Dr. Wasif shares the most important question a woman needs to ask her doctor before consenting to a mastectomy and explains if a woman's arms will swell after the procedure.
With a mastectomy itself where you are just removing the breast, that doesn’t happen. What you are referring to is called lymphedema, and what lymphedema comes from is actually surgery on the lymph nodes.
What are lymph nodes? They are, we can call them drainage channels and they are usually under the arm and if you have a cancer on the breast on the left side, we know that if it’s going to spread anywhere it would go to the lymph nodes under your arm.
So a part of all surgeries for the breast, including mastectomy, is to check those lymph nodes to make sure that the cancer hasn’t spread to the arm and you get swelling of the arm as a side effect, or as a complication, of checking those lymph nodes.
So let me go in a little more detail about that – again, about 30 years ago, everyone who had breast cancer would have all the lymph nodes under the arms removed and when we did that, we would find that up to 30% of these women were getting swelling of the arm or lymphedema and in many cases this was permanent.
So we wanted to figure out a way where we could check the lymph nodes and not have this complication and that’s how this sentinel lymph node biopsy procedure came into evolution, and what that is is we figured out that if breast cancer was going to go from the breast to the lymph nodes there was going to be maybe one or two lymph nodes where it will go first. So why take out all the lymph nodes when you can only check those one or two lymph nodes and these lymph nodes were called the so-called sentinel lymph nodes.
I think the most important question is, if someone has told you, “You have breast cancer and you need a mastectomy,” is to ask the question, “Well, can I have a smaller operation for my breast cancer?”
The most common operation we do for breast cancer is the segmental mastectomy in which only part of your breast is taken out, the part with the cancer, and you can keep the rest of your breast, and there’s significant advantages to doing that. It’s less surgery, the recovery is much faster, and you obviously don’t need any reconstruction.
So I think that’s the most important question to ask your surgeon – “Am I a candidate for a smaller operation?” And the medical term for that is ‘breast conservation therapy’. Not all women are candidates, but the majority of women should be offered that option.
About Dr. Nabil Wasif, M.D.:
Dr. Nabil Wasif, M.D., is a general surgeon at Mayo Clinic in Arizona, certified by the American Board of Surgery. He graduated from Aga Khan University Medical College in Pakistan and completed his residency in general surgeon at New York Presbyterian Hospital-Cornell in New York. His interests include surgical oncology, general surgery, GI oncology, breast cancer, melanoma, and sarcomas.