes under the arm, and the chest muscles. For many years, this was the standard operation. However, today a radical mastectomy is rarely performed and is generally only recommended when the breast cancer has spread to the chest muscles.

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:

  • Skin-sparing mastectomy: In this procedure the breast tissue, nipple and areola are removed, but most of the skin over the breast is saved. This type of surgery appears to be similar to modified radical mastectomy in effectiveness for many women. It is used only when breast reconstruction is performed immediately after the mastectomy and may not be suitable for tumors that are large or near the skin surface.
  • Nipple-sparing mastectomy: This is similar to the skin-sparing mastectomy, and it is sometimes referred to as a “total skin-sparing mastectomy.” All of the breast tissue, including the ducts going all the way up to the nipple and areola, are removed, but the skin of the nipple and areola is preserved. The tissues under and around the nipple and areola are carefully cut away and examined by a pathologist. If no breast cancer cells are found close to the nipple and areola, they can be preserved. Otherwise, nipple-sparing mastectomy is not recommended.

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 sections to 20 sections, called lobes, which 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 (tumour 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, which is a type of BCT, may be performed, rather than a mastectomy. However, if the tumour is large with respect to the size of the breast, if it involves more than 1 area of the breast, or if there are contraindications to radiation therapy, doctors usually recommend a mastectomy. The size of the breast involved may also influence the choice of procedure.

Breast Reconstruction

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 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.

Before the Surgery

  • The doctor will explain the procedure to the patient/family and offer the opportunity to ask any questions about the procedure.
  • The patient will be asked to sign a consent form that gives permission to do the surgery. The patient/family must read the form carefully and ask questions if something is not clear.
  • In addition to a complete medical history, the doctor may perform a complete physical examination to ensure that the patient is in good health before undergoing the procedure. The patient may undergo blood tests or other diagnostic tests.
  • The patient will be asked to fast for eight hours before the procedure, generally after midnight.
  • In case of suspected pregnancy or confirmed pregnancy, a mastectomy is usually not performed.
  • The patient / attendant should notify the doctor if she is sensitive to or allergic to any medications, iodine, latex, tape, or anaesthetic agents (local and general).
  • The patient / attendant should notify the doctor of all medications (prescription and over-the-counter) and any herbal supplements that she may be taking.
  • The doctor should be notified if the patient has a history of bleeding disorders or if she is taking any anticoagulant (blood-thinning) medications, aspirin, or other medications that affect blood clotting. It may be necessary to stop these medications prior to the procedure.
  • All jewellery should be removed before the surgery
  • The patient should change into hospital gown. Any excessive hair at the surgical site will be clipped off or shaved.
  • The patient will be sedated before being taken to the operating room and will be asleep for the procedure.
  • An antibiotic may be given the day before the procedure.
  • Based on the patient’s medical condition, the doctor may request other specific preparation.

During the Surgery

  • An intravenous (IV) line will be started in the arm or hand of the patient.
  • The patient will be positioned on the operating table, lying on her back.
  • The anaesthesiologist will continuously monitor heart rate, blood pressure, breathing, and blood oxygen level during the procedure.
  • The skin over the surgical site will be cleansed with an antiseptic solution.
  • The surgeon makes an incision depending on the planned procedure.
  • The surgeon removes the underlying breast tissue. This breast tissue is removed and sent to a pathology laboratory for analysis. A pathologist examines the tissue under a microscope to determine if it is benign (noncancerous) or malignant (cancerous).
  • The skin is closed with stitches or staples.
  • Drainage tubes are usually inserted into the operation site to drain out blood and fluid that may continue to ooze out of the tissues after the skin is closed.
  • A pressure dressing may be placed over the operation site to minimize the oozing after the surgery.
  • The duration of the operation depends on the type of mastectomy being performed. Most mastectomies take one to two hours, not including the time required for any lymph node procedures (sentinel lymph node biopsy or axillary node dissection) or reconstruction procedures.
  • If breast reconstruction is to be performed along with the mastectomy, a plastic surgeon will perform the procedure after the mastectomy has been completed.

After the Surgery

After the surgery, the patient will be taken to the recovery room for observation. The recovery process will vary depending on the type of procedure performed and the type of anaesthesia that is given. Once the patient’s blood pressure, pulse, and breathing are stable and the patient is alert, she will be taken to the hospital room.
After a mastectomy, patients generally stay 1 day to 3 days or longer in the hospital, depending on the extent of the surgery and if breast reconstruction was also performed. The extent of pain depends on the amount and location of tissue removed during surgery. Most soreness may last a few days, although many mastectomy patients do not experience soreness after surgery. Pain relievers can be taken for soreness as recommended by the doctor. Aspirin or certain other pain medications may increase the chance of bleeding. Hence only recommended medications should be taken.
Radiation therapy or chemotherapy may or may not be necessary after a mastectomy depending on the patient’s particular situation.

