Mastectomy for Breast Cancer: A Comprehensive Guide

If you have recently been diagnosed with breast cancer, your doctor may tell you that you will need to get surgery on your breast. Whether it is a breast-conserving surgery or a mastectomy, getting surgery can be very intimidating. It is completely normal to feel fearful or anxious about undergoing surgery, even if you won't experience any pain during the procedure. The thought of losing a part of one's body can be overwhelming and distressing. If you are experiencing these emotions, know that you are not alone. A helpful way to cope with these feelings is to educate yourself about the surgery and its expected outcomes. By being mentally prepared, you may find that some of your anxiety is alleviated.

A mastectomy is a surgical procedure to remove the whole breast. It is most commonly used for breast cancer treatment. It may also be used for breast cancer prevention for women with a high risk of developing breast cancer.

A mastectomy may be needed if:

• There are multiple tumors in the breast
• The tumor covers a large area of the breast relative to the size of the breast
• There is a high risk of developing a second breast cancer in the same breast
• The tumor covers more than one quadrant of the breast
• Lumpectomy and radiation are not possible

While it may sound scary and extreme, it is sometimes necessary to undergo certain procedures to extend one’s lifespan. It may be reassuring to know that many breast cancer survivors who have had mastectomies have been able to live normal or even improved lives post-treatment.

There are various types of mastectomies available to cater to different patient needs and circumstances. The specific type of mastectomy recommended will depend on each individual case.

Total mastectomy (also known as standard or simple mastectomy)

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During a total mastectomy, the entire breast, which includes the nipple, areola (the dark area surrounding the nipple), the surface of the main chest muscle, and most of the skin covering the breast, is surgically removed.

Modified radical mastectomy

A modified radical mastectomy involves the removal of the entire breast, as in a total mastectomy, but with the added procedure of removing lymph nodes under the arm through axillary lymph node dissection.

Radical mastectomy

A radical mastectomy involves the removal of the chest wall muscles (pectoralis major and minor), in addition to the breast tissue, while a modified radical mastectomy only removes the breast tissue. While this was once a standard procedure, it is now less common because the modified radical mastectomy is just as effective with fewer side effects. However, a radical mastectomy may still be recommended if the cancer has spread to the chest muscles.

Skin-sparing mastectomy

During a skin-sparing mastectomy, the same amount of breast tissue is removed as in other procedures above, but most of the skin is saved. This procedure is more suited for individuals who plan to undergo breast reconstruction immediately after the mastectomy. However, it may not be recommended for individuals with large tumors or tumors close to the skin. This is a more complex procedure that requires the expertise of experienced surgeons.

Nipple-sparing mastectomy

A nipple-sparing mastectomy is the same as a skin-sparing mastectomy without removing the nipple and the areola. This procedure allows for a more natural-looking reconstruction of the breast. However, there are potential risks involved, including disease recurrence and increased surgical complications, such as loss of the nipple-areola complex (NAC) or skin flap necrosis.

Double mastectomy (also known as a bilateral mastectomy)

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A double mastectomy involves removing both breasts and is commonly performed as a preventative measure or as part of a treatment plan. It is often advised for breast cancer patients who are at a very high risk of developing breast cancer.

As with all surgeries, a mastectomy may come with some side effects:

• Temporary breast swelling
• Pain, tenderness, or soreness at the surgery site
• Wound infection or bleeding
• Phantom breast pain (a feeling of pain in the removed breast)
• Swelling of the arm called lymphedema if lymph nodes were removed during the mastectomy
• An accumulation of clear fluid (seroma) in the wound
• Scarring or hard tissue may form at the surgery site and can cause a pulling sensation post-surgery near the arm.
• Numbness in the chest or upper arm
• Nerve pain (may be a burning or sharp sensation) in the chest of an arm that does not go away over time. This is post-mastectomy pain syndrome (PMPS), which can be treated with medication and treatments.

While these side effects may seem concerning, it is important to note that they are only possible side effects. You may or may not experience them. In the event that you do experience them, communicate clearly with your healthcare team. Rest assured that these side effects can be managed or reduced.

Patients who go through a mastectomy may expect to stay in the hospital for one to three days, depending on the extent of the surgery, if breast construction was done during the surgery, and if there were any complications during recovery. Once you are able to return home, you will be instructed on how to take care of the wound and the things to watch out for, such as:

• How to keep the surgical area clean and dry
• How to take care of the draining tube (a plastic or rubber tube attached at the surgery site to drain the fluid that comes out during healing) if there is one
• Signs of infection
• When you can start using your arm for what purposes, as well as arm exercises to avoid stiffness
• Use of medication
• What to expect in terms of pain, sensations, or numbness in the chest, breast, or arm

Recovery is an important aspect of the whole process. It is normal to feel like you require help while in recovery. However, keep in mind that this is only a temporary situation, and it's perfectly acceptable to rely on others for support. Do not be harsh on yourself or feel embarrassed - your independence will be restored soon enough. Just take things one step at a time, and you'll get there.

Following a mastectomy, there are several additional treatments that may be recommended to eradicate any remaining cancer cells or prevent the cancer from returning. These treatments may involve radiation therapy, hormone therapy, targeted drug therapy, or chemotherapy. Chemotherapy is typically prioritized over other treatments. It's important to keep in mind that this isn't the end of your journey, but it's a significant step towards becoming cancer-free.

When it comes to making decisions about your medical options, it's important to remember that your unique circumstances and needs should be taken into consideration. While it's understandable that aesthetic concerns may be weighing on your mind, know that discussing these concerns with your doctor is a worthwhile conversation to have. The amount of information available can be overwhelming, but taking the time to read up beforehand and asking important questions can help alleviate any doubts you may have. These decisions can be life-changing and confusing, but having informed conversations with your doctor or loved ones can help bring clarity. If you feel like you need a second opinion, remember that seeking one from another doctor is always an option. You don't have to go through this alone. It is important to have a strong support system to help you through it.