What is Mastectomy?
Mastectomy is a surgery performed to treat or prevent breast cancer by removing the breast tissue. Simple or total mastectomy involves the removal of the entire breast tissue (along with the areola and nipples), but the lymph nodes and muscles are left intact. Simple mastectomy is indicated when the cancer has not spread to the lymph nodes, for cancer prevention, patients with ductal carcinoma in situ (non-invasive breast cancer), Paget's disease of the breast (rare cancer in the skin of or surrounding the nipple) and recurrent breast cancer.
The procedure is performed under general anaesthesia. Dr Gordon-Thomson removes the entire breast through a 6 to 7-inch long elliptical cut starting from the inside of the breast, close to the breast bone, and continuing up and out (straight or obliquely) toward the armpit. Dr Gordon-Thomson then inserts a surgical drain (tubes to collect excess fluid) and closes the incision.
Risks and Complications of Mastectomy
As with any surgery, mastectomy also involves certain risks and complications which include infection, bleeding, pain, swelling in your arm, hard scar tissue formation at the site of surgery, shoulder pain and stiffness, numbness (especially under your arm) and accumulation of blood in the surgical site.
Types of Mastectomy for Breast Cancer
- Total Mastectomy: Dr Gordon-Thomson will remove the entire breast and sometimes the lymph nodes from the armpit by making a 6 to 7-inch long elliptical cut starting from the inside of the breast, close to the breast bone, and continuing up and out toward the armpit.
- Skin-sparing Mastectomy: Dr Gordon-Thomson will cut an opening around the nipple and areola to remove the breast tissue. Most of the breast skin is preserved with this technique, which is generally lost in traditional mastectomy. It offers the advantage of negligible scarring and provides the best option for immediate breast reconstruction.
- Nipple-sparing Mastectomy: Dr Gordon-Thomson will make an incision in the fold of skin under or to the side the breast, or around the areola, where the cut cannot be easily seen after healing, and will spare the nipple. Nipple sparing mastectomy is not suitable for all patients.
- Preventive/Prophylactic or Risk-reduction Mastectomy: If you are genetically predisposed and have a high risk of developing breast cancer, you may choose to have preventive surgery.
In some cases, you can choose between mastectomy and lumpectomy. If you have only one cancerous site, less than 4 cm of tumour and a clear margin of healthy tissue, lumpectomy with radiation is as effective as mastectomy.
Breast Reconstruction following Mastectomy
If you choose to rebuild your breasts after mastectomy, Dr Gordon-Thomson will refer you to a reconstructive surgeon who will perform your breast reconstruction. During reconstruction, your surgeon creates a breast mound using an implant or tissue flap taken from your stomach, thighs, back, or buttocks. The reconstructive surgery can be done during or after mastectomy.
Breast reconstruction surgery can be done at the same time as your breast cancer surgery (immediate reconstruction) or at a later time (delayed reconstruction). Some women leave it for a number of years. Breast reconstruction is a very personal decision. If you think you may be interested in having a reconstruction, talk to Dr Gordon-Thomson early on.