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Mastectomy

(Breast Surgery; Surgery for Breast Cancer; Surgery to Remove a Breast)

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Definition

A mastectomy is a surgery done to remove breast tissue. Mastectomy procedures include:
  • Breast-conserving surgery:
    • Lumpectomy—The tumor and a small margin of normal breast tissue around it is removed.
    • Partial mastectomy—Removal of part of the breast that has cancer and some normal tissue around it. This may include removal of lymph nodes or the lining of the chest muscle.
  • Breast-tissue removal surgery:
    • Simple mastectomy—The entire breast is removed, including the nipple and areola.
    • Skin-sparing mastectomy—The skin that covers the breast is left intact except for the nipple and areola. This surgery is similar to a simple mastectomy. It is done when immediate breast reconstruction is planned. The procedure has limitations and may not be an option for all women.
    • Modified radical mastectomy—The entire breast, some lymph nodes in the armpit, and any affected chest muscle is removed.
    • Radical mastectomy—The entire breast, lymph nodes, and muscles of the chest wall are removed (rarely done).
Mastectomy
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Reasons for Procedure

A mastectomy is done:
  • To treat breast cancer—removing cancer cells and any affected tissue
  • To prevent breast cancer—women with a very high risk of developing breast cancer may have one or both breasts removed
  • To treat severe side effects from previous treatment—some people with autoimmune diseases, such as systemic lupus erythematosus or scleroderma may not be able to tolerate skin side effects from radiation therapy

Possible Complications

Problems from the procedure are rare, but all procedures have some risk. Your doctor will review potential problems, like:
  • Bleeding and bruising
  • Seroma—accumulation of clear fluid in the incision
  • Infection
  • Lymphedema—swelling of the arm caused by accumulation of fluid in lymph nodes
  • Limited arm and shoulder movement
  • Numbness of skin on upper arm
  • Pain after the procedure, such as burning pr stabbing pain where breast was removed
Some factors that may increase the risk of complications include:
  • Obesity
  • Poor nutrition
  • Smoking
  • Recent or chronic illness
  • Use of certain medications or dietary supplements

What to Expect

Prior to Procedure

Your doctor may do the following:
  • Physical exam
  • Mammogram—a test that uses low-dose x-rays to make a picture of breast tissue
  • Fine needle biopsy to test the breast tissue for cancer
  • Blood and urine tests
Leading up to the surgery:
  • Talk to your doctor about your medications and supplements. You may be asked to stop taking some medications up to 1 week before the procedure.
  • Arrange for a ride home.
  • Eat a light meal the night before the surgery. Do not eat or drink anything after midnight, unless otherwise instructed.

Anesthesia

General anesthesia—you will be asleep during the procedure

Description of the Procedure

The extent of the surgery will depend on the type of mastectomy you are having.
For breast-conserving surgeries, an incision is made where the tumor is located. The tumor is taken out along with a small bit of normal tissue that surrounds it.
For breast-tissue removal procedures, the entire breast, and fatty tissue are removed. The doctor may also need to remove lymph nodes and portions chest muscles that support the breast. Tissue that is removed during surgery is examined under a microscope for any abnormalities. If you have skin-sparing surgery, the skin around the breast will be retained.
After either surgery doctor will then insert a tube to drain blood and fluids. Lastly, the area will be closed with stitches.

How Long Will It Take?

1-3 hours

Will It Hurt?

Anesthesia will prevent pain during the procedure. Pain and discomfort after the procedure can be managed with medications.

Average Hospital Stay

1-3 days

Post-procedure Care

At the Hospital
Right after the procedure, you will be in a recovery room where your blood pressure, pulse, and breathing will be monitored. Recovery may also include:
  • Pain medications
  • Antibiotics to prevent infection
  • Medication to prevent blood clots
  • Getting out of bed and moving around within 24 hours of your surgery
If you had cancer and it has spread, chemotherapy and/or radiation may be needed.
During your stay, the hospital staff will take steps to reduce your chance of infection such as:
  • Washing their hands
  • Wearing gloves or masks
  • Keeping your incisions covered
There are also steps you can take to reduce your chances of infection such as:
  • Washing your hands often and reminding visitors and healthcare providers to do the same
  • Reminding your healthcare providers to wear gloves or masks
  • Not allowing others to touch your incisions
At Home
Recovery will take about 6 weeks. Self-care measures and medications will help ease discomfort. Activity may be restricted during this time, but complete rest is not necessary. The care staff will help you with exercises to help maintain arm strength and prevent lymphedema. To prevent infection at the incision site, follow instructions on how to clean and care for the wound.
Ask your doctor when you can begin wearing a light-weight prosthetic breast. You can be fitted for a more permanent one when the incision area has healed. If you want breast reconstruction surgery, talk to your doctor.

Call Your Doctor

It is important for you to monitor your recovery after you leave the hospital. Alert your doctor to any problems right away. If any of the following occur, call your doctor:
  • New signs of infection, including fever and chills
  • Increased redness, swelling, increasing pain, excessive bleeding, or discharge from the incision site
  • Cough, shortness of breath, or chest pain
  • Persistent nausea and/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 or worsening pain and/or swelling in your feet, calves, or legs
  • Lumps or skin changes in remaining tissue on mastectomy side
  • Lumps, skin changes, or nipple drainage in remaining breast
  • Symptoms of depression that last more than 2 week
If you think you have an emergency, call for medical help right away.

RESOURCES

American Cancer Society www.cancer.org

Breast Cancer http://www.breastcancer.org

CANADIAN RESOURCES

Canadian Breast Cancer Foundation http://www.cbcf.org

Women's Web http://www.womensweb.ca

References

Axillary lymph nodes. Breast Cancer website. Available at: http://www.breastcancer.org/pictures/breast%5Fanatomy/axillary%5Flymph%5Fnodes. Updated September 17, 2013. Accessed January 3, 2014.

Breast cancer in women. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated December 16, 2013. Accessed January 3, 2014.

Surgery for breast cancer. American Cancer Society. Available at: http://www.cancer.org/cancer/breastcancer/detailedguide/breast-cancer-treating-surgery. Updated December 31, 2013. Accessed January 3, 2014.

Surgery for early and locally advanced breast cancer. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated December 22, 2013. Accessed January 3, 2014.

Treatments and side effects. Breast Cancer website. Available at: http://www.breastcancer.org/treatment. Updated May 15, 2013. Accessed January 3, 2014.

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