MASTECTOMY

WHAT IS MASTECTOMY?

  • Surgical removal of the breast

 

WHAT IS A BREAST?

  • The breast, as we commonly think of it, consists of the breast gland (or mammary gland), it’s overlying skin and the nipple-areola

  • The mammary gland (breast tissue) is made up of 15-24 lobes, where milk production can occur, and a network of ducts (fine tubes) which carry milk from the lobes to the nipple – for a baby to feed

  • At various stages during a woman’s life, the breast undergoes distinct phases of development: before birth, at puberty, and during the childbearing years

  • Changes also happen during a woman’s menstrual cycle, and when a woman reaches menopause

  • Men have breasts too, but these rarely develop much as males are primarily under the influence of different hormones to females

 

ARE THERE DIFFERENT TYPES OF MASTECTOMY?

  • Yes!

  • Simple or Total Mastectomy  means removal of most/all breast tissue, the nipple and areola and enough surrounding skin to facilitate stitching the remaining skin together so it lies as flat as possible across that side of the chest with a neat scar line. 

  • Modified Radical Mastectomy  means simple mastectomy PLUS removal of most of the lymph nodes in the armpit on that side

  • Radical mastectomy  (Halsted Mastectomy) is almost never done these days but involves simple mastectomy PLUS removal of ALL the armpit lymph nodes on that side PLUS removal of the chest muscles underneath the breast

    • An operation which is very disfiguring and doesn’t give better cure rates than more cosmetic/less disfiguring breast cancer operations

  • Skin Sparing Mastectomy  is when the surgeon makes an incision around the nipple-areola and then removes the breast gland (including nipple-areola complex) through that small window – thus preserving the majority of breast skin for use in an immediate breast reconstruction

  • Nipple Sparing Mastectomy  is when the surgeon removes the breast tissue via a small incision preserving both native breast skin AND the nipple-areola complex, for use in an immediate breast reconstruction

    • This can produce the best cosmetic result, but is not always safe and/or possible

    • The preserved nipple is unlikely to have much, if any sensation (and breast feeding is obviously not possible)

  • Double (Bilateral) Mastectomy  is the removal of both breasts

  • Prophylactic (Risk-Reducing) Mastectomy  is removal of the breast when there is no cancer but a known or perceived higher than normal risk of cancer developing later on – as in breast cancer gene carriers for example

    • Reduces a woman’s risk of developing breast cancer on that side by 90-95% (not 100% as there is almost always a little breast tissue left behind after mastectomy in which breast cancer can occasionally develop)


IS MASTECTOMY ALWAYS REQUIRED IN BREAST CANCER TREATMENT?

  • Until the 1970s, mastectomy was a routine recommendation

  • Research has since shown breast conserving surgery in breast cancer treatment (“lumpectomy” – more correctly called wide local excisionor partial mastectomy) is a safe and reasonable alternative to mastectomy for most breast cancer patients

  • Most women with breast cancer now undergo breast conserving surgery

  • Breast conserving surgery is generally combined with subsequent radiotherapy to the remaining breast – giving cure rates equivalent to mastectomy

  • Breast conserving surgery can reasonably be performed if the cancer can be removed with a surrounding rim (or margin) of normal/non cancerous breast tissue, whilst still preserving an acceptable cosmetic result after surgery

  • Some woman who could have breast conserving surgery for their breast cancer still decide on mastectomy:

    • If they can’t have or don’t want radiotherapy

    • To reduce the risk of a second (new) breast cancer in the future, if that risk is higher than normal

    • Patient choice


IF I HAVE A MASTECTOMY FOR BREAST CANCER, DOES THAT MEAN NO RADIOTHERAPY?

  • Usually radiotherapy is not required after mastectomy

  • About 20% of women still warrant consideration for radiotherapy after mastectomy, depending on their cancer type


IF I HAVE A MASTECTOMY INSTEAD OF BREAST CONSERVING SURGERY, CAN I AVOID CHEMOTHERAPY? (THIS IS A QUESTION I GET ASKED A LOT)

  • Full body treatments such as chemotherapy are aimed at the chance of cancer cells having already spread away from the breast +/- lymph nodes, and will be recommended if that chance is moderate or high

  • Whether you have a smaller breast operation or a bigger breast operation doesn’t affect the chance of there being cancer cells elsewhere in the body – this is dependent on the nature and stage of the cancer

  • Your doctor’s recommendation regarding chemotherapy is independent of whether you undergo breast conservation or mastectomy
     

I'VE DECIDED ON MASTECTOMY; CAN I HAVE A BREAST RECONSTRUCTION?

  • Breast reconstruction can be performed either at the time of mastectomy (immediate breast reconstruction), later on after the initial mastectomy (delayed breast reconstruction), or not at all

  • What your best reconstructive option may be depends on the type of breast cancer you have, your age and general health and the treatments you will be recommended – your surgeon will go through this with you (though I’ll add more in a separate section titled “Breast Reconstruction”)

  • In Australia, breast reconstruction is offered under Medicare in the public system and also with your choice of surgeon/s in the private sector

 

WHAT IS RECOVERY LIKE FROM A MASTECTOMY?

  • Whilst mastectomy is a big step mentally, physical recovery may not be as bad as you might expect

  • Most women find regular use of paracetamol and/or anti-inflammatories (such as ibuprofen) is largely all that is required for pain relief

  • A drainage tube is often left in for about a week. Whilst a little annoying, this is usually easily managed by most women at home

  • When immediate breast reconstruction has not been performed, a temporary prosthesis can be used inside the bra as soon as it is comfortable

  • Your breast care nurse will help you in organising a permanent silicon prosthesis when appropriate once healing is complete

  • Mastectomy with immediate breast reconstruction is a bigger operation with a corresponding longer recovery period

Melbourne Breast and Endocrine Surgeons Mr Sunil Jassal
Royal Australasian College of Surgeons Mr Sunil Jassal
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Sunil Jassal Breast and General Surgeon

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