Mastectomy is the surgical removal of the entire breast and can be bilateral (removing both breasts.) The procedure may also be called a simple or total mastectomy.
A total mastectomy may be indicated to treat breast cancer and to prevent breast cancer for those who have a known high risk due to an inherited gene mutation. There are several main reasons why a mastectomy might be recommended over a lumpectomy in the case of breast cancer including but not limited to the following:
- Concerns about breast disfigurement due to the size and location of the tumor(s) as well as the amount of breast tissue that would remain following a lumpectomy
- Cancer is still present at the edges (margins) after a lumpectomy and there are concerns about cancer extending to other places in the breast
- It can prevent the need for the patient to undergo radiation therapy which can be advantageous if the patient wants to avoid radiation, is pregnant, or has a condition like scleroderma or lupus that might impact the ability for skin to tolerate treatments.
- There has been a breast cancer recurrence after previous radiation therapy
- Patient choice
Before you are scheduled for any breast cancer surgery, you should expect a detailed consultation with the surgeon discussing all of your surgical options and how surgery will be coordinated with other treatments such as chemotherapy and radiation if recommended. There are many factors that help to determine the timing and sequence of your treatment plan and your surgeon will work to explain these factors to you in developing your individualized surgical plan.
Routine blood work and heart studies such as an EKG can be ordered prior to surgery based on your age and the presence of any existing medical conditions.
You may be instructed to stop taking some medications before surgery. Make sure your surgeon knows all the prescription and over-the-counter medications you take, including natural or nutritional supplements. For more information related to preparation for surgery click here.
There are essentially three types of total mastectomy:
Total Mastectomy is performed under a general anesthesia, so you will not feel anything. The breast tissue including nipple and areola and all excess skin is removed through an incision over the breast. The incision will be meticulously closed with suture. The suture will all be under the skin, so there will be no stitches to remove after surgery. Immediate breast reconstruction is not an option with this type of mastectomy. These procedures may be performed as an outpatient or in the inpatient setting depending upon patient preference and health history.
Skin-Sparing Mastectomy is performed under a general anesthesia, so you will not feel anything. The breast tissue including nipple and areola is removed through an incision over the breast. Unlike a total mastectomy, the skin over the breast will not be removed which will allow for a plastic surgeon to perform breast reconstruction immediately following the mastectomy. The plastic surgeon will typically place temporary tissue expanders in the chest to form the new breast at this time. These procedures usually require an overnight stay at the hospital and are coordinated with a plastic surgeon. They are performed as an inpatient. The second stage of breast reconstruction surgery will be scheduled for a later date.
Nipple-Sparing Mastectomy is performed under a general anesthesia, so you will not feel anything. The breast tissue is removed through an incision over the breast sparing the nipple, areola and skin. This technique is less common than a skin-sparing mastectomy due to cosmetic considerations but also allows for a plastic surgeon to perform breast reconstruction immediately following the mastectomy. The plastic surgeon will typically place temporary tissue expanders in the chest to form the new breast at this time. These procedures usually require an overnight stay at the hospital and are coordinated with a plastic surgeon. They are performed as an inpatient. The second stage of breast reconstruction surgery will be scheduled for a later date.
Additional procedures may be performed just before or at the time of the mastectomy. Please keep in mind that each patient situation is different, which is why our highly trained and experienced surgeons are here to guide you through these complex decisions.
Information about additional procedures is also shared here:
Lymph Node Removal, also called a Sentinel Node Biopsy, may be recommended at the same time as the mastectomy to determine if the cancer has spread outside the breast if there are no concerns about enlarged lymph nodes before your surgery. During this procedure your surgeon will remove the first one or two nodes into which a tumor drains (sentinel nodes) through the mastectomy incision. The nodes are then sent to be tested for cancer.
In order to identify the sentinel node(s) a radioactive and/or blue dye must be injected into the area of the tumor or the skin just above the tumor. This dye will travel to the sentinel node(s) allowing your surgeon to identify and remove them. If a lymph node removal is recommended, the appointment will be coordinated for you around your planned surgery time.
If no cancer is present, no further lymph nodes need to be removed. If cancer is present, an axillary node dissection is performed.
Axillary Node Dissection may be recommended if a lymph node biopsy shows signs of cancer. During this procedure your surgeon will remove a number of lymph nodes from the axilla (armpit) on the side of the tumor through the mastectomy incision. A drain may be placed. If so, drain care instructions are linked here for your reference.
This varies from patient to patient and by procedure. A Total Mastectomy without immediate reconstruction can be performed on an outpatient or go home the same day basis. A mastectomy with immediate reconstruction by a plastic surgeon usually consists of a 48 hour inpatient stay at the hospital.
Outpatient recovery instructions for a mastectomy without immediate reconstruction are as follows. You may have lifting and activity restrictions after surgery. Plan to avoid bouncing activities like jogging, raising elbows over your shoulders and repetitive arm movements for the first week following surgery and until any drains are removed.
While recovery instructions may be tailored to individualize a plan of care based upon your specific needs, these instructions are common following mastectomy surgery:
- You will need to arrange for a ride home the day of your surgery and we recommend someone stay with you for the first 24 hours at home.
- When you leave the facility after surgery, we will want you to go home and rest. Avoid making any other plans on the day of your surgery. Starting the following day, you can increase your activity as you feel up to it.
- Avoid fried foods, milk products and citrus juices for around one day after your surgery. Suggestions for foods to eat include soup, sandwich, pasta, potatoes, toast, and applesauce.
- You will likely be given a prescription for pain medication following your surgery. The recovery nurse will discuss a pain control plan following surgery specific to you and your needs including activities like ice applied over incisions and a medication regimen. Often times we will recommend taking Tylenol and Advil (same as Motrin, Ibuprofen) or Aleve in addition to the narcotic pain medication.
- It is often suggested to start taking a stool softener twice daily the day following your procedure. You will want to continue this regimen as long as you are taking narcotic pain medications.
- You may be able to shower within a couple of days after your surgery, but will need to avoid soaking in a bath tub for at least 2 weeks and should not swim in a lake or pool for at least 4 weeks.
- If a drain is placed, you can reference the drain care instructions attached.
- The dressings applied to your surgical site will be specific to your procedure. If surgical glue is used, there will be no dressings to remove. If bandages are applied, they can usually be removed at home in 24-48 hours. Ace wraps may be re-applied for comfort until drains are removed. You will receive care instructions specific to your procedure.
For additional information for after surgery preparation click here.
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To find out more about Breast Procedures offered at CSA Surgical Center in Columbia, Missouri please call Columbia Surgical Associates at 573-443-8773 and schedule an appointment with a board-certified general surgeon.