Types of Surgery: Mastectomy

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The Abramson Cancer Center of the University of Pennsylvania
Last Modified: January 22, 2002

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About Mastectomy

Rena Rowan Breast CenterThis "Helpful Facts" sheet is designed to give you basic information on mastectomy. More detailed information can be provided by your doctor or nurse. If, you have questions or would like additional information, please talk to your doctor or nurse.

What is a mastectomy?
A mastectomy is the surgical removal of breast tissue. It is done to remove all evidence of breast cancer. Since a mastectomy will not remove any microscopic (too small to be seen) cancer cells that may be beyond the removed area, additional treatments, chemotherapy and hormonal therapy, may also be recommended.

When is a mastectomy recommended for the treatment of breast cancer?
In general, a mastectomy is recommended if:

  • The breast tumor is more than 4-5cm in size.
  • There are multiple tumors in the breast that can not be removed from one incision.
  • There is a history of radiation therapy to the breast or chest wall.
  • There is a history of connective tissue diseases.
  • The breasts are small and/or the tumor is large such that the breast would be badly disfigured following the lumpectomy.
  • The patient chooses not to have radiation therapy, which is necessary with lumpectomy.
  • The patient prefers a mastectomy for personal reasons.

Are there different types of mastectomies?
There are a few different types of mastectomies. Your doctor and nurse will explain which mastectomy is being recommended for you and why.

  • A simple mastectomy involves removal of the entire breast, skin and nipple.
  • A modified radical mastectomy involves removal of the entire breast, skin, lining over the chest muscles and the nipple. Some axillary (underarm) lymph nodes are also removed. This is called an axillary lymph node dissection. This procedure helps to determine if the breast cancer has spread beyond the breast area to the lymph nodes. The Helpful Facts sheet, About Axillary Lymph Node Dissection, will give you more information about this procedure.
  • A skin-sparing mastectomy involves the removal of the entire breast tissue and nipple. The breast skin is left. This surgery is usually done at the same time as breast reconstruction. Much of the breast's natural shape and feeling is retained. An axillary lymph node dissection may also be performed.
  • A radical mastectomy involves removal of the entire breast, surrounding lymph nodes, chest wall muscles and fatty tissue.

What are the risks of a mastectomy?
As with any surgery, there is a risk of bleeding, infection and poor wound healing. Fluid or blood can accumulate and require drainage. Numbness and tingling across the chest can occur due to nerves cut during surgery. If an axillary lymph node dissection is performed, then lymphedema (swelling of the arm), numbness and tingling of the underarm and arm, and muscle tightness of the underarm and shoulder may occur. There is also a life-long risk of developing arm infections following an axillary lymph node dissection.

How long will I be in the hospital?
Most patients are discharged from the hospital one to two days after surgery. If immediate breast reconstruction is performed, the hospital stay is usually four to five days.

How will I look and feel after the mastectomy?
The chest area will be flat, have a scar and no longer have a nipple. Initially, there will be some swelling and discomfort. Some drains (thin, flat rubber tubes a few inches long) will be in place for a few days to a week to collect fluid. The chest area may be numb and tingling. Removal of breast tissue can cause body weight to shift resulting in neck and back pain. If an axillary lymph node dissection is performed, lymphedema (swelling of the arm), numbness and tingling of the underarm and arm, and muscle tightness of the underarm and shoulder may occur.

What are my options for re-creating my breast?
There are many issues to consider when deciding if and when you may want breast reconstruction. Some women prefer reconstruction surgery at the same time as their mastectomy, while others decide to wait because of the need for additional treatment. Medical considerations along with personal feelings lead ultimately to a decision that is best for you. Your doctors, nurses, counselors and family can help you make the choice with which you will be most comfortable.

After a mastectomy you may choose to wear a breast prosthesis. This is a soft form, shaped liked a breast, that is worn under a bra. Most forms are made of silicone or cotton and come in different sizes and weights. A proper fit is essential for your clothing fit, self-image, posture and body alignment, and comfort. A breast prosthesis can be obtained in The Boutique at the Rena Rowan Breast Center or through a surgical supply or lingerie store.

Surgical reconstruction surgery is performed to reform the shape of your breast. You can decide about reconstruction months or even years after your breast surgery. Make the decision when you feel ready. It's important to get the guidance of your whole medical team including your medical oncologist, surgical oncologist, and radiation oncologist, as well as your plastic surgeon The Helpful Facts sheet, About Breast Reconstruction, will give you more information on surgery to reconstruct your breast.


News
Breast-Conserving Surgery, Mastectomy Rates Surveyed

Sep 16, 2014 - Breast-conserving surgery is attempted in the majority of patients, with factors linked to mastectomy including surgeon recommendation, personal decision and failure of breast-conserving surgery, according to results of a survey published in the Oct. 14 issue of the Journal of the American Medical Association.



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