What's A Mastectomy_ Why Do People Opt For It

Mastectomy is a surgical procedure of removing some or the entire breast tissue as a way to prevent or treat breast cancer. It is both a treatment and a prevention technique that restricts the further spread of cancerous tissue, thus safeguarding the individual.

When Mastectomy is Performed? 

A mastectomy is usually done under the following conditions:

1. When an individual cannot be treated with breast-conserving surgery or lumpectomy that saves most of the breast.
2. When mastectomy is preferred over lumpectomy for personal reasons.
3. When a person has a higher chance of developing a second breast cancer, they choose a double mastectomy as a prevention procedure.

Types of Mastectomy

Mastectomies are classified into different categories based on the extent of tissue removal by the surgeon. 

Simple Mastectomy

A simple or total mastectomy involves removing the entire breast tissue but leaving the pectoral muscles intact. It can be both unilateral (one breast removal) or bilateral (both breasts removal).

Modified Radical Mastectomy

A Modified Radical Mastectomy This involves removing the entire breast tissue and the underarm lymph nodes on the same side, which are often the first sites where breast cancer spreads. The lymph nodes are often the source tissue of breast cancer.

Radical Mastectomy

A radical mastectomy involves the removal of the entire breast tissue along with underarm lymph nodes and pectoral muscles underneath. This surgery is performed on rare occasions, only when the cancer has spread to the muscles.

Nipple-sparing Mastectomy

A nipple-sparing mastectomy involves removal of breast tissue, leaving the healthy breast skin, the nipple and the areola intact. 

Skin-sparing Mastectomy

A skin-sparing mastectomy involves the removal of breast tissue sparing the healthy skin, which can be utilized later during breast reconstruction

Preparation for Mastectomy

Before execution of the surgery, one needs to be acquainted with several instructions and adhere to these guidelines carefully.

Medical Evaluation

It is very important to share the list of medicines, vitamins or supplements that the patient is consuming with the surgeon. This ensures that specific molecules or drugs do not cause any adverse interactions during the surgery. 

Discussing Surgical Options

Before executing a mastectomy, one must meet the surgeon and anaesthesiologist for discussing the operation and determining the plans for anesthesia. This is the best time to consult the doctor and to understand the advantages and disadvantages of the surgery. Further, one can even discuss the breast reconstruction procedure which might be conducted immediately post-surgery, during the same period of anesthesia

Pre-operative Tests

In the weeks or days before surgery, one must perform a few medical tests to ensure that the patient can successfully undergo the procedure and anesthesia. These tests include: 

1. A chest X-ray and electrocardiogram to ensure proper lung and heart functioning.
2. Blood tests to check the blood counts, liver and kidney function, and risk of bleeding or infection. 
3. A urine test could also ensure proper kidney functioning and detect infections.

Pre-operative instructions

Certain instructions are needed to be followed before undergoing the surgery which are:

1. Do not drink or eat for 8-12 hours before surgery.
2. Do not take aspirin or other blood-thinning medications as they can increase the risk of excessive bleeding.
3. Wear comfortable clothing and prepare for a hospital day. This includes arranging all the items one may need for a comfortable stay prior to the operation.

What are The Risks of Mastectomy?

Below are some of the potential early and delayed complications associated with mastectomy: 

Early complications may include:

1. Wound Infection – The risk of developing wound infections is less than 1%. Careful planning and execution allows surgeons to prevent chances of infection during breast cancer surgery. 
2. Hematoma – This complication occurs rarely and involves a build-up of blood under the incision wound.
3. Flap Necrosis – This complication is caused by a lack of blood and oxygen supply to the cut tissue causing tissue death. This is usually evident between the 2nd and 4th day following surgery and can be addressed by removing the dead tissue or through skin grafting. 

Delayed complications may include:

1. Seroma – This involves a build-up of fluid inside the wound causing swelling and tenderness.
2. Post-Mastectomy Pain Syndrome (PMPS). Nearly 20 % of people experience few symptoms of pain or irritation like burning, itching or prickling near the surgical site. This occurs when the surgeon has to take tissue close to the underarm causing nerve damage.
3. Lymphedema – This is often a mild or severe complication arising due removal of several lymph nodes, causing damage to the lymphatic system. The lymph fluid does not drain properly causing swelling and inflammation in the arms and legs. This is not curable but symptoms can be managed. 

The Mastectomy Procedure

A mastectomy is an umbrella term used in numerous techniques of removing one or both breasts. During the surgery, the surgeon may also remove nearby lymph nodes to assess the extent of cancer spread. The lymph nodes are then tested for cancer and if tested positive, radiation therapy is performed. 

