Mastectomy overview

If you havebreast cancer, depending on the stage and type, your cancer care team may recommend a mastectomy. During a mastectomy, your surgeon will remove the entire breast. Most of the time, the nipple and areola—the pigmented skin surrounding your nipple—are removed as well.

Your cancer care team may recommend a mastectomy instead of lumpectomy (also calledbreast-conserving surgery) and radiation therapy if you have:

• Ductal carcinoma in situ(DCIS)
• Invasive breast cancerthat hasn’t spread beyond the breast
• Inflammatory breast cancer
• Paget’s disease of the breast
• Two or more different areas of cancer in your breast
• TheBRCA1 or BRCA2 gene mutations, which increase the risk of a second cancer

A mastectomy also may be the recommended treatment if your breast cancer comes back after you’ve had a lumpectomy and radiation therapy.

Men with breast canceralso are likely to undergo a mastectomy. They often have little breast tissue, and the majority of tumors in men occur under the nipples.

Ductal carcinoma in situ (DCIS) and mastectomy

Since DCIS is noninvasive, you might be wondering why a mastectomy would be considered. While alumpectomy(where only the abnormal tissue is removed) may be an option for some women with DCIS, a mastectomy may be recommended, especially if:

• Your breasts are small, and you have a large area of DCIS.
• DCIS was found in more than one area of your breast ducts.
• 你的DCIS是在你nipple.
• A breast-conserving surgery won’t be able to remove all the DCIS.
• You’re not a candidate forbreast cancer radiation therapy.

Second opinions

Before you decide whether a mastectomy is the appropriatebreast cancer treatmentfor you, you may want to get asecond opinion. This is a common practice, and it may make you feel better if everyone agrees it’s the most appropriate option. Some insurance companies even require it.

Other questions to consider when deciding about mastectomy and breast reconstruction:

• Will I care if the look and feel of my breast change after surgery?
• What other information can help me decide which breast cancer surgery to have?
• Which treatment does my insurance company cover?

Types of mastectomies

The two main types of mastectomies are:

Total, or simple, mastectomy:During a total or simple mastectomy surgery, the surgeon removes your whole breast (tissue and skin) that has DCIS or cancer. The surgeon also may remove one or more lymph nodes under your arm. No muscles are removed. If breast reconstruction is not performed immediately, then redundant breast skin may be removed to create a flat closure. Most patients are able to leave the hospital about 24 to 48 hours after surgery.

Modified radical mastectomy:During modified radical mastectomy surgery, the surgeon removes your entire breast, several lymph nodes under your arm (axillary lymph node dissection) and the lining over the muscles in your chest.

A traditional radical mastectomy also removes the entire chest wall but is rarely performed these days, as the modified procedure has been shown to be just as successful. It’s reserved for large tumors and cancers that have spread to the pectoral muscle.

Breast reconstruction may be performed at the same time as your mastectomy surgery or later, if you choose. If you're interested in immediate breast reconstruction, these specific mastectomy subtypes describe the pattern of skin incisions:

滑雪n-sparing mastectomy:During a skin-sparing mastectomy, your surgeon removes only breast tissue and the nipple and areola, leaving your breast skin intact. The surgeon removes the same amount of breast tissue as with a simple mastectomy. Many women prefer this type of mastectomy because they'll have less visible scars on the breast and, if they opt for breast reconstruction, their breast shape will appear more normal. The risk of breast cancer returning after a skin-sparing mastectomy is about the same as with the other types of surgery. However, you may not be a candidate for skin-sparing mastectomy if the tumor is large or if it’s close to the surface of the skin. For women with larger breasts who wish to reduce their breast size after reconstruction, the plastic surgeon may perform a skin-reduction mastectomy, removing additional breast skin to improve the breast shape.

Nipple-sparing mastectomy:This type of mastectomy is like a skin-sparing mastectomy—breast tissue is removed, but the nipple and areola are left in place. A nipple-sparing mastectomy is an option mostly for women who have early-stage cancer that is near the outer part of the breast with no signs of cancer in their skin or nipple. During the procedure, the surgeon removes a tiny amount of tissue beneath the nipple so it can be checked for cancer cells. If these areas show signs of cancer, the surgeon must remove the nipple.

A nipple-sparing mastectomy leaves behind more tissue than all other types of mastectomy, which could theoretically increase the risk of recurrence. However, improvements in the surgery have helped lower the risk of a recurrence. After your surgery, the blood supply to your nipple may not be as good as it was before. The lack of blood supply can cause tissue to shrink or become deformed. Nerves may be cut, and this may mean you are left with little or no feeling in your nipple.

Double mastectomy:Most double (bilateral) mastectomies, in which both breasts are removed at the same time, are for women who are at very high risk of getting breast cancer, including those who have the breast cancer gene mutations BRCA1 or BRCA2.

TheAmerican Cancer Societynotes that many years of research has shown that the type of surgery you have (breast-sparing with radiation versus mastectomy) for early-stage cancer will not affect how long you live, but sometimes mastectomy is recommended over breast-sparing surgery for medical reasons, such as:

• You can’t have radiation after surgery (such as if you’re pregnant or have other disorders).
• This is a cancer recurrence, and you’ve already had radiation.
• There’s more than one area of cancer.
• Your tumor is larger than 2 inches across, or large in relation to your breast size.
• You have a BRCA mutation, which increases your chance of a second cancer.

