Mastectomy

What Is a Mastectomy?

A mastectomy is the surgical removal of the breast, often accompanied by surrounding tissues. Mastectomies are commonly performed as a means of treating breast cancer or, in some cases, as a form of cancer prevention in patients that show a high probability of developing the disease in the future. It is the primary surgical alternative to a breast-conserving procedure called a lumpectomy, which is the surgical removal of tumors while leaving the remainder of the breast intact. There are now several types of mastectomies, depending on the nature and extent of the cancer diagnosis. Some mastectomies are performed in conjunction with breast reconstruction surgery, which restores the breast to its original size and shape.

Mastectomies have proven effective in the treatment of breast cancer but come with both physical and psychological side effects. If you or a loved one is concerned about breast cancer and is weighing treatment options, the oncologists and other caring professionals at Baptist Health can help.

Why Have a Mastectomy? What Are the Benefits?

A mastectomy is one of two primary options – a lumpectomy is the other – for women contemplating surgery for breast cancer. A mastectomy might seem the safer alternative, because removing the entire breast would eliminate any tumors or cancerous cells that were missed during biopsy and diagnosis. Research has shown, however, that 20-year survival rates for mastectomies vs. lumpectomies, when supplemented by radiation therapy, are roughly the same. Factors that tend to favor mastectomies over lumpectomies with radiation therapy include having:

• A personal preference for removing the whole breast
• Large tumors, two inches or more in length
• Multiple tumors located in different parts of the breast
• Previously received radiation therapy
• Previously undergone a breast-conserving procedure that failed to stop the cancer
• A connective tissue disease, such as lupus, that could be worsened by radiation
• Inflammatory breast cancer
• A genetic precondition for developing breast cancer in the future.

Radiation therapy is also contraindicated for pregnant women with breast cancer, since radiation can injure the fetus.

The benefits of a mastectomy include:

• Greater confidence that cancer has been eliminated from your body
• Avoidance in the short run of any need for radiation therapy
• The knowledge that radiation therapy remains as a possible future treatment option for a resurgent cancer.

There are risks associated with mastectomies as well. Among the physical effects are swelling, soreness, scarring, infections, bleeding, and phantom breast pain. Psychological issues, including depression and concerns over sexual identity, are also common.

What Types of Mastectomies Are There?

The major types of mastectomy are:

• Total mastectomy: A total (or simple) mastectomy involves the removal of the entire breast, including the nipple, areola, and skin.
• Double mastectomy: A double mastectomy is the surgical removal of both breasts.
• Skin-sparing mastectomy: A skin-sparing mastectomy removes the entire interior of the breast, along with the nipple and areola, but leaves the skin in place. Doing so aids in the surgical reconstruction of the breast. This is a favored option for cosmetic purposes, but is not available in cases where tumors lie close to the surface of the breast.
• Nipple-sparing mastectomy: A nipple-sparing mastectomy is similar to the skin-sparing procedure but also leaves the nipple intact. 
• Radical mastectomy: A radical mastectomy is the most extensive of all breast surgeries. In addition to the breast, the surgeon removes underarm lymph nodes and some of the chest wall muscle. Though common in the past, this procedure is performed less frequently now.
• Modified radical mastectomy: A modified radical mastectomy combines whole-breast removal with excision of the underarm lymph nodes.

Patients receiving a mastectomy can choose to have the breast rebuilt by reconstructive surgery. This procedure can be performed at the same time as the mastectomy or scheduled as a follow-up procedure. For women who choose not to have reconstructive surgery, wearing a breast prothesis under their clothes is a second option for retaining their pre-surgical figure.

How Do I Prepare for a Mastectomy?

To prepare for a mastectomy you should:

• If you smoke, stop beforehand, even if just for a few days
• Inform your physician of all current medications. He or she may ask you to stop taking some of them for a short while before the procedure (e.g., blood thinners such as aspirin). 
• Forgo solid food and liquids immediately prior to surgery.
• Prepare for the possibility of an inpatient stay by packing essentials and making arrangements with family or friends for transportation and visitation (if allowed).

What Should I Expect During a Mastectomy?

Here’s what will happen on the day of the procedure:

• Arrive at the hospital or surgical center as instructed.
• A mastectomy typically takes one to three hours and can be treated as an outpatient procedure. However, if complications arise, or if you’re having breast reconstruction performed at the same time, be prepared for an inpatient stay.
• You will be prepped for surgery and given a general anesthesia. You will be unconscious while surgery is performed.
• The incisions will be closed with sutures. These will disintegrate on their own or be removed at a later date by your surgeon.
• When you awake, you may find a tube inserted where your breast was. This allows fluid drainage from the surgical site.  

After the procedure, you will be taken to a recovery room, where your vitals will be monitored. You may feel some pain. Members of your medical team will instruct you on how to care for yourself on returning home. You will be provided with prescriptions for any necessary pain medication and antibiotics.

How Do I Recover from a Mastectomy?

At home you will need to:

• Keep the surgical site dry and clean. You’ll be able to bathe but may need to take precautions to keep the site from getting wet.
• The drainage tube will remain in place for a couple of weeks. You will receive instructions on how to manage it.
• The amount of pain will vary with the type of procedure you underwent. Take only doctor-prescribed pain medications; aspirin and other blood-thinning agents can lead to unwanted bleeding.
• Stiffness and swelling of the armpits are common following breast-removal surgery. You may be prescribed certain exercises to keep your shoulder limber.
• You should be able to resume normal activities after a few weeks of recovery.

An important part of your recovery will be the post-surgical visit with your physician. He or she will share the pathology report that was prepared, based on the analysis of the breast and lymphatic tissues removed from your body. You will be able to discuss possible follow-up treatments, including hormone therapy, chemotherapy, targeted therapy, or, in special cases, radiation therapy. You can also make plans for breast reconstruction surgery, if that didn’t occur at the time of your mastectomy.

Learn More About Mastectomies at Baptist Health

Breast cancer is a common form of cancer affecting as many as one in eight American women. The oncologists and other medical experts at Baptist Health are part of your frontline defense against this form of cancer.