Mastectomy – types, indications, benefits and risks. The course of mastectomy

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A mastectomy is an operation to remove the breast, usually to treat or prevent breast cancer. During a mastectomy, the surgeon removes tissue from one or both breasts. Some types of mastectomy only remove part of the breast tissue, while others are more extensive. The type your doctor recommends will depend on the cause of the procedure. What are the types of mastectomy when they are used and what can I expect after the procedure?

Mastectomy – types

A mastectomy is a common treatment for breast cancer. There are five main types of mastectomy.

Total mastectomy

A total mastectomy is also known as a simple mastectomy. This is a procedure in which the surgeon removes the entire breast, including the nipple, areola, and skin. Sentinel lymph nodes are often removed at the same time so that they can be checked for cancer. A total mastectomy may be an option for early-stage breast cancer that probably hasn’t reached the axillary lymph nodes.

Modified radical mastectomy

A modified radical mastectomy (Patey’s Procedure) helps determine if the cancer has reached the lymph nodes in your armpit.

This type of mastectomy involves the removal of:

1. the entire breast, including the nipple, areola and skin;
2. some axillary lymph nodes.

In some cases, the surgeon will also remove the lining of the chest muscle.

Radical mastectomy

Radical mastectomy is a comprehensive operation to remove:

1. the entire breast, including the nipple, areola and skin;
2. all axillary lymph nodes;
3. major and minor pectoral muscles.

Radical mastectomy was once the standard treatment for breast cancer. With improved imaging techniques and radiation therapy, surgeons are more likely to recommend modified radical mastectomy. A 2021 research review found that this more extensive surgery did not improve overall survival. However, radical mastectomy is still an option when the tumor grows in the muscles of the chest.

Partial mastectomy

In a partial mastectomy, the surgeon removes the cancerous area and the healthy surrounding tissue. This type of mastectomy can be used when there is only one small area of ​​cancerous tissue.

Breast conserving surgery

Less invasive procedures – collectively known as breast conserving surgery – are now an option for many people diagnosed with breast cancer.

Examples of these procedures include:

1. lumpectomy: This is where the surgeon removes the tumor and surrounding tissue, but leaves the breasts intact in general. The patient may need radiation therapy as well as surgery.
2. Quadrantectomy: This is a partial mastectomy. It involves removing more breast tissue than during a lumpectomy, but the surgeon still leaves most of the breast tissue intact.
3. Conserving Mmastectomy: This newer procedure involves preserving the skin of the breast and reconstructing a more natural-looking breast. It can only be an option if no cancer cells are close to the skin.

Reconstruction

Reconstruction is a type of aesthetic procedure that allows you to restore the original appearance of the breast. The patient may have a reconstruction during the same surgery as the mastectomy or in a second surgery, often 6-12 months later. Patients sometimes decide not to undergo reconstructive surgery for various reasons.

Types of mastectomy – indications

Your doctor will recommend the type of mastectomy after considering a number of factors, including:

1. the age of the sick person and his general health;
2. menopause;
3. tumor size;
4. how far has the cancer spread;
5. how quickly the cancer can spread;
6. the likelihood of cancer recurrence;
7. can the person tolerate radiation therapy;
8. individual preferences, including aesthetic problems and the likely duration of recovery.

If tests show that the tumor may respond to targeted treatment, such as hormone therapy, your doctor may recommend using these drugs to target cancer cells instead of surgery.

Mastectomy – indications

Breast cancer and its risks are the most common reasons for having a mastectomy. The doctor may also recommend this procedure if the person has another breast condition.

