Mastectomy

What Is Mastectomy?

Mastectomy is the surgical removal of all or some of a patient’s breast tissue, usually performed in order to treat or prevent breast cancer. Mastectomy is not to be confused with lumpectomy, which is the removal of only the cancerous mass from the breast along with a minimal amount of surrounding healthy tissue.1 Mastectomy is most commonly performed on females, because females have a much higher incidence of breast cancer cases than men. However, when males develop breast cancer, they can be treated with a mastectomy.2

The details of mastectomy procedures vary between patients depending on the severity of the breast cancer, but in general there are five types of mastectomy procedures.1

  • Simple Mastectomy: Simple mastectomy, also called “total mastectomy” involves the removal of the entire breast without the removal of the underlying lymph nodes or muscle. This procedure is usually recommended for patients who have multiple cancerous masses in the breast or females who elect to have a prophylactic (preventative) mastectomy.
  • Radical Mastectomy: In a radical mastectomy, the whole breast is removed along with some of the underlying muscle and most of the lymph nodes in the chest. A surgeon will recommend this procedure if the cancer has spread to the muscle tissue under the breast. This type of mastectomy is not often used because it can have severe effects on the appearance of the chest, and other procedures are usually just as effective.
  • Modified Radical Mastectomy: A modified radical mastectomy is similar to a radical mastectomy but without the resulting chest deformations. In this procedure the whole breast and the lower lymph nodes are removed, but none of the chest muscle is removed. Patients with cancer that has spread from the breast to other parts of the body are most likely to have this type of mastectomy. After the lymph nodes are removed, a doctor can examine them to determine the extent to which the cancer has spread.
  • Partial Mastectomy: A partial mastectomy is similar to a lumpectomy, except that more healthy tissue is removed from the breast, but the remainder of the breast is left intact.
  • Subcutaneous Mastectomy: Subcutaneous mastectomy is also called “nipple-sparing” mastectomy, as all of the breast tissue is removed except for the nipple. Males and females who would prefer to keep the appearance of their natural nipple after a mastectomy choose this procedure. Some surgeons will not recommend a nipple sparing procedure, especially if the patient would like to undergo breast reconstruction. The reason for this is the appearance of the nipple often gets changed in a reconstructive surgery anyway, and leaving any bit of breast tissue behind poses a risk for the return of cancer. Subcutaneous mastectomy can also be called “skin sparing” mastectomy, when tissue beneath the skin of the breast is removed but the skin remains intact. This can make it slightly easier to perform reconstructive surgery. Skin-sparing mastectomies cannot be performed if there is any possibility that the cancer has spread to the skin.

These 5 types of mastectomy can be performed on one or both of the breasts, and can be changed slightly by a surgeon to fit the needs of each patient’s specific case of cancer. An experienced mastectomy surgeon will understand the details of each type of surgery, and will be able to effectively discuss their pros and cons.1

Choosing Mastectomy

The biggest reason that a patient may choose to have a mastectomy is that the cancerous tumor in the affected breast is so large in comparison to the breast that having a lumpectomy would leave very little tissue behind. Mastectomy is also often recommended for patients who, for any reason, cannot undergo radiation therapy to treat the cancer. Some patients may even choose to have a mastectomy when it has not been specifically recommended for them simply because a mastectomy can leave less of a chance of breast cancer returning than a lumpectomy.

