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Mastectomy is a way of treating breast cancer by removing the entire breast through surgery. It’s often performed when a woman cannot be treated with breast-conserving surgery (lumpectomy), which spares most of the breast. Often a patient may choose a mastectomy over breast-conserving surgery for personal reasons. Women at very high risk of a recurrence, sometimes have a double mastectomy, the removal of both breasts.
A prophylactic mastectomy is reserved for those with a very high risk of breast cancer, which is determined by a strong family history of breast cancer or the presence of certain genetic mutations that increase the risk of breast cancer.
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There are several different types of mastectomy procedures:
Simple (or total) mastectomy
The surgeon removes the entire breast, including the nipple, areola, and skin. Some underarm lymph nodes may or may not be removed.
Most of the skin over the breast is left intact. Only the breast tissue, nipple and areola are removed. The amount of breast tissue removed is the same as with a simple mastectomy. Implants or tissue from other parts of the body are used at the time of surgery to reconstruct the breast. Many women prefer skin-sparing mastectomy because it offers the advantage of less scar tissue and a reconstructed breast that seems more natural. But it may not be suitable for larger tumors or those that are close to the surface of the skin.
Is a variation of the skin-sparing mastectomy. The breast tissue is removed, but the breast skin and nipple are left in place. This can be followed by breast reconstruction. The surgeon often removes the breast tissue beneath the nipple (and areola) during the procedure to check for cancer cells. If cancer is found in this tissue, the nipple must be removed. Even if no cancer is found under the nipple, some doctors give the nipple tissue a dose of radiation during or after the surgery to try to reduce the risk of the cancer coming back.
There are still some issues with nipple-sparing surgeries. Afterward, the nipple may not have a good blood supply, causing the tissue to shrink or become deformed. Because the nerves are also cut, there often may be little or no feeling left in the nipple. For women with larger breasts, the nipple may look out of place after the breast is reconstructed. As a result, many doctors feel that this surgery is best done in women with small to medium sized breasts.
Modified radical mastectomy
Combines a simple mastectomy with the removal of the lymph nodes under the arm (called an axillary lymph node dissection).
In this extensive operation, the surgeon removes the entire breast, axillary (underarm) lymph nodes, and the pectoral (chest wall) muscles under the breast. This surgery was once very common, but less extensive surgery (such as the modified radical mastectomy) has been found to be just as effective and with fewer side effects, so this surgery is rarely done now. This operation may still be done for large tumors that are growing into the pectoral muscles.
If a mastectomy is done on both breasts, it is called a double (or bilateral) mastectomy. When this is done, it is often a risk-reducing surgery for women at very high risk for getting breast cancer, such as those with a BRCA gene mutation. Most of these mastectomies are simple mastectomies, but some may be nipple-sparing.
Additional factors to consider:
1. Breast reconstruction surgery after mastectomy: After having a mastectomy a patient might consider having the breast mound rebuilt to restore the breast's appearance. Although each case is different, most mastectomy patients can have reconstruction. Reconstruction can be done at the same time as the mastectomy or sometime later.
Some patients choose not to have reconstructive surgery. Wearing breast prosthesis (breast form) is an option for those who want to have the contour of a breast under their clothes without having surgery. Many women are comfortable with just ‘going flat,’ especially if both breasts were removed.
2. Recovery: In general, patients stay in the hospital for 1 or 2 nights and then go home or for those staying in Ukraine, they would need to stay local for 7-10 days post-surgery. How long it takes to recover from surgery depends on what procedures were done, and some women may need help at home. Most women should be fairly functional after going home and can often return to their regular activities within about 4 weeks. Recovery time is longer if breast reconstruction was done as well, and it can take months to return to full activity after some procedures.
The side effects of mastectomy (more extensive surgeries tending to have more side effects), include pain or tenderness, Swelling at the surgery site, buildup of blood in the wound (hematoma), buildup of clear fluid in the wound (seroma), limited arm or shoulder movement, numbness in the chest or upper arm, post-mastectomy pain syndrome or PMPS.
4. For an in-depth analysis of the mastectomy, watch this short video.
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