Mastectomy
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Definition
Mastectomy refers to one of several operations in which some part of the breast is removed. A number of different mastectomy procedures exist, including:
- Partial mastectomy or lumpectomy—the tumor and a small margin of surrounding breast tissue is removed
- Simple mastectomy—the entire breast is removed
- Modified radical mastectomy—entire breast and some axillary lymph nodes are removed, but chest muscles are left in place
- Radical mastectomy—entire breast, axillary lymph nodes, and chest muscle are removed (this type used to be common, but now is rarely performed)
Parts of the Body Involved
This depends on the specific procedure followed, and may include some part or all of the breast, axillary lymph nodes, and (rarely) chest wall muscle.
Reasons for Procedure
- Treatment of breast cancer
- Occasionally done to prevent breast cancer in a woman with a family history of breast cancer
- Rarely necessary to perform if a patient has experienced severe side effects from previous treatment for breast cancer
Risk Factors for Complications during the Procedure
- Obesity
- Poor nutrition
- Smoking
- Recent or chronic illness
- Use of certain medications or dietary supplements
What to Expect
Prior to Procedure
Your doctor will likely do the following:
- Physical exam
- Mammogram
- Fine needle biopsy of the breast
- Blood and urine tests
In the days leading up to your procedure:
- Discuss any medications or dietary supplements you are taking with your surgeon
- Arrange for a ride to and from the procedure
- Do not eat or drink anything for 8 to 12 hours prior to surgery, unless your surgeon tells you otherwise
During Procedure
IV fluids and anesthesia will be administered. Intubation, a tube will be inserted down the throat so that a ventilator can assist with breathing.
Anesthesia
General anesthesia will be administered for this surgery.
Description of the Procedure
An oval-shaped incision is made in the breast. The breast tissue, including the nipple and areola, are removed by cutting the tissue off of the underlying muscle. Nearby lymph nodes (toward the underarm) may also be removed. A tube may be inserted for fluid drainage, which will be removed in the surgeon's office 1 to 2 days later. The area is closed with stitches.
Simple Mastectomy © 2008 Nucleus Medical Art, Inc.
After Procedure
Removed tissue is examined by a pathologist. Chemotherapy and/or radiation may be necessary if the cancer has spread.
How Long Will It Take?
The procedure takes about 1 to 3 hours.
Will It Hurt?
Anesthesia prevents pain during the procedure.
Possible Complications
- Hematoma (accumulation of blood in the wound)
- Seroma (accumulation of clear fluid in the wound)
- Infection
- Swelling of the arm caused by accumulation of fluid in lymph nodes (lymphedema)
- Limited arm and shoulder movement
- Numbness of upper inner arm skin
- Postmastectomy pain syndrome (burning, stabbing pain where breast was removed; thought to be due to nerve damage)
Average Hospital Stay
The typical hospital stay is 1 to 2 days.
Postoperative Care
- Keep the surgical area clean and dry.
- You will have a bandage over the surgery site and may have one or more tubes to drain blood and fluids that collect during the healing process. You must empty the drains, measure the fluid, and report any problems that your doctor may tell you to watch out for.
- Avoid vigorous activity for about six weeks, or as directed by your doctor.
- You may have physical therapy to learn special exercises that will help you regain shoulder and arm mobility.
If you've had lymph nodes removed, your arm is at risk of fluid accumulation and swelling (lymphedema) and/or serious infection (lymphangitis). You'll need to take some special precautions:
- Don't have blood pressure taken, blood drawn, or shots given in that arm.
- Wear gloves to do dishes, household scrubbing, and yard work.
- Don't wear anything tight on that arm, including elastic in sleeves.
- Don't carry heavy packages, purses, suitcases, grocery bags, etc. with that arm.
- Keep the skin of that arm well-moisturized with a lanolin-containing product.
- Use an electric shaver if you wish to shave your armpits.
- Do not get a sunburn.
Outcome
The average time for complete recovery is about six weeks.
There is usually little pain after a lumpectomy, but there may be temporary unpleasant sensations, including numbness and a pinching or pulling feeling in the underarm area. You may be prescribed pain medication or antibiotics.
You'll see your doctor for a follow-up appointment within 7-14 days after the surgery. Your doctor should explain the results of your pathology report and talk to you about the need for further treatment. If more treatment is needed, you will be referred to a medical oncologist and/or radiation oncologist.
About a month after surgery, you can begin wearing a light-weight prosthetic breast. You can be fitted for a more permanent prosthesis when your surgeon says your incision is healed. If you wish to have breast reconstruction performed, discuss this with your surgeon.
Call Your Doctor If Any of the Following Occurs
- Signs of infection, including fever and chills
- Redness, swelling, increasing pain, excessive bleeding, or discharge from the incision site
- Cough, shortness of breath, chest pain, or severe nausea or vomiting
- Redness, warmth, swelling, stiffness, or hardness in the arm or hand on the side of the body where the lymph nodes were removed
- New, unexplained symptoms
- Lumps or skin changes in remaining tissue on mastectomy side
- Lumps, skin changes, or nipple drainage in remaining breast
CANADIAN RESOURCES:
Canadian Breast Cancer Foundation
http://www.cbcf.org/
Canadian Cancer Society
http://www.cancer.ca
References:
American Cancer Society. Available at: http://www.cancer.org .
Last reviewed March 2008 by Igor Puzanov, MD
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
Copyright © 2007 EBSCO Publishing All rights reserved.
