A mastectomy is a surgical procedure in which the whole breast is removed.
Surgeons will try to conserve the breast if possible, but there are some situations in which a mastectomy is necessary:
- If the tumour is large, or large relative to the size of the breast
- If there are multiple tumours occurring in different areas of the breast
- If there is widespread DCIS in the breast
- If the patient is medically unable to have radiation treatment, making partial mastectomy inadvisable due to the increased risk of recurrence.
Mastectomy may also be performed due to patient choice.
Types of mastectomy
The whole breast is removed along with the nipple, areola and an area of surrounding skin. A sentinel lymph node biopsy may be used to check the first draining nodes in the axilla for cancer cells.
Modified radical mastectomy
The whole breast is removed along with the nipple, areola and surrounding skin and the lymph nodes in the axilla, usually up to level two (axillary node dissection).
The whole breast is removed along with the nipple and areola but more surrounding skin is preserved in order to facilitate immediate breast reconstruction. Sentinel node biopsy or axillary node dissection is done as appropriate.
The whole breast is removed but the nipple and areola are preserved. Sentinel node biopsy or axillary node dissection is done as appropriate. Nipple-sparing mastectomy may be suitable for selected patients and is done in conjunction with immediate reconstruction.
The post-mastectomy appearance is of a flat chest with a scar running horizontally from the mid-line to near the armpit.
Recovery following mastectomy (without immediate reconstruction) will usually involve a one to two day hospital stay and a further three to four weeks for healing.
Initially, you will be unable to lift anything heavy and you should not attempt to drive until your movements are pain-free. You will have a drain inserted under the chest wound and possibly one under the arm for a few days, removing any excess lymphatic fluid. Where possible, the chest wall drain is removed before discharge from the hospital, but many patients go home with a drain still in place. This is usually easily managed with the help of district nurses, and the drain is removed when the fluid output has reduced to an acceptable level.
Breast prostheses and bras
Following mastectomy, all women who have not had immediate breast reconstruction are offered an external prosthesis. This is a silicone breast form which is funded by the Ministry of Health. The grant also covers pocketed bras to hold a prosthesis. A lightweight temporary prosthesis is usually provided by your breast care nurse, to wear for the first six weeks while the wound is healing.
Following a mastectomy, radiation therapy is less likely to be needed; however if the tumour is large, has four or more positive lymph nodes, or has positive margins or other high risk features, then radiation to the chest wall may be recommended.
If one to three lymph nodes are involved and there are other potentially high risk features (such as Grade 3, triple receptor negative, or lymphovascular space invasion), then an appointment with the radiation oncologist may be arranged to discuss whether chest wall radiation would add benefit and help to reduce the chance of the cancer recurring.