Mastectomy means removal of the entire breast, usually including the nipple. This procedure is most commonly used to treat a cancer (tumor) of the breast. Different procedures are available for treatment, depending on the size of the cancer, the number of cancers within the breast, the stage of the breast cancer, and patient preference. Discuss this with your surgeon(a specialist for performing an operation such as this), or your oncologist (someone specialized in the treatment of cancer) before deciding which surgical treatment is best for you.
In most cases, an axillary sentinel lymph node sampling (to remove only a few lymph nodes in your armpit) or a more complete axillary node dissection will be performed at the same time as the mastectomy. These operations are done to determine whether the cancer has spread to any of the lymph nodes and this information will help to plan any further treatments that you may need.
The board certified surgeons at Central Carolina Surgery specialize in diagnosing and treating breast cancer in Greensboro, NC. Learn about mastectomy and lumpectomy surgery, and call Central Carolina Surgery today at (336) 387-8100.
Are There Alternatives to a Mastectomy?
In some cases an operation can be offered that removes only a small part of the breast. This is called lumpectomy, or partial mastectomy, and is used more frequently now. It can be offered when the cancer is small. You are usually offered radiation therapy postoperatively in these cases. This is also discussed elsewhere in our web site.
Radiotherapy alone or drug therapy alone is not suitable in almost all cases. If nothing is done the cancer in your breast will get worse.
What are the Different Types of Mastectomy?
Nipple-sparing mastectomy: A nipple-sparing mastectomy involves removal of only breast tissue, sparing the skin, nipple, areola and chest wall muscles. However, skin sensation is reduced or sometimes absent because of interruption in the nerve supply from the underlying removal of all the breast tissue. A sentinel lymph node biopsy also may be done. Breast reconstruction is performed immediately afterward.
Modified Radical mastectomy: This operation is similar to the radical mastectomy described above, but the muscles of the chest wall are not removed. The axillary lymph nodes are removed. There is less chest wall deformity and very little loss of muscle strength, so patients recover better.
Total Mastectomy: This is also called a complete mastectomy or a simple mastectomy. It involves removal of only the breast. The lymph nodes and muscles are left in place. This is often done in patients who have very early stage breast cancer, patients who would not benefit from lymph node biopsy, and in a few high risk patients for prevention of cancer.
Skin-sparing mastectomy: A skin-sparing mastectomy involves removal of all the breast tissue, nipple and areola, but not the breast skin. Breast reconstruction is performed immediately after the mastectomy. Skin-sparing mastectomy may not be suitable for larger tumors.
Lumpectomy, or partial mastectomy: In this operation, the cancer is conservatively removed from the breast with a margin of surrounding normal breast tissue. This leaves the majority of the breast intact and has a minimal defect in most cases. This is a simpler form of treatment. As mentioned above radiation therapy is usually offered in these cases. Sentinel lymph node biopsies or complete axillary lymph node dissections are often performed at the same time, but in some cases no lymph node dissection is required.
What is Breast Reconstruction?
In some cases it is possible to reconstruct the breast that has been removed and to achieve symmetry (similar shape and size) with the opposite breast. Sometimes reconstruction can be done at the same time as the mastectomy operation, but sometimes the reconstruction operation is done as a second operation at a later time. With some reconstructions further surgery is needed to match the appearance of the reconstructed breast with the original breast. This may include operating on the unaffected breast to achieve symmetry. There are many different types of reconstruction, and your cancer surgeon will usually begin this conversation with you before your cancer surgery. Final decisions about which options you could choose are made in consultation with a plastic surgeon. If you are interested in reconstruction then you should consider consultation with a plastic surgeon early in your treatment planning. Breast reconstruction is part of your cancer treatment and is not considered a purely “cosmetic” operation.
What are the risks and possible complications of mastectomy breast surgery?
Bleeding: Bleeding can occur from the stitches on the skin or from deeper inside the wound. A small amount of blood spotting the bandage is not unusual, but if more bleeding occurs you should contact the nurses and doctors at CCS immediately.
