MASTECTOMY

What is a Mastectomy?

Simple or total mastectomy is surgery to treat or prevent breast cancer by removing the breast tissue (along with the areola and nipples) Where possible, chest muscles are maintained. 

Often breast cancer surgery will also involve the removal of one or more lymph nodes from the armpit (axilla). 

When is a Mastectomy Performed?

Mastectomy is recommended when your breast is affected by cancer, or you have a high risk of developing breast cancer. Simple mastectomy is indicated when 

• cancer has not spread to lymph nodes, 
• for cancer prevention, 
• patients with ductal carcinoma in situ (non-invasive breast cancer), 
• Paget's disease of the breast (rare cancer in the skin of or surrounding the nipple) and 
• recurrent breast cancer.

Types of Mastectomy?

There are different types of mastectomy depending on the stage of cancer, size of the breast tumour and lymph node involvement:

• Simple or Total Mastectomy: Your surgeon will remove the entire breast and sometimes the lymph nodes from the armpit by making a 6 to 7-inch long elliptical cut starting from the inside of the breast, close to the breast bone, and continuing up and out toward the armpit.
• Skin-sparing Mastectomy: Your surgeon will cut an opening around the nipple and areola to remove the breast tissue. Most of the breast skin is preserved with this technique, which is generally lost in a traditional mastectomy. It offers the advantage of negligible scarring and provides the best option for immediate breast reconstruction.
• Nipple-sparing Mastectomy: Your surgeon will make an incision in the fold of skin under or to the side of the breast or around the areola, where the cut cannot be easily seen after healing and will spare the nipple. Nipple-sparing mastectomy is not suitable for all patients.
• Preventive/Prophylactic or risk-reduction Mastectomy: If you are genetically predisposed and have a high risk of developing breast cancer, you may choose preventive surgery.
  In some cases, you can choose between mastectomy and lumpectomy. If you have only one cancerous site, less than 4 cm of tumour and a clear margin of healthy tissue, lumpectomy with radiation is as effective as mastectomy.
• Double Mastectomy - Some women requiring a mastectomy choose to have both breasts removed. This is also known as a contralateral prophylactic mastectomy. This may be recommended for women at risk due to gene mutations or at increased risk.
• Partial mastectomy

Mastectomy Considerations

Mastectomy has pros and cons, such as:

• Possibly avoiding adjuvant Radiotherapy treatment,
• Less concern about cancer recurrence when compared with partial breast removal
• No ongoing breast imaging is required for the removed breast
• Some women find the loss of their breast(s) confronting. This can be addressed with breast reconstruction or wearing a prosthesis in your bra.
• A loss of balance, especially with larger breast women
• Longer hospital stays and recovery periods.

Mastectomy Procedure

The procedure is performed under general anaesthesia. 

Your 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, if there is invasive cancer. 

A surgical drain (tubes to collect excess fluid) is usually inserted and the incision closed.

Surgery for invasive breast cancer usually involves a separate procedure to remove some or all of the lymph nodes in the armpit to be tested for cancerous cells. There are two types of axillary surgery - 

• sentinel node biopsy (removal of a few nodes) and 
• axillary dissection (removal of all the lymph nodes). 

Recommendations for treatment of the lymph nodes are separate from recommendations for the treatment of the breast. A mastectomy can be combined with sentinel node biopsy or axillary dissection.

Post-op a Mastectomy Care

This surgery will require you to stay in the hospital overnight.  To avoid stiffness and scar formation, you must follow some simple hand exercise regimes. 

Breast Reconstruction is often considered if you choose to rebuild your breasts after mastectomy.



Risks and Complications of a Mastectomy Procedure

As with any surgery, 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 or fluid (seroma) in the surgical site.