Overall, a doctor will likely recommend a mastectomy if a person has:

1. non-invasive breast cancer: Ductile breast cancer (DCIS) is the most common type of non-invasive breast cancer. It is formed in the milk ducts and, by definition, does not enter the breast tissue.
2. Stage 1, 2, and 3 breast cancer: A mastectomy can help treat breast cancer until it is in its terminal stage and has spread to more distant parts of the body, such as the lungs.
3. inflammatory breast cancer: This is an aggressive form of breast cancer and your doctor may recommend chemotherapy before surgery.
4. Paget’s cancer: This rare type of cancer affects the skin of the nipple and areola and often includes DCIS or invasive breast cancer.
5. locally recurrent breast cancer: A mastectomy may be necessary if the cancer returns to the breast or an area of ​​the breast in question.

A mastectomy can also play a role in gender reassignment surgery, such as when a person moves from a female to a male body. In this case, the surgeon will leave the skin intact but remove any underlying breast tissue.

Additionally, your doctor may recommend a mastectomy for some non-cancerous conditions, although this is rare. They include:

1. severe chronic pain in the breast;
2. fibrocystic disease of the breast;
3. thick breast tissue.

In addition, some people who have had breast cancer before or who have had a family history of breast cancer may have this surgery as a preventative measure.

See also: Comforting news for women with thick breasts

Mastectomy – how is the procedure performed?

At the hospital, you will be given an intravenous (drip) infusion of fluids and medicines. In the case of a sentinel node biopsy, a radioactive isotope will be administered near the tumor. This will help the surgeon find sentinel nodes.

After general anesthesia, the surgeon will make an incision around the breast and remove the breast tissue. Depending on the type of mastectomy, the surgeon will remove the skin, areola, nipple, and lymph nodes. The samples of breast tissue and lymph nodes will be sent to the laboratory for analysis.

If a breast reconstruction is going to be performed at the same time, it may include:

1. use of breast tissue expanders;
2. the use of implants;
3. autologous tissue reconstruction.

All the cuts will be closed with sutures. The surgical team will leave one or two surgical drains exiting the wound. This is a temporary measure to prevent fluid build-up in the chest. The entire procedure may take anywhere from 90 minutes to several hours.

See also: Silicone breast implants can promote RA, melanoma, and stillbirth

Mastectomy – is it painful?

Most likely, you will experience tenderness and pain at the surgical site. Some people also experience:

1. numbness and tingling in the chest and arm;
2. difficulty moving your arm or shoulder;
3. itching, burning, or stabbing neuralgia in the chest, armpit, arm or shoulder;
4. phantom breast pain.

The level of pain depends on the type of surgery. For example, you may experience more pain if at the same time the patient undergoes reconstructive surgery or if there are complications. Pain and other side effects are different for everyone.

When the patient leaves the hospital, he or she will likely be prescribed a strong painkiller. This one may work better if you take it before the pain gets too bad.

For most people, the side effects disappear within a few weeks. The American Cancer Society says that approximately 20 to 30 percent of women develop post-mastectomy pain syndrome, a condition in which pain and strange sensations persist indefinitely.

See also: Reconstructive surgery as a chance for patients with disfiguring neoplasms

Mastectomy – convalescence

After the procedure, your doctor will monitor your heart rate, blood pressure, pain levels, and any nausea. Medications, such as painkillers, can help relieve symptoms.

After a mastectomy, a person stays in the hospital about 3 days on average. However, if a person has had reconstructive surgery at the same time, they may need a little more time.

Your healthcare professional will advise you on:

1. exercises to minimize stiffness and scarring;
2. activities to avoid during recovery;
3. appropriate pain medications;
4. how to care for a wound;
5. what to expect from any seams and staples;
6. how to recognize the signs of infection or lymphedema;
7. when to resume wearing a bra or start using a prosthesis as needed.

Some bras are designed to provide comfort and support after surgery, and your doctor can advise you on choosing the right option.

The first follow-up visit will be in a week or two after the operation. During this time, the surgeon may remove the surgical drains. If no dissolving sutures have been used, they will also be removed.

Recovery rates vary from person to person. This usually takes several weeks, but may take longer if the reconstruction was part of the surgery.

Probably it will come to:

1. bruises;
2. swelling;
3. low fever.

