All you need to know about mastectomy

A mastectomy is a surgical procedure that removes all of the breast tissue from a breast in order to treat breast cancer, in patients in whom breast conservation may not be safe. In patients with breast cancer, breast surgery may be combined with axillary staging procedures, such as sentinel node biopsy and/or axillary clearance and is then labelled as Modified Radical mastectomy (MRM). Latest developments in this surgical technique enable surgeons to save patient’s native breast skin or sometimes even the nipple and areola, which is referred to as skin- sparing or nipple-sparing mastectomy.

Why is it done?

Mastectomy is advised in those patients with multiple cancer foci or extensive disease within the breast, in patients with extensive DCIS. Basically, in those patients in whom breast conservation may not be feasible. A mastectomy may also be considered in some women, who do not have breast cancer but may be at a high risk of developing the disease. A preventative (prophylactic) or risk-reducing mastectomy includes removing both of your breasts and dramatically decreases your future chance of getting breast cancer, when diagnosed to have a known genetic mutation that may increase your risk for developing the disease.

What are the complications?

Some of the complications of mastectomy, include bleeding, infection, flap necrosis, paresthesias / numbness over chest wall, under surface of arm, discomfort or swelling (lymphedema) over the arm if axillary lymph node dissection is done, and shoulder pain and stiffness, in a few.

How to prepare?

Before the surgery, one should meet their surgeon to discuss surgical options, surgical procedure, possible complications and extent of risk. They will be referred to the anesthesiologist, who will check the patient’s fitness for anaesthesia and the planned surgical procedure. This is an excellent moment to ask questions and ensure that you fully comprehend the surgical process.

What is a Clinical Breast Exam?

A clinical breast exam is performed by a doctor or nurse who utilizes his or her hands to examine for lumps or any other changes in the breast.

What are the different types of Mastectomy?

1. Modified Radical Mastectomy – Entire breast tissue is removed along with overlyign sking, nipple and areola, along with accompanying axillary lymph nodes, is removed.

2. Skin-sparing mastectomy – Entire breast tissue is removed along with skin, nipple, and areola, while overlying skin is saved.

3. A nipple – or areola-sparing mastectomy removes just the breast tissue while leaving behind the skin, nipple, and areola intact.

Preparing for your surgery

The individual undergoing surgery will be given instructions to fast overnight, or for a few hours, abstaining from certain medications just prior to surgery, etc. They will be asked to remove all jewellery and trinkets that they may be wearing / carrying and may order the operated area to be prepared by shaving or even preparing the bowel by giving an enema, as and when required.

Preparing for your surgery

The individual undergoing surgery will be given instructions to fast overnight, or for a few hours, abstaining from certain medications just prior to surgery, etc. They will be asked to remove all jewellery and trinkets that they may be wearing / carrying and may order the operated area to be prepared by shaving or even preparing the bowel by giving an enema, as and when required.

During the procedure

A mastectomy is often performed under general anaesthesia, so that the person is not conscious throughout the procedure. In those unfit for general anaesthesia, alternate modalities of anaesthesia, such as sedation, spinal anesthesia, local blocks etcetera, may be considered.

After the procedure

The individual will be brought to the recovery room to be monitored in the immediate post- operative period and will be given supportive medications. They will have a drain or two placed with the tubes placed within the operated site on the chest. If stable on obervation, he/she will be shifted to the room, and may be discharged the following morning, if stable, and will be educated regarding post-op wound and drain care at home, identifying signs of infection, exercise, physical activity etc.

Results

Next treatment (chemotherapy =/- radiotherapy +/- hormonal therapy) will be decided based on the Pathology report, which will be ready within a week or 10 days after surgery.