Mastectomy
Mastectomy is a surgical procedure that involves the removal of one or both breasts to treat breast cancer. In oncoplastic breast surgery, a mastectomy aims to effectively remove cancerous tissue while preserving the aesthetic appearance of the breast as much as possible.
Why is it recommended?
Mastectomy may be recommended for several reasons, including:
Extensive cancerous tissue: When the cancer is large or involves multiple areas of the breast, mastectomy may be the best option to ensure complete removal.
Risk reduction: In some cases, women with a high risk of developing breast cancer may choose to undergo preventive mastectomy to reduce their risk.
Patient-specific factors: These will be assessed and discussed with the breast cancer specialist surgeon.
Types of Mastectomy
The choice of mastectomy type depends on factors like cancer stage, tumour size/type, and patient preference. There are several types of mastectomy procedures, including:
Total or simple mastectomy — removal of the entire breast tissue
Skin-sparing mastectomy and Nipple-sparing mastectomy: Both skin-sparing and nipple-sparing mastectomies are undertaken in conjunction with reconstructive surgery.
Before the operation
Before undergoing a mastectomy, you'll have thorough discussions with your healthcare team to understand the procedure, potential risks, and expected outcomes. You will undergo imaging tests, such as Mammogram, Ultrasound +/- MRI/PET CT scan to assess the extent of the cancer. Your surgeon will provide preoperative instructions, including fasting requirements and medications to adjust.
During the operation
On the day of the surgery, you'll receive anesthesia to ensure your comfort throughout the procedure. Your surgeon will carefully remove the breast tissue while preserving the surrounding skin envelope to facilitate reconstruction. Depending on your situation, you may also have lymph nodes removed from the underarm area to assess cancer spread.
After the operation
Following a mastectomy, you'll spend time in the recovery area under close monitoring. You may experience some discomfort, swelling, or bruising, but your medical team will provide pain relief medication and supportive care. You'll receive instructions on wound care, activity restrictions, and follow-up appointments to monitor your progress and discuss further treatment options, such as breast reconstruction.
Expected recovery time
Recovery time varies for each individual, but most patients can expect to stay in the hospital for a few days following a mastectomy. You may need to take several weeks off work to rest and allow your body to heal fully. Your surgeon will advise you on when it's safe to shower and resume normal daily activities, typically within a week or two after surgery.
Risks and complications
While generally safe, Mastectomy — like any other major surgery — carries potential complications.
These include bleeding, infection, seroma (fluid accumulation), delayed wound healing, nerve damage leading to numbness or tingling, lymphedema (swelling), and arm and shoulder stiffness.
Chronic pain and psychological effects such as grief and body image changes can also occur. Careful preoperative assessment and postoperative management are essential to minimise risks and optimise recovery. People who are considering mastectomy should discuss potential complications with their healthcare provider and follow postoperative instructions as diligently as possible.
Finally, is a mastectomy right for you?
Mastectomy is reserved for patients with disease involving more than 40% of the breast or disease which is present in multiple parts of the breast. It is also recommended for women who are unable to have radiotherapy due to other health conditions or if they have had radiotherapy to the chest in the past.
It goes without saying that there are disadvantages to undertaking a mastectomy. The loss of the breast can have a profound impact on some women, affecting not only their body image and self-esteem, but their emotional wellbeing as well. It's important for people to weigh the potential benefits and disadvantages of a mastectomy carefully and to explore all available treatment options before making a decision.
Research from around the world conducted over the past decade supports breast conservation (removal of the cancerous lump rather than the whole breast) followed by radiotherapy, as opposed to mastectomy. Breast conservation coupled with radiotherapy offers better overall survival and disease-free survival to breast cancer patients.
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