What Is A Mastectomy?

A mastectomy is a surgical procedure that involves the removal of breast tissue, often performed as a treatment for breast cancer. This procedure may be recommended if the cancer covers a large area of the breast or has spread throughout. A mastectomy may also be done to prevent breast cancer in individuals with a high risk of developing the disease.  

What Are The Different Types Of Mastectomy?

There are several types of mastectomy, depending on how much tissue needs to be removed, and your individual medical needs. Factors such as the size and location of the cancer and whether you plan to have a breast reconstruction are considered.

Depending on whether a pre-surgery assessment has found cancer in the lymph nodes, you may either have the lymph nodes removed during the mastectomy or have a sentinel lymph node biopsy (removal of some nearby lymph nodes to inspect for cancer cells) during the procedure. The reason for this is that the lymph nodes are often the first place the cancer spreads to.

Total Mastectomy

This procedure is also known as a simple mastectomy. The entire breast tissue is removed, including the nipple and areola. However, the lymph nodes and chest muscles are left intact. The mastectomy can be unilateral (one breast) or bilateral (both breasts, also called a double mastectomy).

Modified Radical Mastectomy

This type of mastectomy involves removing the entire breast tissue, along with some lymph nodes under the arm (a procedure called axillary lymph node dissection). However, the chest muscles remain in place. A radical mastectomy is the most extensive or invasive mastectomy type. During a radical mastectomy, the entire breast tissue, axillary lymph nodes, and chest muscles are removed. Fortunately, this procedure is rarely performed today.

Partial Mastectomy

Also known as a segmental mastectomy, lumpectomy, or breast-conserving surgery. The purpose of a partial mastectomy is to conserve the breast as much as possible. The surgery involves the removal of the cancerous tumour and a margin of healthy tissue surrounding it, aiming to both get rid of cancer in this area and keep as much of the breast tissue as possible.

Skin-Sparing Mastectomy / Nipple-Sparing Mastectomy

In these procedures, the breast tissue is removed, but most of the skin over the breast or the nipple is preserved. This option is suited to those considering immediate breast reconstruction.

Who Is A Mastectomy Recommended For?

A mastectomy is mainly used for the treatment of breast cancer. This procedure might be recommended to you if a lumpectomy is not suitable for your breast cancer due to the size or location of the tumour if you have multifocal or multicentric breast cancer (multiple tumours in the same breast, either in the same or different sections of the breast respectively), or if there is widespread ductal carcinoma in situ. 

A mastectomy might also be recommended to you if your breast cancer comes back after initial treatment with a lumpectomy. For individuals with a strong family history of breast cancer or a genetic predisposition, a prophylactic (preventive) mastectomy may be considered to reduce the risk of developing breast cancer.

What Should I Expect From A Mastectomy?

As with any surgery, a mastectomy carries some risks. When making your treatment decision, be sure to have your doctor run you through the preparation, surgery, and recovery processes for the type of mastectomy that you are considering. Sometimes chemotherapy or hormone therapy is also done to reduce the tumour size before surgery.

During The Surgery

The operation is usually about 1-3 hours, carried out under general anaesthetic. The amount of tissue removed from your breast will depend on the type of mastectomy.

After the surgery, you may have one or more drainage tubes placed near the surgical site to remove excess fluid. These tubes are usually removed within one to two weeks. The hospital stay after a mastectomy is usually 1-3 days, or longer if a breast reconstruction is incorporated.

Recovery

The recovery process after a mastectomy will vary depending on factors such as your overall health, the type of mastectomy performed, and whether additional treatments are needed. An estimated recovery time is about 4-6 weeks. 

You may need to await lab results in which the breast tissue and lymph nodes are checked for cancer. If cancer is present then further surgery or other treatment could be required.

Regular follow-up appointments with your healthcare team are essential in order to monitor your recovery, address any concerns, and discuss additional treatments such as radiation therapy or chemotherapy if your doctor is concerned about your cancer returning.

Side Effects And Risk Factors

The prognosis for a mastectomy depends on several factors, including the reason for the mastectomy, the stage and characteristics of the breast cancer (if applicable), the presence of any metastasis (spread of cancer to other parts of the body), and individual factors such as overall health and response to treatment.

Mastectomy complications may include infection at the surgical site; excessive bleeding; a seroma (fluid-filled pocket) which could require additional procedures; nerves in the chest and arm may be damaged leading to numbness, tingling, or pain; or the formation of a blood clot after the surgery. Removal of lymph nodes may also lead to lymphedema, which is the buildup of lymphatic fluid causing swelling.

Pain and discomfort are common after a mastectomy. Your healthcare team can provide pain relief medications to help manage postoperative pain. Gentle exercises may be recommended to help restore arm and shoulder movement, as well as to prevent stiffness and lymphedema. Physiotherapy is also an option.

Many of the side effects of a mastectomy go away after some time. The mastectomy scar will eventually fade but might cause discomfort, which should be discussed with your medical team. You will need to avoid strenuous exercise including heavy lifting until your doctor recommends otherwise.

The loss of a breast can also have a significant psychological impact, leading to feelings of grief, depression, or anxiety. Support from mental health professionals, support groups, or loved ones can help you cope, from preparing for the procedure to post-recovery phases of the journey.

Do I Need Breast Reconstruction After A Mastectomy?

If you are planning to undergo a mastectomy, your doctor will discuss the option of breast reconstruction with you. Breast reconstruction is a surgical procedure to replace the tissue removed in a mastectomy. The surgeon will create a new breast shape using an implant or another part of your body, or both.

You could undergo immediate reconstruction, which is when the breast reconstruction is done at the same time as the mastectomy, or delayed reconstruction, where the procedure is done months to years after the mastectomy. Some people also choose to be without any breast shape after the surgery. It is up to you to decide what you would prefer.

If you do not opt for immediate reconstruction, you will have the option of a breast-shaped prosthesis that is placed inside your bra. The first one (a “softie”) is temporary and light to allow for wound healing. Once your mastectomy wounds are better, a permanent prosthesis can be provided. Your medical team will help you to find the right shape and size.

Is A Mastectomy The Best Treatment?

There are several types of treatments for breast cancer, with a mastectomy being one of them. There are also different types of mastectomies, each with its own indications and extent of tissue removal. The recovery process after a mastectomy can vary but generally includes pain management and follow-up care. While there are potential complications associated with the procedure, it remains an essential treatment option for many patients facing breast cancer. Discuss your options with a medical team, and make the best choice for you as an individual.