Mastectomy

Payam Rasouli The Author of Medical and Health Content
March 17, 2019
2023-08-20 23:30:19

What is a Mastectomy?

How long does it take to recover from a mastectomy?

Can breast tissue grow back after mastectomy?

A mastectomy is surgery to remove all breast tissue from a breast as a way to treat or prevent breast cancer.

For those with early-stage breast cancer, a mastectomy may be one treatment option. Breast-conserving surgery (lumpectomy), in which only the tumor is removed from the breast, may be another option.

Deciding between a mastectomy and lumpectomy can be difficult. Both procedures are equally effective for preventing a recurrence of breast cancer. But a lumpectomy isn’t an option for everyone with breast cancer, and others prefer to undergo a mastectomy.

Surgery to restore shape to your breast — called breast reconstruction — may be done at the same time as your mastectomy or during a second operation at a later date.

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. Mastectomy to prevent breast cancer

You might also consider a mastectomy if you don’t have breast cancer, but have a very high risk of developing the disease.

A preventive (prophylactic) or risk-reducing mastectomy involves removing both of your breasts and significantly reduces your risk of developing breast cancer in the future.

A prophylactic mastectomy is reserved for those with a very high risk of breast cancer, which is determined by a strong family history of breast cancer or the presence of certain genetic mutations that increase the risk of breast cancer.

Risks

Risks of a mastectomy include:

. Bleeding

. Infection

. Pain

. Swelling (lymphedema) in your arm if you have an axillary node dissection

. Formation of hard scar tissue at the surgical site

. Shoulder pain and stiffness

. Numbness, particularly under your arm, from lymph node removal

. Buildup of blood in the surgical site (hematoma)

. Scabbing, blistering, or skin loss along the site of the incision

. Damage to nerves in the back, arm, or chest wall

How you prepare

Meet with your surgeon to discuss your options

Before your surgery, you’ll meet with a surgeon and an anesthesiologist to discuss your operation, review your medical history and determine the plan for your anesthesia.

This is a good time to ask questions and to make sure you understand the procedure, including the reasons for and risks of the surgery.

One issue to discuss is whether you’ll have breast reconstruction and when. One option may be to have the reconstruction done immediately after your mastectomy, while you’re still anesthetized.

Breast reconstruction may involve:

. Using breast expanders with saline or silicone implants

. Using your body’s own tissue (autologous tissue reconstruction)

. Using a combination of tissue reconstruction and implants

Breast reconstruction is a complex procedure performed by a plastic surgeon, also called a reconstructive surgeon. If you’re planning breast reconstruction at the same time as a mastectomy, you’ll meet with the plastic surgeon before the surgery.

Preparing for your surgery

You’ll be given instructions about any restrictions before surgery and other things you need to know, including:

. Tell your doctor about any medications, vitamins or supplements you’re taking. Some substances could interfere with the surgery.

. Stop taking aspirin or other blood-thinning medication. A week or longer before your surgery, talk to your provider about which medications to avoid because they can increase your risk of excessive bleeding. These include aspirin, ibuprofen (Advil, Motrin IB, others) and other pain relievers, and blood-thinning medications (anticoagulants), such as warfarin (Coumadin, Jantoven).

. Don’t eat or drink 8 to 12 hours before surgery. You’ll receive specific instructions from your health care team.

. Prepare for a hospital stay. Ask your doctor how long to expect to stay in the hospital. Bring a robe and slippers to help make you more comfortable in the hospital. Pack a bag with your toothbrush and something to help you pass the time, such as a book.

. Tell your provider if you are pregnant or think you may be pregnant.

Before the procedure

Your doctor or nurse will tell you when to arrive at the hospital. A mastectomy without reconstruction usually takes one to three hours. You will likely stay in the hospital for 1 to 3 days after your mastectomy. This will depend on the extent of your surgery and if you also had breast reconstruction done.

If you’re having both breasts removed (a double mastectomy), expect to spend more time in surgery and possibly an additional day in the hospital. If you’re having breast reconstruction following a mastectomy, the procedure also takes longer and you may stay in the hospital for a few additional days.

If you’re having a sentinel node biopsy, before your surgery a radioactive tracer and a blue dye are injected into the area around the tumor or the skin above the tumor. The tracer and the dye travel to the sentinel node or nodes, allowing your doctor to see where they are and remove them during surgery.