Some people experience a sore throat because the surgeon inserts a tube down their throat during the procedure. It’s also not uncommon for skin numbness anywhere from the top of the ribs to the collarbone. You can get a little feeling back over time, but it will probably never be the same as before.

If any symptoms persist or worsen, it is recommended that you contact your doctor.

Tips for Recovery After Mastectomy

The following items may help improve your comfort and speed of recovery:

1. rest: People often feel tired after surgery. Getting enough rest can help your body recover.
2. Pain management: Your doctor will advise you on pain relief and will issue a prescription if necessary. If the pain persists or worsens, it’s best to talk to a doctor who can change your medication to investigate the cause of the pain.
3. Managing constipation: Pain medications can lead to constipation. Eating plenty of fluids and high-fiber foods can help.
4. exercise: It is important to follow your doctor’s instructions about when and how to exercise.
5. let us not be ashamed to ask for help from family members and friends.

Recovery from a mastectomy can take several months. Many people return to work within 3-6 weeks.

Mastectomy – appearance and sexuality

Many women are concerned about how they will look after surgery, how they will feel about their body, and how others, including their partner, will see them. They may also worry about loss of feeling around the breasts.

According to the American Cancer Society, the overwhelming response from most people’s partners is relief that their loved one is alive and well.

Some people believe that the following things can enhance a sense of sexuality:

1. searching for new erogenous zones such as the neck and scalp;
2. wearing attached nipples;
3. wearing breast forms inside the bra;
4. wearing underwear that gives the appearance and feeling of having a breast.

In addition, some people prefer to wear clothes that pay less attention to the chest area. This may include:

1. clothes with irregular patterns;
2. short skirts or dresses with a high neckline, backless, which draw attention to other parts of the body;
3. scarves or shawls that cover the chest.

Some women believe that reconstructive surgery has given them a breast shape that is better than the one they had originally. Carefully discussing your reconstruction with your doctor can help you obtain the most favorable result. It may also be a good idea to sign up for therapy and use specialist psychological help.

See also: Can breast implants be dangerous?

Mastectomy – Benefits and Risks

The main benefit of a mastectomy is the removal of neoplastic tissue. Checking your lymph nodes also helps to determine the stage of the cancer and make other treatment decisions.

The risks of any such surgery include bleeding and infection. A 2020 study by Washington University School of Medicine suggested that infections and wound complications are the most common causes of rehospitalisation after mastectomy.

Removal of lymph nodes increases the risk of developing lymphedema, leading to:

1. swelling of the arm, hand, fingers, chest or back;
2. limited range of motion;
3. skin discoloration;
4. infections.

Lymphedema is a chronic and often debilitating condition.

Mastectomy – prevention

Some women at high risk of breast cancer have a preventive or prophylactic mastectomy to reduce the risk of cancer. In some cases, the surgeon may remove the breast tissue but leave the nipples intact.

A doctor may recommend a prophylactic mastectomy if a person has:

1. BRCA1 or BRCA2 mutations: These two genes help repair damaged DNA. If they don’t work properly, a tumor can develop (women with BRCA1 and BRACA2 mutations also have a higher risk of developing ovarian cancer).
2. Family history of breast cancer: You may be more likely to develop breast cancer if one or more members of your close family have had breast cancer before the age of 50.
3. non-invasive lobular carcinoma in situ (LCIS): This is an area of ​​abnormal cell growth. It is not breast cancer, but it does increase your risk of developing breast cancer. A doctor will usually only recommend a mastectomy if the person also has family history of breast cancer.
4. have had radiotherapy before: People who have had radiotherapy to the chest area before the age of 30 may opt for a mastectomy.

According to the National Cancer Institute, prophylactic mastectomy can reduce the risk of breast cancer by up to 95% in people with these genetic characteristics and up to 90% in people with multiple family history of breast cancer.

See also: Paulina Młynarska has undergone a prophylactic mastectomy. Up to 300 people qualify for it. Polish women

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