What is mastectomy?
A mastectomy is a surgical procedure that removes the entire breast primarily to treat breast cancer or to reduce one's risk of breast cancer.
Types of mastectomy
There are several different types of mastectomy, and each is performed based on the amount of breast tissue involved in the surgery:
Standard or total mastectomy
The surgeon removes all of the breast tissue including the nipple, areola, and most of the overlying skin.
Skin-sparing mastectomy
The whole breast, including the nipple is removed, but most of the skin over the breast is preserved. This is typically done together with immediate breast reconstruction.
Nipple-sparing mastectomy
A skin-sparing mastectomy where only the breast tissue is removed, leaving the skin, nipple, and areola intact.
Radical mastectomy
It is a more extensive procedure in which the entire breast, including the skin covering it, the two muscles under the breast, and the axillary (underarm) lymph nodes, are removed. This is done if the cancerous involvement is extensive.
Modified radical mastectomy
The procedure involves the removal of the entire breast. This includes the nipple, the areola, and the overlying skin except for the muscles behind the breast.
Why do you need a mastectomy?
A mastectomy is done to reduce one’s risk of breast cancer (prophylactic mastectomy) and to treat several types of breast cancers such as:
- Ductal carcinoma in situ (DCIS). This is a type of non-invasive breast cancer that develops in the milk duct and has not spread to the breast tissue.
- Stages 1, 2 (early-stage) and 3 (locally advanced) breast cancer. Mastectomy is used to treat breast cancer that has not spread to involve other body systems e.g. lung, liver, bones, brain (metastasised).
- Inflammatory breast cancer. Mastectomy is recommended after chemotherapy as this is an aggressive form of breast cancer.
- Paget's disease of the breast. A rare type of cancer that affects the skin of the nipple and areola.
- Locally recurrent breast cancer. This refers to cancer that has returned to the same breast despite breast conserving surgery and radiation treatment.
The procedure may also be done if:
- Cancer has spread to a large area of the breast and cannot be treated with a lumpectomy (a breast-conserving surgery)
- An individual (e.g. genetic mutation carrier) has a high lifetime risk of developing breast cancer. In this case, a double mastectomy (removal of both breasts) will be recommended
Who should not go for a mastectomy?
Mastectomy is generally not recommended for women who:
Have a known metastatic disease (cancer that spreads from one part to another)
Have an advanced disease that requires neoadjuvant therapy (any treatment given for the cancer before the main treatment) to shrink the tumour before surgical resection
What are the risks and complications of a mastectomy?
Although mastectomy is considered a relatively safe procedure, it has a few post-operative side effects, the majority of which are temporary and will resolve with time:
- Fluid accumulation beneath the surgical wound (seroma). This arises from the raw surgical surfaces but reduces in amounts over time. A drainage tube is typically required for 7 – 14 days to assist with drainage so it does not build up to cause discomfort.
- Bleeding
- Wound infection
- Pain in the shoulder and stiffness
- Hardness due to scar tissue at the surgical site
How do you prepare for a mastectomy?
Before surgery, you should inform your doctor about any medications, vitamins or supplements you are taking. In addition, you may be advised to:
- Stop taking any blood-thinning medications
- Fasting (no food for 6 hours and no drink for 2 hours) prior to surgery
What can you expect in a mastectomy?
Estimated duration
A mastectomy usually takes around 2 – 4 hours. Skin and nipple sparing mastectomies take a longer time due to greater complexity.
During the procedure
A mastectomy is performed under general anaesthesia, so you will not be aware during the procedure.
- Your surgeon will make a cut for access in order to remove the entire breast. The type of incisions varies according to the type of mastectomies performed.
- The tissue removed will then be sent to the lab for examination.
- Drainage tube(s) will be placed into the operative site to assist with the fluid build-up.
After the procedure
After the surgery, you will be taken to the recovery room in the operating theatre where you will be monitored to ensure your parameters (heart rate, blood pressure and breathing) are stable. You will also be checked for any post-operative pain.
You will be escorted to your room in the hospital ward once it is safe to do so.
Care and recovery after a mastectomy
Depending upon the surgery you had, you can expect to:
- Return home 1 – 2 days after your surgery
- Resume normal daily activities in 1 – 2 weeks
- Resume light to moderate exercises in 1 month
