A mastectomy is surgery to remove a person's breast. In the past, a radical mastectomy with complete removal of the breast was the standard treatment for breast cancer. Surgical breakthroughs over the past two decades; however, have given women more options than they had before. Less invasive breast-conserving treatments are available to women today. The type of mastectomy that is right for a particular woman depends on a number of things to include:
Mastectomy is defined as the medical term for the surgical removal of one or both breasts, partially or completely. A mastectomy is usually carried out to treat breast cancer. In some cases, people believed to be at high risk of breast cancer have the operation prophylactically, that is, as a preventive measure. It is also the medical procedure carried out to remove cancerous tissues. Alternatively, some patients can choose to have a wide local excision, also known as a lumpectomy, an operation in which a small volume of breast tissue containing the tumor and a surrounding margin of healthy tissue is removed to conserve the breast. Both mastectomy and lumpectomy are referred to as "local therapies" for breast cancer, targeting the area of the tumor, as opposed to systemic therapies, such as chemotherapy, hormonal therapy, or immunotherapy.
Different types of mastectomy procedures are available to women. What follows are descriptions of these procedures.
Total mastectomy, also called, 'simple mastectomy,' is a procedure where a doctor removes a woman's entire breast, to include the nipple. The woman's lymph nodes, which are small glands that are part of her immune system, are not removed. A woman is more likely to have a total mastectomy if cancer is not in her lymph nodes, or if she is having a preventative mastectomy to decrease her chance of experiencing breast cancer.
Women who have a high risk of breast cancer might choose to have a preventative mastectomy which is also referred to as a, 'prophylactic mastectomy.' Studies show that women with a high risk of breast cancer might be as much as 90% less likely to experience the disease after preventative mastectomy. Usually, a total mastectomy or removal of the woman's entire breast and nipple is recommended. In some instances, women have both of their breasts removed, something called a, 'double mastectomy.'
Some women who have experienced breast cancer in one breast will choose to undergo a preventative mastectomy to remove the other breast. Doing so may reduce the chance of cancer re-occurrence. Women who plan to have breast reconstruction can have it done at the time of preventative mastectomy, or at a later time. During breast reconstruction, a surgeon might use synthetic implants or tissue flaps from another part of the woman's body to create a breast.
Women with stage I or stage II breast cancer may choose to pursue a partial mastectomy, which is a breast-conserving method in which the tumor and the tissue around it are all that is removed. The surgery is followed by radiation therapy to the remaining breast tissue. With radiation therapy, powerful X-rays target the breast tissue. The radiation kills cancer cells while preventing them from spreading. There are two kinds of partial mastectomy:
In some instances, additional surgery is needed after a partial mastectomy. Sometimes, if cancer cells remain in the person's breast tissue, it might be necessary to remove the entire breast.
A radical mastectomy involves the complete removal of the breast, to include the nipple. The surgeon also removes the overlying skin, the lymph nodes, as well as the muscles beneath the breast. Due to the fact that radical mastectomy is not more effective than other, less extreme forms of mastectomy, is is rarely performed today. Radical mastectomy is only recommended when the cancer has spread to the person's chest muscle.
Modified Radical Mastectomy
A less traumatic and more widely used procedure is the, 'modified radical mastectomy (MRM).' With the modified radical mastectomy, the person's entire breast is removed as well as the lymph nodes; chest muscles are left intact. The skin covering the chest wall may or may not be left intact. The procedure may be followed with breast reconstruction.
Following Mastectomy Surgery
Following mastectomy surgery, the person is moved to a recovery area where health care staff will monitor their body temperature, heart rate and blood pressure. If the person experiences nausea from the anesthesia or pain, they can be given medication. The person is then admitted to a hospital room. Hospital stays for mastectomy average three days or less. If the person has a mastectomy and reconstruction at the same time, they might be in the hospital a bit longer.
The morning after surgery, the person's surgeon or nurse will show them an exercise routine they can do to prevent arm and shoulder stiffness on the side where the person had the mastectomy and to help prevent the formation of significant scar tissue. Some exercises should be avoided until drains are removed. Before the person leaves the hospital to go home, a surgeon or nurse will provide them with information about recovering at home. The information includes the following.
Recognizing Signs of Infection: The person's surgeon should explain how to tell if the person has an infection in their incision, as well as when to contact the office.
Recognizing Signs of Lymphedema: If the person has had axillary dissection, they will be provided with information on taking care of their arm and being alert to signs of lyphedema.
Wearing a Prosthesis or Bra: The site of the mastectomy surgery and particularly mastectomy with reconstruction needs time to heal before the person can wear a prosthesis or bra. The person's doctor will tell them how long they might need to wait.
Caring for the Bandage: The person's surgeon or nurse will show them how to take care of the mastectomy bandage. The surgeon might ask that the person not attempt to remove the bandage and instead wait until their first follow-up appointment so the surgeon can remove the bandage.
Pain Medication: The person's surgeon will most likely give them a prescription to take with them when they leave the hospital. The person may want to have it filled on their way home, or have a family member or friend fill the prescription as soon as the person is home so they have it available.
Exercising the Person's Arm: A surgeon or nurse may show the person an exercise routine they can do to prevent arm and shoulder stiffness on the side where they had surgery. Usually, the person will start the exercises the morning following surgery. Some exercises should be avoided until drains are removed.
Stitches and Staples: The majority of surgeons use stitches that dissolve over time, so there is no longer any need to have them removed. On occasion, someone who has had a mastectomy will see the end of a stitch poking out of the incision. If this occurs, the person's surgeon can easily remove it. Surgical staples are removed during the person's first office visit following surgery.
Caring for a Surgical Drain: If the person has a drain in their breast area or their armpit, the drain might be removed before the person leaves the hospital. At times; however, a drain remains inserted until the first follow-up visit with the doctor - usually one or two weeks after surgery. If the person is going home with the drain inserted, they will need to empty the fluid from the detachable drain bulb a few times each day.
Mastectomy rates vary tremendously worldwide, as was documented by the 2004 'Intergroup Exemestane Study', an analysis of surgical techniques used in an international trial of adjuvant treatment among 4,700 females with early breast cancer in 37 countries. The mastectomy rate was highest in central and eastern Europe at 77%. The USA had the second highest rate of mastectomy with 56%, western and northern Europe averaged 46%, southern Europe 42% and Australia and New Zealand 34%.