Some females choose to have a prophylactic, or preventative, mastectomy. A prophylactic mastectomy is performed on patients who have not been diagnosed with breast cancer, but are considered to be at high risk for developing breast cancer and would like to take any necessary steps to lower their risk.1 The decision to have a preventative mastectomy can come from assessing a patient’s age, family breast cancer history, history of cancer in other parts of the body, and level of emotional attachment to the breasts. Prophylactic procedures are usually in the form of total or subcutaneous mastectomies. A total mastectomy lowers the risk of breast cancer the most because it removes all of the breast, but a subcutaneous mastectomy is recommended for females that want more natural looking breasts after reconstructive surgery. Studies have shown that when a female chooses to have a preventative mastectomy, the likelihood of developing breast cancer is decreased by significant amounts.3

If you are a male or female considering having a mastectomy procedure, be sure to thoroughly discuss your options with your doctor. Battling cancer can be an emotional journey, and some patients often feel hopeless or confused. It is important that you understand what is happening to your body in the best way that you can so you can make the decision that is best for your life. Keep in mind that you have a right to assert your opinion about what your body goes through during cancer treatment. Ask your doctor about the possible alternatives to mastectomy that may be right for you, such as lumpectomy or non-surgical treatments, and don’t be afraid to ask for a second opinion if you are unsatisfied.1 Friends, family, and sexual partners can be a great support system, but ultimately the decision of whether or not to have a mastectomy is a personal one.

After you have made the choice to have a mastectomy, talk to your doctor about what to expect. Ask as many questions as you feel necessary, such as what the details of the procedure are, how you should prepare, what you should expect during recovery, what the emotional effects of this type of procedure are, and whether there is potential for complications. No question is a bad question, and chances are that the more information you have, the more at ease you will feel about having the procedure.

Cost

In the United States, mastectomy procedures are usually covered by health insurance. However, there may be certain criteria that need to be met. Some companies will only cover certain types of mastectomies. Prophylactic mastectomies and reconstructive surgeries are not always covered. Look at the details of your health insurance plan and talk to your doctor about any issue that may arise with the cost of the surgery. He or she may be able to make subtle changes that will be more affordable for you. Try not to let the cost of the surgery be the biggest factor in your decision to have the procedure. It is likely that if you discuss your financial concerns with your doctor, you may be able to find a treatment that is affordable and satisfies your needs and expectations.3

Mastectomy Procedure Details

Mastectomy procedures are performed while the patient is under general anesthesia. The patient can also be given relaxing medication prior to going into the operating room. The average mastectomy takes about two to three hours to complete, but the procedure may last longer if the patient chooses to have breast reconstruction done at the same time. The type of incision made on the breast is dependent on the type of mastectomy and the patient’s desired aesthetic outcome of the surgery. Sometimes, after surgery, fluid can collect in the spaces of the breast where tissue was removed. For this reason, drainage tubes are often inserted during surgery to collect this fluid and can be taken out by the surgeon at a later date. When the procedure is complete the surgeon wraps the breast area in several bandages that are to be left on during the recovery period.

Recovery

After surgery a mastectomy patient usually stays in the hospital for about three days. This stay can be longer if a reconstructive surgery was involved. Common symptoms prior to surgery are fatigue and phantom pains due to nerve removal or damage. Pain medication is prescribed to make the patient more comfortable during recovery. During the stay at the hospital, patients are given instructions on how to care for bandages, stitches, and drainage tubes. Patients are also taught how to do daily exercises that help to prevent stiffness of the arm or chest and severe scarring. A doctor will mostly likely schedule an appointment for a recovery check up about one to two weeks after the procedure. During the check up the drainage tubes, staples, and bandages will be removed.1

After being released from the hospital, there are still several precautions a mastectomy patient should take to ensure a healthy recovery from the procedure. Certain exercises and strenuous activities should be avoided, as should wearing a bra or tight clothing, until permitted by a doctor. Plenty of rest is required, as this is the best way for the body to heal. Patients are advised to seek help from family and friends to ease the stress of daily activity as they recover. The recovery instructions from a doctor should be followed very carefully to make sure that there are no infections or complications.1

Risks and Complications

As with any other surgery, there is a risk of complications such as infection and severe scarring. A trained surgeon will take the necessary precautions to avoid these, but if they occur they can often be effectively treated if they are caught early enough. Other complications include reduced blood flow to the area, which causes scabbing and tissue damage and can delay the healing process. Extreme sensitivity or numbness of the affected breast can occur as a result of the nerve damage done by the surgery. Any uncomfortable or worrisome symptoms should be reported to a doctor as soon as possible so that dangerous complications such as infection can be tended to in a timely manner.1

