What is Mastectomy?
Mastectomy is a surgery to remove the breast, usually performed to treat or prevent breast cancer. There are 4 main types of mastectomy depending on the stage of cancer, size of the breast tumour and lymph node involvement:
Total Mastectomy
In this procedure, all of the breast tissue, including nipple are removed.
Modified Radical Mastectomy
It involves surgical removal of the entire breast, lymph nodes under the arm, and the lining over the chest muscles.
Radical Mastectomy
It is surgical removal of the entire breast tissue, all the lymph nodes in the armpit and chest muscles that lie under the affected breast. It is a rare procedure and is now only performed on patients who have advanced breast cancer.
Nipple and Skin Sparing Mastectomy
This technique can be used in combination with the above surgeries to retain your natural skin and nipple. This can only be done when the tumour is at least 2 cms away from the tissue that is to be retained.
Indication
Mastectomy is recommended when your breast is affected with cancer or you have a high risk of developing breast cancer. Total mastectomy is usually indicated for patients with noninvasive breast cancer, Paget's disease of the breast, or recurrent breast cancer.
Modified radical mastectomy is usually indicated for patients with early-stage breast cancer, locally advanced breast cancer (to shrink the tumour after chemotherapy), inflammatory breast cancer (mostly after chemotherapy), or Paget's disease of the breast.
Procedure
Prior to your surgery, your nurse or surgeon will mark the area where the cut will be made. The procedure is performed under general anaesthesia. The surgeon will make an oval-shaped incision around the nipple, across the breadth of the breast. Depending on the type of mastectomy, the breast tissue underlying the skin will be removed, along with lymph nodes and the inner layer of muscle tissue. The surgeon will then insert surgical drains, (tubes to collect excess fluid) and close the incision.
Reconstruction
If you choose to rebuild your breasts after mastectomy, your plastic surgeon will perform a surgery called breast reconstruction. During reconstruction, your surgeon creates a breast mound using an implant or tissue flap taken from your stomach, thighs, back, or buttocks. Reconstructive surgery can be done during or after mastectomy.
Post-operative Care
This surgery will require you to stay in the hospital for about 3 days or a little longer if you have opted for immediate reconstruction. After discharge, you will be given instructions on how to care for the surgical drain, bandage, and stitches. In order to avoid stiffness and scar formation, you will have to follow some simple hand exercise regimes. Your surgeon will also recommend the appropriate time for you to start wearing a bra or prosthesis.
If you do not develop any complications from the surgery, you can resume physical activities within 6 to 8 weeks.
You may experience sensation or pain in the breast that has been removed (phantom pain) over a period of months after surgery. Pain medications can be used to treat this type of pain.
Risks and Complications
Mastectomy procedures are usually safe but may involve the risk of infection, bleeding, pain, swelling in your arm, hard scar tissue formation at the site of surgery, shoulder pain and stiffness, numbness (especially under your arm), and accumulation of blood in the surgical site.