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Breast removal surgery (mastectomy)

What is a mastectomy?

A mastectomy, otherwise known as breast removal surgery, is the removal of the entire breast. The extent of your surgery is dependent on your presenting condition and response to previous medical therapy (if taken).

How is a mastectomy done?

Once under general anaesthesia, an elliptical incision is made around the breast, the skin is opened to reveal the breast tissue and the breast tissue is removed. Depending on the type of mastectomy, other parts of the breast may be removed or spared.

During this surgery, Dr. Noorbhai may also wish to remove the lymph nodes under your arms if he believes the lump is cancerous or has been found cancerous through previous tests. Finally, your surgeon will cover the wound with skin and close the incision with absorbable stitches or surgical staples. A drainage bag will be attached to drain excess fluid for the next few days.

  • A simple or total mastectomy involves the removal of the breast tissue, areola and nipple.
  • A radical mastectomy is the removal of the entire breast tissue, nipple and areola as well as the muscles beneath the breasts and the lymph nodes. This mastectomy is only done when the cancer has spread (metastasised) to the chest.
  • A modified radical mastectomy is when all the breast tissue and the majority of the lymph nodes are removed.
  • A partial mastectomy is also known as a lumpectomy [insert hyperlink to page] and is done for those with early stages of cancer. This procedure involves the removal of the tumour as well as surrounding tissue.
  • A skin-sparing mastectomy is the removal of breast tissue, areola and nipple but the skin is left loose to accommodate for breast reconstruction surgery by a plastic surgeon. Depending if you are having radiation after surgery or not, you may need expanders to be temporarily put in before reconstruction can occur.
  • A nipple-sparing mastectomy is a breast removal in which the skin, areola and nipple are spared.

A mastectomy may be unilateral (removal of one breast) or bilateral (removal of both breasts).

Why would a mastectomy be done?

A mastectomy is done to remove a cancerous tumour from the breast and the surrounding affected tissue. Whether or not you are able to have a partial mastectomy (lumpectomy) or mastectomy will depend on the size of the tumour and whether or not the cancer has spread. A partial mastectomy (lumpectomy) is the less invasive of the two and is able to keep breast symmetry, and is therefore preferred in some cases. If you have been diagnosed with cancer, chemotherapy and radiation may be advised in combination with a mastectomy, and therefore a plan should be discussed with your oncologist and Dr Noorbhai in terms of whether reconstruction is desired.

Mastectomies are usually done in combination with radiation or chemotherapy, and are done for the following kinds of cancer:

  • Stage 1, 2, or 3 breast cancer.
  • Paget’s disease of the breast.
  • Recurrent breast cancer.
  • Inflammatory breast cancer.
  • Ductal carcinoma in situ (DCIS)
  • Non-invasive breast cancer.

A mastectomy is also done to prevent breast cancer in those who of very high risk of developing this cancer. In these cases, we refer to the mastectomy as a prophylactic or risk-reducing mastectomy.

How long will I be in hospital?

Most patients are able to go home after a few days of observation in the hospital. How soon you will be discharged from hospital depends on whether you are able to drink liquids when waking up, how much pain you have and whether you have someone to look after you at home.

What will happen after surgery?

Following a mastectomy you may experience the following:

  • Pain in your breast area.
  • Inability to lift your arms due to the incision.
  • Red skin around your wounds.

All these symptoms are normal and are nothing to be concerned about. Re-consult if you have an unusually high temperature, chills, vomiting, swelling around the incisions, bleeding or you are experiencing excessive pain as emergency care may be needed. Approximately 3 weeks after your operation you will be seen by your surgeon to check your wounds and drainage.

After surgery, you will be instructed on how to care for your incisions. You may be given instructions to keep the wound dry and be given arm exercises. Resting, wearing a sports bra and arm exercises should aid your healing and make you more comfortable.

It may be necessary to have a follow-up surgery if you require reconstructive breast surgery or the cancer returns.

How soon after the surgery can I resume normal activities?

You will be able to resume normal activities soon after your surgery; however, it is important to start slowly. If you experience pain during a certain activities, stop that activity. You may not do any heavy lifting or vigorous physical activity for at least 6 weeks after your procedure.

What are the potential risks and complications a mastectomy?

The risk of complications during open surgery include:

  • Infection of the wound or internal infection.
  • Bleeding.
  • Pain.
  • A painful scar.
  • Swelling in your arm (lymphedema) if an axillary node is dissected
  • Shoulder pain and stiffness
  • Build-up of blood near the incision site.
  • Deep vein thrombosis (DVT) or blood clots.
  • Risks from general anaesthetic.
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