Rehabilitation

Once at home, it will be important to keep the surgical area clean and dry. The doctor will give specific bathing instructions. Unless instructed otherwise, the narrow strips of tape across the incision can become wet during a shower. The wet dressing should be replaced with a clean, dry one.
Instructions will be given about how to take care of the drainage tube, which should be removed after about 2 weeks at the first follow-up examination.
If lymph node dissection (removal) was performed with mastectomy, the doctor may recommend exercises to help limber up the shoulder and arm area. Soreness after lymph node dissection may cause the patient to keep the 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. These exercises may be recommended even if lymph node dissection was not a part of the procedure.
Normal activities can usually be resumed within a few weeks, based on the doctor’s recommendations. Meanwhile, the patient should avoid strenuous activities, particularly those that involve extensive use of the arm, such as cleaning windows or vacuuming for long periods. The doctor will provide advice about when the patient can start driving again and when she can return to work.

The doctor should be notified if any of the following symptoms are noticed during recovery:

  • Fever and/or chills
  • Redness, swelling, or bleeding or other drainage from the incision site
  • Increased pain around the incision site
  • Swelling or numbness and/or tingling of the affected arm

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 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:

  • No needle sticks or IV insertions in the affected arm
  • No blood pressure measurements in the affected arm
  • Follow instructions regarding exercises of the arms carefully
  • Avoid injuries, such as scratches or splinters, to the affected arm
  • Elevate the arm, with the hand above the elbow, to assist with drainage of lymphatic fluid
  • Wear gloves when gardening or performing any activity in which there is a risk for skin puncture of the fingers and/or hands, or when using strong or harsh chemicals, such as detergents or household cleaners
  • Avoid sunburns
  • Use an electric shaver rather than a razor with a blade to shave under the arm
  • Avoid any constrictive items on the affected arm, such as elastic cuffs or tight watches or other jewellery
  • Use the unaffected arm to carry heavy packages, bags, or purses
  • Avoid insect bites or stings by using insect repellents and/or wearing long sleeves

Outlook

If breast cancer is detected in its earliest stage, treatment results in a 10-year survival rate (that is, percent of women still living) was 82 % of 2011. Long-term survival is similar whether the woman chooses lumpectomy or mastectomy.
Self-examination of the breast and an annual mammography help in the early detection of breast cancer. Usually, yearly mammography screening is recommended for women older than 40 years.
In addition to mastectomy, treatments such as hormonal therapy, radiation therapy, and chemotherapy (if required) improve the chances of recurrence-free, long-term survival.
A woman who undergoes a mastectomy has to deal with not only the stress of coping with the cancer but also the anguish of losing her breast. Interacting with other women who have undergone mastectomies can help in dealing with these feelings

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.

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.

The types of mastectomy include:

  • Total (or simple) mastectomy: Removal of the entire breast, including the nipple, the areola, and most of the overlying skin.
  • Modified radical mastectomy: Removal of the entire breast, including the nipple, the areola, the overlying skin, and the lining over the chest muscles. In addition, some of the lymph nodes under the arm, also called the axillary lymph nodes, may be removed. The bean-shaped lymph nodes under the arm drain the lymphatic vessels from the upper arms, the majority of the breast, the neck, and the underarm regions. Often, breast cancer spreads to these lymph nodes, thereby entering the lymphatic system and allowing the cancer to spread to other parts of the body. In some cases, part of the chest wall muscle is also removed.
  • Radical mastectomy: Removal of the entire breast, including the nipple, the areola, the overlying skin, the lymph nodes under the arm, and the chest muscles. For many years, this was the standard operation. However, today a radical mastectomy is rarely performed and is generally only recommended when the breast cancer has spread to the chest muscles.

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:

  • Skin-sparing mastectomy: In this procedure the breast tissue, nipple and areola are removed, but most of the skin over the breast is saved. This type of surgery appears to be similar to modified radical mastectomy in effectiveness for many women. It is used only when breast reconstruction is performed immediately after the mastectomy and may not be suitable for tumors that are large or near the skin surface.
  • Nipple-sparing mastectomy: This is similar to the skin-sparing mastectomy, and it is sometimes referred to as a “total skin-sparing mastectomy.” All of the breast tissue, including the ducts going all the way up to the nipple and areola, are removed, but the skin of the nipple and areola is preserved. The tissues under and around the nipple and areola are carefully cut away and examined by a pathologist. If no breast cancer cells are found close to the nipple and areola, they can be preserved. Otherwise, nipple-sparing mastectomy is not recommended.

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.

