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Mastectomy and Breast Reconstruction

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?

A mastectomy is performed to remove the tumour from the breast, and is generally recommended in the following situations:

  • The cancer is large in relation to the size of the breast
  • There is more than one cancer in the breast

A mastectomy may also be recommended after a lumpectomy for the following reasons:

  • The surgical margin around the cancer is found to contain cancer cells
  • Breast cancer has returned in the same breast
  • Radiotherapy has been used to treat cancer in the same breast and the cancer has returned

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.


Breast reconstruction

After a mastectomy, many women may choose to have a breast reconstruction, which is surgery to rebuild the breast shape. This can take place at the same time as a mastectomy or be carried out at a later date, several months or years later. A breast reconstruction can consist of two different procedures:

  • Breast implants

This typically involves implants made of saline or silicone

  • Tissue flap reconstruction

This involves the transfer of skin or tissue from a different part of your body. This can be from the back or abdomen, known as attached flaps, or the abdomen and buttocks, known as free flaps.

Some women may choose not to have a breast reconstruction. Another option is to wear a breast prosthesis, which is an artificial breast shape worn underneath the clothing. These can come in a variety of shapes and materials, and are some lingerie stores, department stores or specialty stockists.

Side effects of breast surgery

Everyone responds differently to the side effects that are experienced after a breast surgery and these may vary in severity. According to Cancer Australia, the side effects may happen straight after surgery or develop over time.

Some of these may include:

  • Pain, discomfort or numbness in the breast area and/or underarm while the wounds are healing – this usually settles after a few weeks
  • Stiffness in the arm or shoulder – it may be helpful to do some approved exercises after surgery
  • numbness or tingling in the arm or shoulder if lymph nodes have been removed – this may improve with time, but feeling in these areas may change permanently
  • Fluid may collect in or around the scar in the breast area or underarm – this is called a seroma and may need to be drained using a fine needle and a syringe; this can be done by a breast care nurse or another health professional in the clinic or by a GP
  • Mild pain in the arm and/or underarm – this can last a year or more after surgery if lymph nodes have been removed.
  • If lymph nodes have been removed, there may be swelling in the arm, breast area, hand or chest that lasts after the initial side effects of surgery are over; this is called lymphoedema and can develop a few months or years after .
  • Cording, a condition that can feel like a tight cord running from the underarm down the inner

Source: Cancer Australia


Frequently Asked Questions About Mastectomies and Breast Reconstruction

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.