Mastectomy

What is a Mastectomy?

A mastectomy is a surgical procedure that involves the removal of all or part of the breast, primarily used as a treatment for breast cancer.


Who is Suitable for Mastectomy?

Here are some typical scenarios where a mastectomy might be recommended:

  • Early-stage Breast Cancer: For women with stage I or II breast cancer, mastectomy can be a treatment option, especially if the tumour is large relative to the size of the breast or if there is a desire to avoid radiation therapy.
  • Advanced Breast Cancer: In cases of larger or more aggressive tumours, or if the cancer has spread extensively within the breast, mastectomy may be necessary.
  • Preventive (Prophylactic) Mastectomy: Women at very high risk of developing breast cancer due to genetic factors (like mutations in the BRCA1 or BRCA2 genes) may choose to have a mastectomy to prevent breast cancer.
  • Recurrent Breast Cancer: If breast cancer returns after initial treatment, such as lumpectomy and radiation therapy, a mastectomy may be considered as a treatment option.
  • Persistent Cancer after Lumpectomy: If cancer remains after a lumpectomy, a mastectomy may be necessary to remove any remaining cancer cells.


Benefits of a Mastectomy

The primary benefits of a mastectomy, particularly for those undergoing it as a treatment for breast cancer, include:

  • Effective Cancer Removal: Mastectomy provides a comprehensive way to remove cancerous tissue from the breast, which can be crucial for preventing the spread of cancer.
  • Reduction in Cancer Recurrence: For many patients, especially those with high-risk or genetic predispositions (like BRCA mutations), a mastectomy significantly reduces the risk of breast cancer recurrence compared to breast-conserving surgery.
  • Prevention for High-Risk Patients: Prophylactic mastectomy in high-risk individuals without breast cancer can drastically reduce the risk of developing breast cancer in the future.
  • Simplification of Treatment: In some cases, undergoing a mastectomy may reduce or eliminate the need for radiation therapy, which can be an advantage for patients looking to minimise overall treatment time and potential side effects.
  • Psychological Relief: For some patients, especially those with a very high risk of breast cancer, having a mastectomy can relieve the anxiety and stress associated with constant monitoring and the fear of cancer development.


Types of Mastectomy

  • Total (Simple) Mastectomy: Involves the removal of all breast tissue, including the nipple and areola, but does not involve the removal of lymph nodes or muscle tissue from beneath the breast.
  • Modified Radical Mastectomy: This type involves the removal of the entire breast along with the axillary lymph nodes (located in the underarm), but the chest muscles are preserved.
  • Radical Mastectomy: Once common but now rare, this extensive surgery involves removing all of the breast tissue, the chest wall muscles under the breast, and all of the lymph nodes under the arm.
  • Partial (Segmental) Mastectomy: More commonly known as a lumpectomy, this procedure removes only the part of the breast containing cancer along with a margin of normal tissue around it. It's considered a breast-conserving surgery rather than a full mastectomy.
  • Skin-Sparing Mastectomy: The breast tissue, nipple, and areola are removed, but most of the skin over the breast is preserved, making immediate reconstruction easier and more aesthetically pleasing.
  • Nipple-Sparing Mastectomy: All of the breast tissue is removed, but the nipple and skin are left intact. This option can provide a more natural appearance after breast reconstruction but is not suitable for all patients, especially those with tumours near the nipple.


Preparation Before a Mastectomy

Preparation for a mastectomy involves several steps to ensure safety and the best outcomes:

  • Medical Evaluations: Complete all required pre-operative tests, such as blood tests, mammograms, or other imaging studies recommended by your surgeon.
  • Consultations: Discuss with your surgeon the details of the surgery, including the type of mastectomy, the possibility of immediate reconstruction, and what to expect during recovery.
  • Medication Review: Inform your medical team about all your medications and supplements. Some medications may need to be stopped before surgery.
  • Preparation at Home: Arrange for help at home for post-surgery recovery, prepare meals in advance, and create a comfortable recovery space.
  • Mental Health Support: Consider speaking with a counsellor or support group to mentally prepare for the changes to your body image and to manage stress.


Mastectomy Procedure

During the mastectomy procedure, the steps generally include:

  • Anaesthesia: You will be given general anaesthesia, which means you will be asleep during the surgery.
  • Incision: The surgeon makes an incision on your breast. The location and size of the incision depend on the type of mastectomy and whether reconstruction is performed simultaneously.
  • Tissue Removal: The surgeon removes breast tissue and possibly other tissues, such as lymph nodes or muscles, depending on the type of mastectomy.
  • Reconstruction (if applicable): If immediate reconstruction is planned, a plastic surgeon may begin reconstructive procedures once the breast tissue is removed.
  • Closure: The incisions are stitched closed, often with drains placed to remove excess fluids.


Mastectomy Recovery Plan

A typical recovery plan includes:

  • Rest: Ensure you have plenty of rest and avoid strenuous activities.
  • Physical Therapy: Engage in recommended exercises to restore mobility and strength.
  • Wound Care: Follow instructions for caring for your incisions and managing drains.
  • Monitoring for Complications: Watch for signs of infection or other complications.


Mastectomy Prognosis

The prognosis after a mastectomy largely depends on the stage and type of breast cancer. Early detection and treatment generally lead to a better prognosis. Regular follow-up care is critical to manage any potential recurrence or new cancer.


Mastectomy Risks

Potential risks of mastectomy include:

  • Infection
  • Bleeding
  • Pain or numbness
  • Swelling (lymphedema) in the arm if lymph nodes are removed
  • Anaesthetic complications
  • Issues related to breast reconstruction, such as implant failure


What if Mastectomy is Delayed?

Delaying a mastectomy can lead to:

  • Progression of cancer, potentially making it more difficult to treat.
  • Higher risk of cancer spreading to other parts of the body.
  • Reduced options for breast-conserving surgeries or potential reconstruction in the future.


Making timely decisions about mastectomy, especially when recommended based on cancer diagnosis and individual risk factors, is crucial for effective treatment. Always discuss the timing and necessity of surgery with your surgeon to understand the best approach for your specific condition.