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Mastectomy

 

What is a mastectomy?

A mastectomy is surgery to remove the entire breast. This surgery may also include removal of one or more lymph nodes in the underarm. A mastectomy differs from a lumpectomy (also known as breast conserving surgery), which involves the removal of the cancer from the breast, whilst conserving the rest of the breast tissue.

When is a mastectomy needed?

– If there is cancer in more than one area of the breast
– If the tumour is large in comparison to the breast itself
– If the patient carries a gene mutation (such as BRCA1/2) that could pose an increased risk of developing breast
A mastectomy may also be recommended after breast-conserving surgery:
– If previous radiation therapy has taken place in the same breast and the cancer has returned
– If breast cancer comes back in the same breast
– If cancer cells appear in the surgical margin surrounding the tumour that was previously removed.

Prophylactic (preventative) mastectomy

A mastectomy may be recommended for women who have not been diagnosed with breast cancer, but who have a high risk of breast cancer. For example those with a strong family history of breast cancer or those that carry a gene mutation (such as BRCA 1 or BRCA 2).

 

What does mastectomy surgery involve?

There are different types of mastectomy procedures including:

  • Total mastectomy

A total mastectomy is the removal of the entire breast, including the areola, nipple and most of the overlying breast skin.

A skin-sparing mastectomy involves the removal of the breast tissue, areola and nipple, but not the breast skin. This is generally performed in order to allow for a breast reconstruction, which can be performed straight after the mastectomy. This procedure may not be suitable for large tumours.

A nipple-sparing mastectomy involves the removal of the breast tissue only, conserving the areola, nipple and entire breast skin. This kind of surgery is typically performed before a breast reconstruction.

 

Lymph node removal during a mastectomy

During a mastectomy, the surgeon will often remove the lymph nodes in the underarm known as the axillary lymph nodes. This is because the lymph nodes are one of the first places that the cancer will spread to once it leaves the breast, and by examining them doctors can provide the best recommendation for further treatment. There are two ways in which lymph nodes can be removed:

  • Axillary dissection

Axillary dissection is the removal of several or all the lymph nodes in the underarm. This is done at the same time as the breast cancer surgery.

  • Sentinel node biopsy

A sentinel node biopsy involves the removal of the first lymph node (or nodes) in the underarm in which cancer cells are most likely to spread from the breast. A dye or low-grade radioactive fluid is injected into the breast, and the first node (or nodes) that it spreads to (known as the sentinel node (or nodes) will be removed during the surgery. The lymph node (or nodes) will be examined after the surgery and used to inform further treatment.

Recovering from a mastectomy

The surgery itself will take place under general anaesthetic and will usually take between 1-2 hours. If breast reconstruction is performed at the same time, the procedure will take longer. In addition to this, there will be preparation time and time to recover from the anaesthetic.

After the surgery, you’ll need some time to let your body recover. The period of recovery in hospital can take anywhere between one day and one week, depending on the extent of the procedure and how quickly your body heals.

You will likely have a large bandage wrapped around your chest, and you may have a surgical drain for a period to dispose of excess fluid. While you recover, you will usually be offered pain medication, and a prescription of this to take home with you when you leave.

The recovery period at home may take a few days or a few weeks or longer if a breast reconstruction took place. During this time it’s recommended to rest, take pain medications if required and begin to do gentle arm exercises to maintain mobility in the arms.

A double or bilateral mastectomy is the removal of both breasts.

A mastectomy normally takes between 1-2 hours.

As with all surgeries, there may be some pain in the hours and days following the mastectomy, but pain relief will be provided to help manage this.

Your doctor may suggest chemotherapy and other treatment before breast surgery. This is to shrink the breast cancer prior to surgery and control the cancer in other parts of the body like the lymph nodes.

A breast reconstruction can take place straight away after a mastectomy. It can also take place later if this is clinically indicated or preferred by the patient.