Anesthesia

A mastectomy is typically performed under general anesthesia. The surgery starts by making an elliptical incision around the breast following which the breast tissue is removed.

Duration of Surgery

A mastectomy without breast reconstruction is performed over one to three hours. An additional day may be necessary in case of a double mastectomy. 

What to Expect After The surgery

1. Dressing of the surgical site
2. Some pain or numbness in the underarm region
3. Blood pressure, pulse and breathing rate monitoring
4. Guidance on the best self-care practices
5. Guidance on consuming pain medications like antibiotics
6. Guidance on bra-usage 

Recovery After Mastectomy

One may take 4 to 6 weeks to get fully recovered. However, a feeling of tiredness along with soreness and stiffness in the chest is common. Thus, some post-operative care must follow after the surgery is done.

Most people manage with mild pain relievers, and the stiffness improves with exercise. Your healthcare provider will give you specific exercises to do to help your recovery. They’ll let you know when it’s safe to do heavier work.

Post-Operative Care

Breast surgery post-operative care involves the following steps:

1. Monitoring of body temperature and signs of complications
2. Checking the incisions and surgical drains
3. Checking the vital signs like pulse, breathing or blood pressure
4. Monitoring the intravenous infusions and urine output
5. Maintaining comfort with respect to body positioning and pain medication

Pain Management

Doctors prescribe paracetamol to regularly control mild to moderate pain post-surgery.

Non-steroidal anti-inflammatory drugs (NSAIDs) like diclofenac or ibuprofen can help to relieve pain. However, drug allergies and reactions must be kept in mind. Often an ice pack can help to decrease discomfort and swelling, particularly in the armpit region after a lymph node dissection.

Follow-up Appointments

One goal of follow-up appointments with Oncology doctors is to check for a recurrence of cancer. Doctors give treatments for early-stage or locally advanced breast cancer to get rid of as many cancer cells in the body as possible.

Rehabilitation Exercises

Some rehabilitation exercises are given to patients to prevent the scar tissue from forming in their armpit or shoulders. Scar tissues can often limit arm movements later. Thus, rehabilitation therapies can help an individual regain full function following the mastectomy surgery.

Side Effects of Mastectomy

There is a risk of complications or side effects after any operation. Most problems are trivial but some can be serious. Thus, treating them as soon as possible is important.

Pain

Patients often have fluids collected around the site of operation or armpit which is called seroma. This occurs when the wound drain is removed causing swelling, pain and an increased risk of infection. One might also feel numbness or shooting pain in the armpit, shoulder or chest wall due to nerve damage during surgery.

However, giving proper medication and draining the fluid with a needle or syringe may help in relieving the pain.

Swelling

People have swollen arms or hands post-surgery which usually settles down soon. However, in a few instances, the swelling is long-term resulting in lymphoedema. This condition develops when the lymphatic system fails to work properly and needs early treatment.

Infection

At times, infection or wound may develop at the operation site which appears to be red or swollen, feels warm and painful, and discharges liquid. These are infection signs which require immediate treatment with antibiotics.

Bleeding

A small amount of bleeding might be observed on the wound dressing post-surgery. However, if the bleeding did not stop, it is better to consult a healthcare professional.

Conclusion

Mastectomy may or may not be the end of the breast cancer journey, however, proper treatment can surely bring a lot of relief. While losing the breast can take a toll on emotions, with advanced breast reconstruction surgeries, people feel quite comfortable and satisfied with the newly reconstructed cancer-free breasts.

Frequently Asked Questions (FAQ)

What Happens to The Breast After Mastectomy?

In most instances of mastectomy, the entire breast tissue is removed and as such it is extremely unlikely for the breast tissue to grow back after the procedure. However, one can undergo breast reconstruction to restore the natural breast appearance.

Can a Woman Still Breastfeed After Mastectomy?

Women with a mastectomy of one breast may do unilateral breastfeeding as a single breast can produce enough milk. However, those undergoing bilateral mastectomy have reduced capabilities of breastfeeding or producing breast milk.  

Is a Mastectomy Painful?

Reports indicate that 40 % to 60% of patients undergoing mastectomy may have chronic pain which lasts longer than 3 months.

How Long Does it Take to Recover After Mastectomy?

People usually take three to six weeks to fully recover post-operation.

Can Breast Reconstruction be Done After Mastectomy?

Surgery to reconstruct the breasts can be done both at the time of surgery (immediate reconstruction) or after the incisions have healed and therapy has been completed (delayed reconstruction).