After Mastectomy

A mastectomy procedure is not always the end of a patient’s battle with breast cancer. There are many things to think about after a mastectomy has been successfully completed. The first thing to consider is whether or not the patient needs further cancer treatment such as radiation or chemotherapy. This may be necessary if the mastectomy was not able to remove all of the cancerous tissue, which could be the case if the breast tumor was very large, if the cancer was in several parts of the breast, or if the cancer had spread to the lymph nodes and other parts of the body.1 Other important things to consider after a mastectomy are the physical and emotional effects of the procedure. It may be very important to address these effects in order for patients to return to their lives as normal.

Physical Effects of Mastectomy

The removal of breast tissue and sometimes muscle tissue can leave a patient with physical deformations that can affect their ability to wear certain clothing and ultimately their self-esteem. There are several options for adjusting physically after a mastectomy.

Breast Reconstruction

The first option for physical repair after mastectomy is breast reconstruction. Breast reconstruction is a surgical procedure meant to match the cancer-affected breast to the size and shape of the other breast after a mastectomy. The nipple and areola can also be reconstructed to match the healthy breast. Breast reconstruction can also involve reshaping both breasts to look a certain way, even if one of them was not affected by cancer. Most often the breast or breasts are reconstructed using silicone implants or fatty tissues from other parts of the body.2

Breast reconstruction is the first option to consider because it may have an effect on the mastectomy procedure itself (i.e. how much tissue and skin is removed) or the recovery period afterwards. A patient can choose to have breast reconstruction surgery immediately following a mastectomy, but some patients decide to have the reconstructive surgery several months or years later.1

The advantage of having breast reconstruction immediately following a mastectomy is that the mastectomy and reconstructive surgery can often be done at the same time. This allows the patient to possibly avoid having multiple surgeries. The patient can also avoid the emotional effects of experiencing the loss of one or both breasts by having the procedures done simultaneously. The disadvantages of having reconstruction done immediately following a mastectomy are that the recovery period is often longer and if the patient requires further radiation treatment, there is possibility of damage to the reconstructed breast.1

Many patients decide to wait to have a reconstructive surgery because they do not want to subject their body to more surgery at one time than necessary. Patients may also choose to wait because planning a reconstruction is too much to think about while dealing with the other important decisions surrounding their cancer treatment. Some believe that waiting to have a reconstructive surgery can make it easier to undergo future breast cancer treatment or screenings. There have been no studies that prove that returning breast cancer is harder to detect in patients who have had reconstructions, but some find that there is peace of mind in waiting until they have been declared cancer free to have reconstructive surgery done.2

The decision to have reconstructive surgery is usually dependent on whether a patient is healthy enough to undergo the extra procedure, the cost and insurance coverage, and the desire to have one or both breasts reconstructed. Some doctors prefer that a patient decide if they may want to do reconstructive surgery, even if they plan to delay it, before they make plans for a mastectomy. This way every option can be planned out beforehand and fully informed decisions about procedure details can be made according to what is best for the patient’s desired outcome.2 The decision to have reconstruction should not come directly from the opinions of other people. Friends, family, and sexual partners can be amazing forms of support, but they should not increase the pressure for the patient to do something that they would not otherwise want to do.

