by Krisha McCoy, MS
Anatomy and Physiology
A woman's breasts are composed of glandular tissue and ducts, fat, connective tissue, blood vessels, and lymph vessels. The glands produce and secrete milk for breastfeeding an infant.
Changes in the breast are common. A woman's breast tissue changes over the course of her lifetime. It also changes during her menstrual cycle or if she is taking hormones.
One type of breast change is the development of a lump or mass. Breast masses are often found upon self-examination or by a mammogram. Most are not cancerous; about 80% of breast lumps that require a biopsy prove to be benign. A breast biopsy is necessary to determine if a mass is cancerous.
Reasons for Procedure
A mastectomy is used to treat a cancerous mass or lump by removing the affected breast. A mastectomy may also be combined with the removal of lymph nodes under your arm to determine if the cancer has spread beyond the breast to nearby lymph nodes.
If a breast biopsy determines that a breast mass or lump is cancerous, surgical removal is most often recommended. Depending on the kind of procedure performed, breast cancer surgery may be combined with radiation therapy, chemotherapy, and/or hormonal therapy to increase the likelihood that the cancer is completely eliminated.
The most common types of surgical procedures to remove breast cancers are: lumpectomy, simple mastectomy, modified radical mastectomy, and radical mastectomy.
Comprehensive treatment for breast cancer often involves breast reconstruction following a mastectomy. You and your doctor can explore your options for breast reconstruction prior to your surgery.
In the days leading up to your procedure: Arrange for a ride to and from the hospital. You may also wish to arrange for help at home once you return. The night before, eat a light meal and do not eat or drink anything after midnight. If you regularly take medications, ask your doctor about the need to temporarily discontinue them. Do not start taking any new medications before consulting your doctor. Most breast surgeries last between one and three hours. In most cases, you will be given general anesthesia to put you to sleep for the duration of the operation. This will involve the insertion of a breathing tube through your mouth and into your windpipe to help you breathe.
In a lumpectomy, your surgeon will use a scalpel to make an incision in the skin, remove the tumor together with a margin of surrounding tissue, then close the wound with sutures. Since lumpectomies are intended to preserve the appearance of the breast, reconstructive surgery is not generally required. This procedure may be done under local, rather than general, anesthesia.
In a mastectomy, your surgeon will begin by making an incision along the length of your breast. The incision may be smaller if you are planning to have breast reconstruction at the same time.
In a simple mastectomy, your surgeon will separate all of your breast tissue from the muscle underneath and remove the tissue for examination.
In a modified radical mastectomy, your surgeon will separate and remove your breast tissue from the muscle beneath. In addition, your surgeon will perform an axillary lymph node dissection, in which approximately 10 to 15 lymph nodes will be removed together with your breast.
Many surgeons use a special technique called a sentinel node biopsy. During this procedure, a dye is injected into the breast to determine which lymph nodes drain fluid first, since these are most likely to contain cancer. Your surgeon will remove 1 to 3 of these nodes for examination. Further lymph node surgery may be recommended if these nodes contain cancer.
In a radical mastectomy, your surgeon will separate and remove all of the breast tissue and muscle from the chest wall, along with all visible lymph nodes from under the arm. This operation is rarely done today and is typically reserved only for very advanced breast cancers.
After your surgeon has completed the procedure, he or she will insert one or two drains to prevent fluid accumulation, and close the wound with sutures.
Risks and Benefits
Complications associated with mastectomy may include: bleeding from the wound, accumulation of blood or fluid in the wound, wound infection, inadequate wound healing, adverse reactions to general anesthesia.
Additional complications of the surgery may include: recurrence of tumor in or around the scar, heart and lung problems, blood clots in the legs that may travel to the lungs, psychological effects, including anxiety, depression, and/or a diminished sense of sexuality related to the loss of the breast.
Complications associated with an axillary lymph node dissection may include: lymphedema, or swelling of the arm on the side of the surgery, numbness in the upper arm on the side of the surgery, difficulty with shoulder movement, chronic pain.
Benefits of a mastectomy include: removal of the entire breast minimizes the risk of developing either recurrent cancer in the breast or another new cancer in the same breast at a later date. Removal and examination of lymph nodes can identify cancer that may have spread to those lymph nodes. If the cancer has already spread beyond the breast at the time of surgery, a mastectomy should not be expected to eliminate all of the cancer. For this reason, additional treatment, such as chemotherapy, radiation, and/or hormonal therapy, is often recommended.
In a mastectomy, or any procedure, you and your doctor must carefully weigh the risks and benefits to determine whether it is the most appropriate treatment choice for you.
After the Procedure
After the procedure, you will be taken to the recovery area for monitoring. depending on which surgery you had, you may go home the same day. Most mastectomy patients, however, remain in the hospital 1 to 2 days. Your doctor will want to arrange a follow-up office appointment several days after discharge to check the wound, and remove any remaining drains and sutures. The two of you may also use this visit to plan for additional treatments as necessary.
After you leave the hospital, be sure to contact your doctor promptly if you experience:a fever over 101°F Increasing or persistent swelling, redness, or discharge from the wound, redness, swelling, or pain in your arm or your legs, cough, chest pain, or shortness of breath, new lumps or skin changes on the side of the mastectomy, lumps, skin changes, or nipple discharge in the remaining breast.
- Breast Cancer Treatment. National Cancer Institute website. Available at: http://www.cancer.gov/cancer_information/doc_pdq.aspx?version=patient&viewid=53d97cba-89a2-45d4-b55d-b7b5ad7dc2dd#Section_185. Accessed February 9, 2004.
- Breast Cancer: Treatment. Mayo Clinic website. Available at: http://www.mayoclinic.com/invoke.cfm?objectid=B105D3F6-BFE9-4D89-A5E53914589F7E86§ion=7. Accessed February 9, 2004.
- Breast surgery mastectomy. Queensland Government website. Available at: http://www.health.qld.gov.au/informedconsent/ConsentForms/surgery/Breast/b_s_mastectomy.pdf. Accessed February 19, 2004.
- Surgery for Breast Cancer: Reference Summary. National Library of Medicine website. Available at: http://www.nlm.nih.gov/medlineplus/tutorials/breastcancer.html. Accessed February 9, 2004.
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- Surgery. BreastCancer.org website. Available at: http://www.breastcancer.org/tre_surg_idx.html. Accessed February 9, 2004.
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