Infection: This happens when bacteria (germs) begin to grow in the wound. This is not common, but if the wound becomes inflamed, red, hot, painful or drains fluid with an odor you should contact us immediately.
Lymphedema: This is swelling of the arm on the side of the mastectomy caused by surgery or radiotherapy. This does not happen to everyone, but is more common if there is extensive lymph node surgery. You should receive information on exercises and advice on preventing this.
Numbness: Surgery can cause damage to the small nerves in the skin of the breast and the arm, causing a pins and needles feeling or complete numbness. This is most often unavoidable. Some of this will improve over time although the skin around the scar itself will remain permanently numb.
Shoulder problems: There may be a difficulty in moving the arm and shoulder in a full range of motion right after the surgery. This can result in a “frozen shoulder” if not treated. You will be referred to a physical therapist pre op to go over exercises and advice on how to prevent this.
Blood clots: Thrombosis, or blood clots are a risk of all surgery and occurs when a blood clot forms in a vein, usually in a leg. Usually blood thinners and given around the time of surgery to prevent this. Lots of walking in the post operative period reduces the chance of this.
Recurrence of breast cancer: Even with the very best surgery and treatments there is a very small chance that the breast cancer could recur. Some cancer cells are microscopic and cannot be seen with the naked eye and may have already spread at the time of the surgery. When this happens other treatments are available, including radiation, medications, further surgery or a combination of these.
Drain Care After Your Breast Surgery
How do I take care of my drains?
After your breast surgery, you may be sent home with one or more soft plastic drains under your incisions. These drains create a gentle suction that removes excess fluid from the surgical wound. This encourages healing and reduces the chance of infection. These drains stay in place for 7-14 days (possibly longer) and can be removed in your surgeon’s office once the volume of the drainage has just about stopped.
The drains look like hand grenades connected to a drainage tube, and have fluid measures marked on their outside. They may be called grenade drains, JP drains, or Jackson-Pratt drains.
You will be taught how to care for the drains by the nursing staff before going home from the hospital
Care of the drains: Keep the bulb compressed at all times, except when you are emptying it. Check it frequently. It will drain less and less as the days go by. Keep the site where the drain enters the skin clean, dry, and covered with a dry bandage. Avoid pulling on the tube. It is sutured to your skin. Pin the bulb to your shirt with a safety pin. Keep a written record (chart) of the drainage and bring that to the office with you.
How to empty your JP drain:
- Wash your hands
- Unpin the drain from your clothing
- Open the top of the drain and let the air enter the bulb. Note the amount of fluid in the drain. Turn the drain upside down and empty the drainage completely into a measuring cup.
- Record the amount of drainage in your chart, noting the date and time
- If you have more than one drain, remember to record the drainage from each drain separately.
- To prevent infection, do not allow the stopper of the drain bulb to touch the measuring cup or other surface.
- Use one hand to squeeze all of the air from the drain bulb, and while keeping the bulb squeezed, used the other hand to replace the top.
- Pin the drain back on your shirt
- Wash your hands again.
Stripping the tube: Sometimes small clots and solid material will build up in the tubing. To prevent this from clogging the tube and interfering proper drainage, you will need to “strip” the tube from time to time.
- Hold the tube near where it it is inserted into the skin with one hand.
- With the other hand, “milk or strip” the JP tubing away from its insertion site with a pencil or between your thumb and forefinger. Do this all the way to the bulb.
- Repeat as necessary to start the drainage again
Notify Your Surgeon’s Office If:
- You develop fever of 100.5 or greater
- There is increased redness or tenderness at the JP drain site or your surgical incision
- There is a large amount of leakage around the drain tubing insertion site.
- The drainage develops a bad odor
- The amount of drainage suddenly increases or suddenly decreases
- The drain falls out
- The drain bulb does not maintain suction (stays flat) after reactivating
- If you have any other questions or concerns