During Mastectomy

Types of mastectomy procedures

There are several types of mastectomy procedures:

. Total (simple) mastectomy. This method removes the whole breast, including the nipple, the colored ring around the nipple (called the areola), and most of the overlying skin.

. Double mastectomy. This involves the surgeon removing both breasts, usually as a preventive measure — if genetic features indicate a high risk of breast cancer, for example.

. Modified radical mastectomy. The entire breast is removed. This includes the nipple, the areola, the overlying skin, and the lining over the chest muscles. Some of the lymph nodes under the arm are also removed. Breast cancer often spreads to these lymph nodes. It can then spread to other parts of the body. In some cases, part of the chest wall muscle is also removed.

. Radical mastectomy. The entire breast is removed, including the nipple, the areola, the overlying skin, the lymph nodes under the arm, and the chest muscles under the breast. For many years, this was the standard surgery. But today it is rarely done. It may be advised when breast cancer has spread to the chest muscles.

Some newer mastectomy methods may offer more surgery options. But more studies are needed to see if these methods work as well to fully remove breast cancer or stop from starting or coming back after treatment. Newer methods include:

. Skin-sparing mastectomy. The breast tissue, nipple, and areola are removed. But most of the skin over the breast is saved. This type of surgery seems to work as well as radical mastectomy. It is used only when breast reconstruction is done right after the mastectomy. It may not be a good method for tumors that are large or near the skin surface.

. Nipple-sparing mastectomy. This is similar to the skin-sparing mastectomy. It is sometimes called a total skin-sparing mastectomy. All of the breast tissue, including the ducts going all the way up to the nipple and areola, is removed. But the skin of the nipple and areola are preserved. The tissues under and around the nipple and areola are carefully cut away and checked by a doctor called a pathologist. If no breast cancer cells are found close to the nipple and areola, these areas can be saved. Otherwise, this method is not advised. Reconstruction is done right after the mastectomy.

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During procedure

A mastectomy is usually performed under general anesthesia, so you’re not aware during the surgery. Your surgeon starts by making an elliptical incision around your breast. The breast tissue is removed and, depending on your procedure, other parts of the breast also may be removed.

Regardless of the type of mastectomy you have, the breast tissue and lymph nodes that are removed will be sent to a laboratory for analysis.

If you’re having breast reconstruction at the same time as a mastectomy, the plastic surgeon will coordinate with the breast surgeon to be available at the time of surgery.

One option for breast reconstruction involves placing temporary tissue expanders in the chest. These temporary expanders will form the new breast mound.

For women who will have radiation therapy after surgery, one option is to place temporary tissue expanders in the chest to hold the breast skin in place. This allows you to delay final breast reconstruction until after radiation therapy.

If you’re planning to have radiation therapy after surgery, meet with a radiation oncologist before surgery to discuss benefits and risks, as well as how radiation will impact your breast reconstruction options.

As the surgery is completed, the incision is closed with stitches (sutures), which either dissolve or are removed later. You might also have one or two small plastic tubes placed where your breast was removed. The tubes will drain any fluids that accumulate after surgery. The tubes are sewn into place, and the ends are attached to a small drainage bag.

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After Mastectomy

After mastectomy surgery

You’ll be moved to the recovery room after mastectomy surgery, where staff will monitor your heart rate, body temperature, and blood pressure. If you are in pain or feel nauseous from the anesthesia, let someone know so that you can be given medication.

You’ll then be admitted to a hospital room. Hospital stays for mastectomy average 3 days or less. If you have a mastectomy and reconstruction at the same time, you may be in the hospital a little longer.

The morning after your surgery, your surgeon or nurse will show you an exercise routine you can do to prevent arm and shoulder stiffness on the side where you had the mastectomy and to help prevent the formation of significant scar tissue. Some exercises should be avoided until drains are removed. Ask your surgeon any questions you may have to make sure the exercise routine is right for you. Your surgeon should also give you written, illustrated instructions on how to do the exercises.

Before you leave the hospital, your surgeon or nurse will give you information about recovering at home:

. Taking pain medication: Your surgeon will probably give you a prescription to take with you when you leave the hospital. You might want to get it filled on your way home or have a friend or family member get it filled for you as soon as you are home so that you have it available.

