A mastectomy is a surgery intended to remove all breast tissue from a breast to treat or prevent breast cancer. It may be a treatment option for many types of breast cancer.
Newer mastectomy techniques help preserve breast skin and give the breasts a more natural appearance following the procedure. You may decide to have breast reconstruction, which could be performed at the same time as your mastectomy or at a later date.
This article explains more about what to expect during a mastectomy and recovery.
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Once you arrive in the healthcare facility on the day of your mastectomy surgery, you will change into a gown and wait in a preoperative holding section. Some health care facilities allow you to have one or more family members or friends in the room.
Your nurse or surgeon may place markings on the breasts to show which path the incision will follow. They usually do that with a felt-tip marker. You will sit up while the process occurs to allow marking of the natural crease of your breast.
The doctor then leads you into the anesthesia room, where they'll insert an intravenous (IV) line into your arm and tape it into place. Before the surgery, the health care professional administers anesthetic medications via the IV line. A mastectomy requires general anesthesia.
The mastectomy procedure
Before surgery, you meet a surgeon and an anesthesiologist who discuss the operation, evaluate your medical history, and establish the plan for your anesthesia. At this point, you can ask questions to ensure you understand the procedure, including the importance and risks involved.
You will also discuss the possibility of having breast reconstruction at this point. The breast reconstruction may be performed at the same time as the mastectomy (immediate reconstruction) or as a second surgical procedure later on (delayed reconstruction).
The main techniques to reconstruct your breast are:
Implant reconstruction: this is usually a two-stage procedure, initially placing an expander underneath your skin. Expanders are temporary implants gradually inflated with saline over time, stretching the skin to make room for the final implants. Months later, in stage two, the expander will be removed and replaced for a final soft implant.
In some cases, everything can be done in one stage, with the final soft implant being placed right away, without requiring an expander. This approach is, however, not possible for most patients.
Autologous or ‘flap’ reconstruction: This approach uses tissues from a different part of your body, such as fatty tissue from your abdomen or behind your arm, rather than an implant. It is a more involved surgery, with a longer recovery time.
Or you may have a combination of both.
Mastectomy procedures requiring axillary dissection last for two to three hours, while one requiring reconstruction may take longer.
The incisions are often in a round, oval shape around the nipple, running across the breast. Individuals with a skin-sparing mastectomy may need a smaller incision that only includes the areola, nipple, and the original biopsy scar. But when using a nipple-sparing mastectomy, you might need several incisions.
After making the incision, the breast tissues separate from the overlying skin and chest wall muscle below it.
The surgeon removes all the breast tissues that lie between the collarbone and ribs.
In the last stages, the breast surgeon examines the surgery areas for bleeding and places surgical drains. The drains help the fluid flow out of your body.
Finally, the surgeon may perform breast reconstruction if it is part of the plan.
Inform the doctor about any vitamins, medications, or supplements you are taking
Avoid taking aspirin or any other blood-thinning drug
Avoid eating or drinking 8-12 hours prior to the surgery
Prepare to stay in the hospital
Before the mastectomy, you may have a chance to discuss the surgery with a specialist nurse or surgeon. You can talk about how the procedure may affect you emotionally and physically.
The morning after the surgery, your nurse or surgeon will show you an exercise routine you can perform to prevent shoulder or arm stiffness. It also helps prevent scar tissue from forming in your armpit and shoulder.
Taking pain medication
The surgeon can give a prescription as you leave the hospital.
Caring for a surgical drain
Any drain present in the breast area or armpit may be removed before you leave the hospital, but sometimes, the drain remains inserted until the doctor removes it during the follow-up visit.
If you go home with the drain inserted, ensure you empty the fluid a few times a day, as instructed by your nurse or surgeon.
Care for the bandage (dressing) over the incision
Your surgeon or nurse will guide you on how to care for your mastectomy dressing. They may ask you not to try removing the bandage but instead wait until your initial follow-up visit to have it removed.
Stitches and staples
Most surgeons use stitches and staples that dissolve with time, meaning you won't need to have them removed. However, on some occasions, you may see the end of the suture poking out of the incision. If this happens, do not remove them yourself but instead, let your surgeon do it.
Normally for the first week after the surgery, you will wear special tops to help you heal. Typically, you can only wear a bra or prosthesis (breast-shaped piece worn inside bras to look like the shape of a real breast) once the site of mastectomy surgery heals, especially if you had reconstruction. Your doctor will tell you the duration you may need to wait.
When recovering from home, ensure you follow some of the guidelines such as:
Ensure you get extra rest in the initial weeks after surgery.
Take pain medication as required
You may feel some pain and numbness around the chest wall and the breast incision. Take pain medication if you feel the need but follow your doctor's instructions.
Continue with daily exercises
These will help prevent stiffness and ensure your arm remains flexible.
Avoid lifting objects that are over 5 pounds heavy unless your doctor considers it safe. It may take six weeks for individuals who undergo surgery with tissue transfer and 4-6 weeks for those who undergo surgery with tissue expanders to lift heavy objects again.
Jogging and tennis
Avoid such strenuous exercises until the doctor considers them safe. Your physiotherapist can give instructions on the exercises and movements you can take as the incisions heal.
You can speed up your recovery process by performing exercises such as:
Arm and shoulder exercise where you move the arm over your head, behind the neck, and to the middle of the back
Shoulder blade stretch
Don’t start exercising until your doctor says it is okay. If you are unsure how to do an exercise, don’t start it until your doctor or physiotherapist shows you how.
Mastectomy is a breast cancer operation that removes the entire breast. It is recommended in situations where 1) a lumpectomy is not suitable for a person, 2) personal reasons, 3) the patient is at high risk of getting second breast cancer, and 4) the patient wishes to have both breasts removed.
The operation takes only about 90 minutes, but it takes longer if an axillary dissection and/or breast reconstruction are required.
Most patients can go home the following day. Full recovery occurs in about 4-6 weeks.