Mastectomy

Breast cancer is the second leading cause of death in women next to lung cancer. It is also the most invasive cancer in women. Although there is noninvasive breast cancer, it may progress to invasive breast cancer as well. The two types of surgeries to treat breast cancer are lumpectomy and mastectomy. Lumpectomy is the removal of the tumor together with surrounding healthy tissues.

At Brookwood Baptist Health, we make sure that we are treating you with the same passion and urgency as we would a family member. In collaboration with a team of multidisciplinary cancer specialists, our oncologists in Central Alabama, along with you and your family, will try to make the best possible care decisions. We will also make sure you have a comfortable, compassionate care every step of the way.

What Is Mastectomy?

Mastectomy is a surgical procedure which involves removing a part of or the whole breast. It is usually performed to treat or prevent breast cancer. Sometimes, it also involves the removal of lymph nodes near the underarm and tissues near the breast. Alongside mastectomy, oncologists perform radiation therapy, hormone therapy and chemotherapy.

Who Should Get a Mastectomy?

Women with early onset cancers still have a choice between breast-conserving surgery (BCS) and mastectomy. People might think that mastectomy is the better choice for longer survival in the future, but studies show that BCS alongside radiation therapy work the same way in the long run. Although BCS might be more preferred by women and their doctors, there are certain factors that mastectomy might be the better choice:

• Inability to have radiation therapy
• Preference of more extensive surgery instead of radiation therapy
• Having prior radiation therapy treatment for breast cancer
• Having had BCS with re-excision(s) that did not completely remove the cancer
• Having two or more areas of cancer in the same breast that are not close enough to be removed together without changing the look of the breast too much
• Having a tumor larger than 5 cm (2 in) across, or a tumor that is large relative to the size of the breast
• If radiation therapy is needed during pregnancy (risking harm to the fetus)
• Presence of BRCA mutation in the genes, which might increase the risk of a second cancer
• Having a serious connective tissue disease, such as scleroderma or lupus, which may cause increased sensitivity to the side effects of radiation therapy
• Having inflammatory breast cancer

Still not sure if you should get a mastectomy? Our team at Brookwood Baptist Health will provide ongoing education and support to encourage and help patients make informed decisions about their health.

Types of Mastectomy

1. Single Mastectomy – only one breast is removed
2. Double or Bilateral Mastectomy – combination of single mastectomy in the breast with cancer and contralateral prophylactic mastectomy in the other breast without cancer.
3. Preventive or Prophylactic Mastectomy – for women carrying BRCA1 or BRCA2 gene, a single or double mastectomy may be performed to reduce the risk of developing breast cancer

There are six different types of mastectomy according to how much tissue is removed:

1. Simple or Total Mastectomy – the surgeon removes the entire breast, but does not include lymph nodes or muscles. This surgery is recommended for women who want to prevent breast cancer from occurring.
2. Modified Radical Mastectomy – the surgeon removes the entire breast and some lymph nodes, but does not include muscles. This surgery is performed to examine the lymph nodes and to check if the cancer has already spread beyond the breast.
3. Radical Mastectomy – the surgeon removes the entire breast, lymph nodes and chest muscles. This surgery is performed if the cancer has already spread to the chest muscles. This may be have been popular in the past, but now modified radical mastectomy is found to be as effective and less disfiguring.
4. Partial Mastectomy – the surgeon removes a portion of the breast affected by the cancer together with some tissues. This is different from lumpectomy in a way that this procedure removes more surrounding tissue.
5. Nipple-Sparing Mastectomy – also called subcutaneous mastectomy. The surgeon removes the entire breast while preserving the nipple.

6. Skin-Sparing Mastectomy – the surgeon removes the breast tissues through the small opening created from the removal of the skin of the nipple, the areola and the previous biopsy scar. The pouch provides the best environment for an implant and immediate breast reconstruction using your own tissues. This is why it is quite a popular choice for women.

   Most women are eligible for skin-sparing mastectomies, but there are exceptions:

   • If you will not undergo immediate breast reconstruction. The surgeon will remove as much skin to flatten the chest skin.
   • If there is a possibility that tumor cells are close to the skin (e.g., tumors that involve the skin, such as inflammatory breast cancer).

Mastectomy in Men

The risk of men developing breast cancer is very rare. In fact, less than 1% of breast cancers occur in men. However, when men do develop breast cancer, the most common surgery performed is mastectomy instead of a lumpectomy. Men have very small breasts and by the time the tissue and lymph nodes are removed, there is very little breast tissue left.

The various treatment options can be overwhelming. But our dedicated, multidisciplinary team of experts across Central Alabama are here to support you as you decide what is most comfortable for you and your family.

Risks of Mastectomy

Like all surgeries, mastectomies have risks:

• Numbness of the skin along the incision site and tenderness of the surrounding area due to nerves cut during surgery
• Extra sensitivity within the area of surgery caused by irritated nerve endings, that improves with time
• Fluid accumulation under the scar – this might be because of a hematoma, accumulation of blood in the wound; or seroma, accumulation of clear fluid in the wound. Both conditions resolve on their own or by the help of a doctor draining the accumulation with a needle.
• Delayed wound healing – occurs when blood vessels which supply the breast tissue are cut. This can cause a problem when healing, but is uncommon and generally, not a serious complication.
• Increased risk of infection –usually discovered early and can be treated right away
• Formation of lumpy or painful scar tissue

How Long Is the Recovery from Mastectomy?

According to the American Cancer Society, most women can go back to their normal lives in about 4 weeks. But recovery can take months for some individuals who undergo a more extensive surgery, such as radical mastectomy, and for those who have breast reconstruction right after a mastectomy. During recovery, you may feel numbness around the surgical site but it may be temporary and may disappear as you heal. However, the surgical scar might be permanently numb.

At Brookwood Baptist Health, we make sure you are not alone in this journey. Our team is a multidisciplinary group of physicians, nurses and other healthcare professionals that aims to deliver the most sophisticated treatment available while continuing to provide a caring and personalized environment for you and your family. Rest assured, you are in good hands.