How to prepare

Once your mastectomy is scheduled, it can help to learn more about what to expect. Questions to consider asking your care team include:

• How long will the surgery take?
• Who will keep my loved ones informed of what’s happening?
• What will my hospital stay be like?
• How long until I can resume normal activities?
• What are the possible risks of this procedure?
• What cancer treatments and follow-up will I need after surgery?

Your care team will likely provide specific instructions for the days before your surgery. These may include:

• Stop taking certain medications, especially blood thinners and anti-inflammatory pain meds.
• Stop eating and drinking before getting anesthesia.
• Take a prescribed antibiotic before surgery to lower your risk of infection.

The procedure

You’ll be given general anesthesia during surgery, and you’ll likely spend at least one night in the hospital recovering.

The surgeon will make a cut in your breast and remove the breast (and other tissue depending on the type of mastectomy). When complete, the incision will be closed with stitches. The mastectomy itself will take about 2 to 3 hours.

One or two small plastic drains are likely to be left in your chest. These surgical drains are tubes to remove extra fluid and will stay in your breast for 7 to 10 days.

You may opt to havebreast reconstructionat the same time if it’s possible, but you also have the option of undergoing the procedure at another time or not at all.

Understanding your results

The tissue removed from your breast is sent to the pathology lab where it’s looked at under a microscope. The pathologists look at the rim of tissue around the tumor—called a margin—to determine whether all the cancer was successfully removed.

The pathologist looks at:

• The deep margin—the margin closest to the chest wall
• The superficial margin—the skin margin

In rare cases, pathologists see cancer cells in the margins, and your surgeon may recommend additional surgery, radiation therapy or a combination. However, because your entire breast was removed, it’s not likely that, even if your margins are positive, your treatment plan will change.

It typically takes about a week to get your results.

If during surgery your surgeon finds more cancer than your imaging showed, it doesn’t mean your cancer has spread. It just means it didn’t show up on yourmammogramor otherimaging tests.

According to theNational Cancer Institute, there’s a small chance (about 5 percent) that after mastectomy, cancer could develop on the same side of the chest within 12 years. About 10 percent of women who undergo breast-conserving surgery get breast cancer in the same breast within 12 years.

Breast reconstruction

If you choose, there are several options post-surgery for breast reconstruction. These include:

• Usingimplants, made of either saline or silicone
• Using autologous tissue (tissue from elsewhere in your body, such as your stomach or thighs)
• Using a combination of both implants and autologous tissue

You also can choose to have:

• Immediate reconstruction: This is started at the time of your mastectomy
• Delayed reconstruction: This is done after your incisions have healed and therapy is completed (this can be months or years later)

Your surgeon may suggest you delay your reconstruction until after your mastectomy if you’re a smoker or have other health problems, since they may have a detrimental effect on your healing.

If your nipple and areola were removed during your mastectomy, they can be reconstructed after your main breast reconstruction surgery, after your chest has had time to heal.

Some women may also want surgery on their remaining breast, so they match in size and shape.

Federal law, the Women’s Health and Cancer Rights Act of 1998 (WHCRA), requires insurance companies that cover mastectomy to cover reconstructive surgery after the mastectomy as well, but it’s best to double-check with your insurance provider beforehand.

Medicare may cover breast reconstruction if your mastectomy is deemed medically necessary. Medicaid benefits for breast reconstruction vary by state, so check with your state’s Medicaid office for more information about what’s covered.

If you don’t wish to have breast reconstruction surgery at the time of your mastectomy or later, you have other options, including a breast prosthesis—a noninvasive, nonpermanent option.

Side effects and complications of mastectomy

Depending on the type of surgery, you may have some or all of theseside effects:

• Pain or tenderness near the incision
• Swelling where your breast was removed
• Blood buildup (hematoma) at the wound site
• Buildup of clear fluid at the wound site (seroma)
• Limited movement in your arm or shoulder
• 燃燒或射擊在你的胸部疼痛,armpit or arm that doesn’t get better with time (This is sometimes calledpost-mastectomy pain syndromewhen it lasts for a long time.)
• Lymphedema(buildup of lymph fluid that causes swelling) where your axillary lymph nodes were removed

You’re not likely to have feeling in the skin around where the surgeon cut. It could take up to two years until you start to have some feeling back in that area, and your skin also may feel tight.

Recovery from mastectomy

Most people can resume the majority of their normal activities about four weeks after surgery. However, it may take a bit longer to return to your full pre-surgery activities.

You should leave the hospital with clear instructions on how to:

• Care for your incision and surgical drain or drains
• Recognize signs of an infection
• 洗澡和淋浴沒有濕潤你的切口
• Start using your arm again and what exercises you can do to prevent your arm from becoming stiff

You also need to know:

• When to call your care team if necessary
• When to start wearing a bra or use a prosthesis (and what type)
• When to schedule a follow-up appointment with your care team
• 你應該采取什麼藥物(疼痛和prevent infections) and when
• What activities you should limit
• What to do if your pain control doesn’t work

You may need additionalchemotherapy,targeted therapy for breast cancer, radiation therapy orhormone therapy. Stay connected with your care team about what treatment, if any, you’ll need after surgery and when it will start.