. Caring for the bandage (dressing) over your incision: Ask your surgeon or nurse how to take care of the mastectomy bandage. The surgeon may ask that you not try to remove the bandage, and instead wait until your first follow-up visit so that he or she can remove the bandage.

. Caring for a surgical drain: If you have a drain in your breast area or armpit, the drain might be removed before you leave the hospital. Sometimes, however, a drain stays inserted until the first follow-up visit with the doctor, usually 1-2 weeks after surgery. If you’re going home with a drain inserted, you’ll need to empty the fluid from the detachable drain bulb a few times a day. Make sure your surgeon gives you instructions on caring for the drain before you leave the hospital.

. Stitches and staples: Most surgeons use sutures (stitches) that dissolve over time, so there’s no longer any need to have them removed. But occasionally, you’ll see the end of the suture poking out of the incision like a whisker. If this happens, your surgeon can easily remove it. Surgical staples — another way of closing the incision — are removed during the first office visit after surgery.

. Recognizing signs of infection: Your surgeon should explain how to tell if you have an infection in your incision and when to call the office.

. Exercising your arm: Your surgeon or nurse may show you an exercise routine you can do to prevent arm and shoulder stiffness on the side where you had surgery. Usually, you will start the exercises the morning after surgery. Some exercises should be avoided until drains are removed. Ask your surgeon any questions you may have to make sure the exercise routine is right for you. Your surgeon should also give you written, illustrated instructions on how to do the exercises.

. Recognizing signs of lymphedema: If you have had axillary dissection, you will be given information on taking care of your arm and being alert to signs of lymphedema.

. When you can start wearing a prosthesis or resume wearing a bra: The site of mastectomy surgery, and especially mastectomy with reconstruction, needs time to heal before you can wear a prosthesis or bra. Your doctor will tell you how long you may need to wait.

At-home recovery from mastectomy

It can take a few weeks to recover from mastectomy surgery, and longer if you have had reconstruction. It’s important to take the time you need to heal.

In addition to your surgeon’s instructions, here are some general guidelines to follow at home:

. Rest. When you get home from the hospital, you will probably be fatigued from the experience. Allow yourself to get extra rest in the first few weeks after surgery.

. Take pain medication as needed. You will probably feel a mixture of numbness and pain around the breast incision and the chest wall (and the armpit incision, if you had axillary dissection). If you feel the need, take pain medication according to your doctor’s instructions.

. Take sponge baths until your doctor has removed your drains and/or sutures. You can take your first shower when your drains and any staples or sutures have been removed. A sponge bath can refresh you until showers or baths are approved by your doctor.

. Continue doing arm exercises each day. It’s important to continue doing arm exercises on a regular basis to prevent stiffness and to keep your arm flexible.

. Have friends and family pitch in around the house. Recovery from mastectomy can take time. Ask friends and family to help with meals, laundry, shopping, and childcare. As your body heals, don’t feel you should take on more than you can handle.

In the months after mastectomy

Your body will continue to adjust to the effects of the surgery over a period of months. Here are some things to keep in mind:

. You may have “phantom sensations” or “phantom pain” in the months after mastectomy: As nerves regrow, you may feel a weird crawly sensation, you may itch, you may be very sensitive to touch, and you may feel pressure. Your discomfort may go away by itself, or it may persist but you adapt to it. Analgesics and NSAIDs (pronounced EN-seds) such as acetaminophen and ibuprofen usually can address the pain related to this type of nerve injury. Opioids (pronounced OH-pee-oydz) also can be used to treat this type of pain.

. Continue doing regular arm exercises: Stay with your arm exercise routine to keep your arm limber.

. You may experience fatigue from time to time in the early months after surgery: If you’re having trouble with fatigue, ask your doctor about things you can do.

Results

The results of your pathology report should be available within a week or two after your mastectomy. At your follow-up visit, your doctor can explain the report.

If you need more treatment, your doctor may refer you to:

. A radiation oncologist to discuss radiation treatments, which may be recommended if you had a large tumor, many lymph nodes that tested positive for cancer, cancer that had spread into the skin or nipple, or cancer remaining after the mastectomy

. A medical oncologist to discuss other forms of treatment after the operation, such as hormone therapy if your cancer is sensitive to hormones or chemotherapy or both

. A plastic surgeon, if you’re considering breast reconstruction

. A counselor or support group to help you cope with having breast cancer

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