As with all cosmetic surgery, it is important to have realistic expectations for the final outcome. If you are considering reconstructive surgery, be sure to communicate effectively with your doctor and make sure that he or she is understanding of your goals. Keep in mind that after reconstruction, although the breasts may look the same as before, the reconstructed breast(s) may feel different to the touch or have less sensitivity than they did before the mastectomy.2

Prostheses

Although breast reconstruction is right for some patients, there are alternatives for those who do not want to undergo surgery. Prosthetic breasts can be used to facilitate the appearance of a breast. Prostheses can be worn in bras or swimsuits and come in several sizes and shapes according to the patient’s preferences. Some prostheses can even adhere to the chest so that they may be worn without a bra under clothing or during sex. A prosthesis can be made in materials that are suitable for wearing in chlorinated pools or salt water. These prostheses are usually priced between $100 and $500 USD, according to quality, and some may even be covered by insurance.4

Wearing Your Scars

Some mastectomy patients decide not to have reconstructive surgery or prostheses at all. Many men and women express that their mastectomy scars and deformations make them feel proud and empowered because they represent their perseverance through a tough time in their lives. There is no functional reason to recreate the appearance of breasts after a mastectomy, so the decision to do so is purely based on the individual preferences of the patient who has undergone the mastectomy.

Emotional Effects of Mastectomy

Mastectomy and its aftermath can have a large effect on the mental and emotional well-being of the patients who undergo it. Some people experience grief about the loss of one or both of their breasts or about the entire breast cancer experience.1 Mastectomy may lead to issues with body image and overall confidence. Sometimes the results of the surgery can have negative effects on a person’s sex life if they are experiencing a loss of self-esteem. The loss of sensation in the breasts can also make arousal more difficult to achieve. Many females feel less feminine than before their mastectomy.3 It can even be harder to connect with sexual partners in the same way emotionally as a result of these sexual difficulties.2

Breasts (or the lack thereof) do not determine femininity. Females who have had their breasts removed are in no way less feminine than they were before the procedure. Similarly, males should not feel that their experience with breast cancer and mastectomy has a negative effect on their masculinity. Femininity and masculinity are the products of personal expression, and cannot be determined solely by physical features. The decision to go through with mastectomy is one that requires a great deal of strength. Having a mastectomy is something that should make males and females proud, as the procedure is a symbol of perseverance after a traumatic breast cancer diagnosis. For some patients, it may take time to restore self-esteem and reestablish their sexuality. The right partner will understand this, and be able to show love and respect regardless. Couples who have been affected by mastectomy can restore and improve their sexual and emotional connection by implementing effective communication and general positivity.

If you or someone you know is suffering emotionally from the effects of a mastectomy procedure, it may help to know that there are other people who are most likely experiencing the same difficulties, and there are plenty of resources to help you. Sometimes a patient’s best support system can come from close friends and family. Ask your doctor about any groups that are designed to help recovering mastectomy patients cope with their emotional burdens and provide them with useful answers to questions and concerns. There are often programs led by cancer survivors who are able to provide the guidance of someone who has been through a similar situation. The American Cancer Society (ACS) offers programs like this. More information about the resources provided by ACS can be found here. Many mastectomy patients feel helpless or scared. Know that this is a normal reaction to a traumatic experience, and that there is help and hope for those who seek it.

Mastectomy is a surgery that involves much more than just the procedure itself. There are many important decisions to be made before and after surgery that can affect a patient’s life immensely. Those considering mastectomy are encouraged to look to trusted family, friends, or partners for much needed support. Keep in mind that the effects of mastectomy do not have to be negative. There are many options for adjusting physically and emotionally to life after the procedure. With the right amount of positivity and perseverance, patients can ultimately recover from mastectomy with feelings of pride and strength.

 

References

1. "What Is Mastectomy?" Breastcancer.org. Breastcancer.org, n.d. Web. 04 Feb. 2016.

2. "What Is Breast Reconstruction?" Cancer.org. American Cancer Society, n.d. Web. 04 Feb. 2016.

3. "Surgery to Reduce the Risk of Breast Cancer." Cancer.gov. National Cancer Institute, n.d. Web. 04 Feb. 2016.

4. "Prosthetics: An Alternative to Reconstruction." Breastcancer.org. Breastcancer.org, n.d. Web. 04 Feb. 2016.

 

Last Updated February 2016.