Mastectomy (Breast removal surgery) – Types and Procedure

Introduction

Mastectomy is a process of removing the entire breast; it is a way to treat and prevent breast cancer. There are different types of breast surgeries, where some surgery recommends only removing the tumours from the breast, and some recommend removing whole breast tissues.  

Lumpectomy is the process of removing breast cancer and abnormal tissue around the tumour. It is also called partial mastectomy or breast conservation therapy.

Based on the type of cancer and its spread rate in the breast, the doctor suggests a suitable procedure of mastectomy. Before recommending a procedure, oncologists take into consideration the person’s age, health, menopause status, size of the tumour, individual preferences etc. In some cases, people don’t have breast cancer, but they have a high risk of developing it, so the doctor recommends a mastectomy.

The development in the medicinal field introduced newer mastectomy techniques which can preserve breast skin, and some surgery may also restore the shape of your breast.

Here in this blog, we discuss the types, procedures, recovery and side effects of mastectomy.

Why is a Mastectomy done?

Mastectomy is the process of removing entire breast tissue if you are diagnosed with breast cancer or if there is a high chance of developing it. One can opt for a mastectomy to remove one breast or both breasts.

The stage of your cancer plays a vital role in deciding the type of treatment you require.   

Types of breast cancer that can be treated with mastectomy include

• DCIS (Ductal Carcinoma in Situ)/ Noninvasive breast cancer
• An early stage of breast cancer (Stages I and II)
• Advanced Stage (Stage III)
• Paget’s disease of the nipple or breast
• Recurrent breast cancer
• Inflammatory breast cancer
• Proven high risk of breast cancer.

Types of Mastectomy

There are various types of mastectomy, and the procedure differs from person to person based on the spread rate, growth and type of tumour. They include

• Total or Simple Mastectomy
• Double Mastectomy
• Radical Mastectomy
• Modified Radical Mastectomy

Total or Simple Mastectomy

Total mastectomy is also commonly known as simple mastectomy. In this surgery, the doctor removes the breast, including the nipple, areola, chest muscle and skin.

Based on the medical condition, underarm lymph nodes are also removed as a part of a sentinel lymph node biopsy.

Double Mastectomy

Double mastectomy, also called bilateral mastectomy, involves the procedure of removing both breasts; it is used as a preventive measure to reduce the risk of breast cancer in a woman at high risk of developing the disease. The patient’s recovery time is comparatively higher than in other surgeries.

Radical Mastectomy

A radical mastectomy removes the entire breast, lymph nodes, pectoral muscles or chest wall muscles present under the breast. However, this type of mastectomy is rarely done these days. It depends on the larger tumours growing into the chest wall muscles.  

According to the American Cancer Society, modified radical mastectomy is effective with minimum side effects.

Modified Radical Mastectomy

Modified Radical Mastectomy involves the procedure of removing the entire breast along with lymph nodes but leaving the chest wall muscle intact. It is an overall process of preserving healthy skin tissues, which may help reconstruct your breast once you heal.

Other types of mastectomy include

Skin Sparing Mastectomy

This mastectomy removes the breast tissue and nipple but leaves the breast skin intact. It also helps in the reconstruction of the breast during the surgery.

Nipple-Sparing Mastectomy

It is a new method of mastectomy which involves removing the affected tissues and leaving the skin, nipple and breast tissues intact.

Steps involved in Mastectomy surgery

• Initially, you meet your medical practitioner and general anaesthetist, where you discuss your medical history and severity of the disease and then determine the plan for your anaesthesia.
• During this time, the patient can clear his doubts regarding the surgery, side effects or risks.
• After discussing the issue, the healthcare provider will let you know about the breast reconstruction, whether it is done along with the mastectomy or it can be done later.
•  On surgery day, your medical practitioner will give you general anaesthesia to make you fall asleep throughout the procedure.
• The patient will have a tube attached to help them breathe and a catheter in their vein to supply IV fluids to the body.
• The patients will be given antibiotics through IV to prevent infections; the practitioner will clean and sterilise the surgical site.
• A mild radioactive tracer is injected into your breast, which helps in highlighting the nearby lymph nodes. The practitioner will use a scanner to find them.
• After identifying the affected tissues, the surgeon will remove the breast and additional tissue if cancer has spread. The practitioner may leave the lymph nodes and nipple or spare the skin, but it depends on your cancer’s severity, stage and spread.  
• Your breast tissues will be sent to the laboratory for analysis.
• The surgeon may or may not perform the process of reconstructing your breast immediately. It depends on the patient’s body condition.
• If the patient is not opting for reconstruction, the surgeon will close the flap and may leave a temporary drain inside the surgical site. This drain will help to collect excess fluids from the wound into a drainage bulb placed outside.

What happens after Mastectomy Surgery?

• After the surgery, the patient will be taken to the recovery room, where the nurses keep an eye on their blood pressure levels, heart rate, breathing etc.
• The patient will be given instructions on how to take care of their wounds at home, also taking care of incisions and drains, and they will also explain the signs of infections.
• The patient should be aware of all do’s and don’ts; if not, you should reach out to the medical practitioners anytime for more clarity.
• Your results will arrive within a week or two; based on the results, the doctor will initiate further treatment steps.
• If you need more treatment, the doctor will refer you to a radiologist or oncologist for radiation or hormone treatments.
• Some patients are even suggested to undergo medical counselling to cope with the situation.

Risks and Complications after undergoing Mastectomy Surgery

Here are some early risks or complications the patient might face after undergoing mastectomy.

• Wound Infection
• Hematoma ( a pool of clotted blood builds up under the incision wound)
• Flap Necrosis (the flap muscle used for reconstruction dies due to improper blood circulation)

Some patients may experience delayed complications, including

• Seroma  

A buildup of fluid inside the wound if the patient doesn’t have a surgical drain. It may result in swelling and tenderness.

• Post-mastectomy pain syndrome  

Patients may experience pain or irritation near the surgical area, and some may also complain of tingling, prickling, burning, itching and shooting pain at the site. The patient should consult the doctor and take medical assistance to overcome the nerve pain.

• Lymphedema

Lymphedema is a risk when a patient has removed the lymph nodes. It damages your lymphatic system. It makes the arms and leg tissue swell and results in severe pain. It is not curable, but symptoms can be treatable.

Conclusion

When a patient is going to undergo a mastectomy, they need to understand the procedure and the need for the surgery. One should consult the health care provider and understand the treatments available and the best-recommended option to treat their cancer stage.

Mastectomy and lumpectomy are the two types of procedures which a patient should undergo to treat breast cancer. The removal of breasts drains women emotionally. There are many options available to reconstruct your breast. Being mentally strong and making peace with the situation helps you to fight cancer more effectively.

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