After a mastectomy, patients generally stay 1 day to 3 days or longer in the hospital, depending on the extent of the surgery and if breast reconstruction was also performed

This decision will depend on the type and extent of cancer as well as the surgery recommended for you. If you’re having an immediate reconstruction, you may be offered a skin-sparing mastectomy, which means that the surgeon removes your nipple and breast tissue, but leaves the skin of your breast intact. This kind of surgery makes reconstruction easier, as there’s already a natural pouch there to hold the new breast. It also gives you a better cosmetic result, as the scar is limited to a small circle around your areola. Unfortunately, some women aren’t eligible for skin-sparing mastectomies. If the tumour was very close to your skin, or you have inflammatory breast cancer, you probably won’t be offered a skin-sparing mastectomy.
The second option is to have reconstruction done later. Sometimes your surgeon and oncologist will recommend that you do wait till later, if they feel it’s important for you to start chemotherapy quickly, without waiting for a reconstruction to heal. If you’re going to need radiation, which can sometimes negatively affect a reconstruction, the reconstruction is usually planned for a later stage. In either of those cases, you’d probably be advised to have reconstruction sometime.
If you do decide to have reconstruction done immediately, you also have to decide whether you want implants (saline or silicone); or an autologous reconstruction, which means your breast is rebuilt using another part of your body, usually tissue from your belly or back.

The duration of the operation depends on the type of mastectomy being performed. Most mastectomies take one to two hours, not including the time required for any lymph node procedures (sentinel lymph node biopsy or axillary node dissection) or reconstruction procedures. If breast reconstruction is to be performed along with the mastectomy, a plastic surgeon will perform the procedure after the mastectomy has been completed. This will take longer.

The patient will be positioned on the operating table, lying on her back. The anaesthesiologist will continuously monitor heart rate, blood pressure, breathing, and blood oxygen level during the procedure. The skin over the surgical site will be cleansed with an antiseptic solution. The surgeon makes an incision depending on the planned procedure. The surgeon removes the underlying breast tissue. This breast tissue is removed and sent to a pathology laboratory for analysis. A pathologist examines the tissue under a microscope to determine if it is benign (noncancerous) or malignant (cancerous). The skin is closed with stitches or staples. Drainage tubes are usually inserted into the operation site to drain out blood and fluid that may continue to ooze out of the tissues after the skin is closed. A pressure dressing may be placed over the operation site to minimize the oozing after the surgery. The duration of the operation depends on the type of mastectomy being performed. Most mastectomies take one to two hours, not including the time required for any lymph node procedures (sentinel lymph node biopsy or axillary node dissection) or reconstruction procedures. If breast reconstruction is to be performed along with the mastectomy, a plastic surgeon will perform the procedure after the mastectomy has been completed.

Once at home, it will be important to keep the surgical area clean and dry. The doctor will give specific bathing instructions. Unless instructed otherwise, the narrow strips of tape across the incision can become wet during a shower. The wet dressing should be replaced with a clean, dry one. Instructions will be given about how to take care of the drainage tube, which should be removed after about 2 weeks at the first follow-up examination.
If lymph node dissection (removal) was performed with mastectomy, the doctor may recommend exercises to help limber up the shoulder and arm area. Soreness after lymph node dissection may cause the patient to keep the 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. These exercises may be recommended even if lymph node dissection was not a part of the procedure.
Normal activities can usually be resumed within a few weeks, based on the doctor’s recommendations. Meanwhile, the patient should avoid strenuous activities, particularly those that involve extensive use of the arm, such as cleaning windows or vacuuming for long periods. The doctor will provide advice about when the patient can start driving again and when you can return to work.

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

  • Temporary swelling of the breast
  • Breast tenderness
  • Hardness due to scar tissue that can form at the site of the incision
  • Wound infection or bleeding
  • Lymphedema, or swelling, of the arm due to lymph node removal. This is preceded by early symptoms, which include a feeling of tightness in the arm, pain, redness, and decreased flexibility of the arm, hand, and wrist.
  • Phantom breast pain – Symptoms include unpleasant itching, “pins and needles,” pressure, and throbbing. These sensations may be managed with medications, exercise, or massage. Phantom breast pain does not mean that cancer cells are still present in the breast or that the cancer may return.
  • 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 the patient’s specific medical condition. Any concerns should be discussed with the doctor prior to the procedure.

If breast cancer is detected in its earliest stage, treatment results in a 10-year survival rate (that is, percent of women still living) was 82 % of 2011. Long-term survival is similar whether the woman chooses lumpectomy or mastectomy. The difference between the treatments is there is an increased risk of a local recurrence (in the breast or on the chest wall) with lumpectomy. Also, lumpectomy is almost always followed by radiation therapy. Self-examination of the breast and an annual mammography help in the early detection of breast cancer. Usually, yearly mammography screening is recommended for women older than 40 years. In addition to mastectomy, treatments such as hormonal therapy, radiation therapy, and chemotherapy (if required) improve the chances of recurrence-free, long-term survival.

Radiation therapy or chemotherapy may or may not be necessary after a mastectomy depending on the patient’s particular situation. These decisions depend on the type and extent of cancer, the surgical procedure that is performed, the histopathological examination of the tissue, etc.

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