Mastectomy is an operation that removes breast tissue from a breast. It is often done to treat breast cancer or prevent it in people at very high risk of developing it. When removing one breast, we call it unilateral mastectomy. The removal of both breasts is called a bilateral.
Types of mastectomy
There are several types of mastectomy: total, radical, modified radical, and subcutaneous (nipple-preserving). Different types of mastectomies use different techniques.
Total or simple mastectomy
- It involves removing the entire breast, including the nipple and areola. A total mastectomy can be unilateral (only one breast) or bilateral (both breasts).
- It may also be called a “skin-sparing mastectomy” if a reconstruction is also performed, as a piece of skin tissue is preserved for use during reconstruction.
- Usually, the surgeon does not remove nearby lymph nodes unless they are in the breast tissue that needs to be removed.
- The chest muscles or tissue under the breast are not removed.
- Some people choose this intervention as a preventive measure to reduce the risk of breast cancer, especially if they are considered to be at high risk. In these cases, mastectomy can be performed on both breasts, known as a double mastectomy.
Radical mastectomy
- A radical mastectomy removes all breast tissue, the lymph nodes in the armpits, and the pectoral muscles underneath. This surgery is rare nowadays, but it may be necessary if the cancer has spread to the muscles.
Radically modified mastectomy
- During a radically modified mastectomy, the surgeon removes all breast tissue and a few lymph nodes from under the arm.
- Lymph nodes are tested to check for cancer spread beyond breast tissue.
- The muscles under the breast are not removed, they remain intact, as in the case of total mastectomy.
- This type of mastectomy is often an option for people who have invasive breast cancer or for those who doctors expect to find cancer at a more advanced stage.
Subcutaneous or nipple-sparing mastectomy
- As the name suggests, this mastectomy aims to remove all breast tissue but keeps the nipple intact.
- If the tissue around the nipple or areola shows signs of cancer, the surgeon may need to remove those as well.
- This type of mastectomy is usually an option for people who have early-stage breast cancer with a smaller tumor.
- Although the nipple is preserved during the intervention, sensation and sensitivity may be lost. It’s important to talk to your doctor about the pros and cons of keeping your nipple during a mastectomy.
Mastectomy and breast cancer
Mastectomy is a treatment option for many types of breast cancer, such as:
- Ductal carcinoma in situ, also called DCIS or non-invasive breast cancer: It is a form of breast cancer in which cancer cells are located in the milk ducts and have not spread to the surrounding tissues. Although it is considered non-invasive, it can progress to invasive cancer if not treated properly.
- Stage 1 and 2 breast cancer: It refers to the early forms of the disease, in which the tumor is relatively small and located in the breast, with a possible spread limited to the axillary lymph nodes. Treatment in these stages may include mastectomy to completely remove the tumor and reduce the risk of recurrence.
- Paget’s disease of the breast: It is a rare form of cancer that affects the skin of the nipple and areola. It is often associated with an underlying ductal carcinoma. Treatment usually includes mastectomy to remove both the main tumor and the affected breast tissue.
- Breast cancer that comes back after treatment: It occurs when the cancer returns to the area of the breast or scar from the initial mastectomy. In such cases, mastectomy may be recommended to remove the affected tissue and prevent further spread of cancer.
For some types of breast cancer, the surgery takes place after chemotherapy, such as for:
- Stage 3 breast cancer, also called locally advanced breast cancer: Advanced local breast cancer is characterized by a larger tumor and/or the spread of cancer to nearby lymph nodes. In these cases, neoadjuvant chemotherapy is used to reduce the size of the tumor.
- Inflammatory breast cancer: It is a rare and aggressive form of breast cancer that causes redness and swelling of the breast. Initial treatment usually includes chemotherapy to reduce inflammation and tumor size, followed by mastectomy to remove the affected tissue and control the spread of the disease.
Many people with breast cancer can choose between mastectomy and lumpectomy for breast cancer surgery. Mastectomy removes all breast tissue, while lumpectomy is breast-sparing surgery. It only removes the cancer and some tissues around it.
When can I start physical exercises?
It is not safe to do certain exercise until drainage and seams are removed. Your doctor may recommend that you wait eight or more weeks before exercising to improve your arm’s strength — especially if he or she removed many lymph nodes during mastectomy surgery. More nerves run through the chest and armpit area, which can be affected by breast cancer surgery. That is why you may find that your muscles are weaker than they were before the surgery.
In the first three to seven days after surgery, the American Cancer Society recommends light exercise and deep breathing to improve mobility:
- Use your arm on the same side as the surgery to bathe, comb your hair, get dressed, and eat. It is important to ask your doctor if you can lift heavier objects.
- Raise your arms to shoulder height—or as high as you can, without pulling drainage—and lower them again a few times. Repeat three or four times a day to help remove lymphatic fluid from your arm and regain your range of motion.
- Raise your arm on the same side as the surgery and open and close your hand 15 to 25 times. Then bend and straighten the elbow several times. You can also bend your elbow and touch your shoulder on the same side a few times. Then, touch the opposite shoulder a few times.
- Practice deep breathing using your diaphragm (the muscle under your lungs) at least six times a day. Lie on your back and inhale slowly. Continue to breathe in as much air as you can as you try to expand your chest and abdomen (push your belly button away from your spine). When you can no longer breathe, relax and exhale all the air. Repeat four or five times. Deep breathing facilitates the functioning of the lungs.
Who is not a suitable patient?
Mastectomy is contraindicated for:
- Patients with known metastatic disease: Surgery is not indicated because the cancer has spread to other parts of the body, making the operation ineffective.
- Patients with poor performance who cannot tolerate general anesthesia: In this case, mastectomy can lead to major complications during and after the intervention.
- Patients with advanced locoregional disease: These patients require neoadjuvant treatment (such as chemotherapy or radiation therapy) to reduce the size of the tumor before any surgery is considered.
How long does the surgery take?
Mastectomy usually lasts 1-2 hours. Preparation time and time for recovery after general anesthesia are also added. A woman can be hospitalized between a day and a week, depending on her individual situation.
If the patient also wants a breast reconstruction at the same time as the mastectomy surgery, the surgery may take longer. This means that hospitalization, at the same time, can last longer.
Breast reconstruction after mastectomy
Breast reconstruction surgery is a surgery that aims to restore one or both breasts after mastectomy. It can restore balance between the two breasts by replacing the skin, breast tissue, and removed nipple. The reconstruction will depend on the mastectomy, the width, size and location of the removed tumor.
Find out more about how much a breast reconstruction surgery costs at this link: Soma Clinic – Prices.
Visit the Soma Clinic Youtube channel to discover more information about what Dr. Nico Ferariu has to say about breast surgery.
References
Breast Cancer – Australian Government Cancer
Breast Cancer Surgery – National Library of Medicine
Breast Reconstruction – Web MD
Mastectomy (Breast Removal) – My Cleveland Clinic
Types of Mastectomies and Reconstruction Surgeries – Healthline
