What is Mastectomy, How is it Applied?

Mastectomy is surgery to remove all breast tissue from the breast as a way to treat or prevent breast cancer. Surgical procedure, also known as breast removal operation, may be a treatment option for those with early stage breast cancer, while lumpectomy in which only the tumor is removed from the breast may be another option. In some cases, it can be difficult to decide between mastectomy and lumpectomy. Both operations are equally beneficial to prevent recurrence of breast cancer. However, lumpectomy is not an option for everyone with breast cancer, and a mastectomy may be required. In addition, newer mastectomy techniques can protect the breast skin and provide a more natural breast appearance after the procedure. This is also known as skin-sparing mastectomy. Breast surgery to reshape the breast is called breast reconstruction. This can be done at the same time as a mastectomy or during a second surgery at a later date.

Situations where mastectomy is applied

Mastectomy technique is used to remove all breast tissue in people with breast cancer or at high risk of developing it. A mastectomy may be done to remove one breast (unilateral mastectomy) or both breasts (bilateral mastectomy). Mastectomy can be a treatment option for many types of breast cancer, including:

• In situ ductal carcinoma (DCIS) or non-invasive breast cancer
• First and second stage (early stage) breast cancer
• Stage III (locally advanced) breast cancer (after chemotherapy)
• Inflammatory breast cancer (after chemotherapy)
• Paget’s disease
• Locally recurring breast cancer

The doctor may recommend a mastectomy instead of a lumpectomy instead of plus radiation if:

• If there are two or more tumors in separate parts of the breast
• If there is widespread or poorly appearing calcium deposits (microcalcifications) throughout the breast that are determined to be cancer after breast biopsy
• If you have had radiation therapy to the breast area before and breast cancer has recurred in the breast
• If the person is pregnant and the radiation poses an unacceptable risk to the unborn baby
• If the person has had a lumpectomy, but there is still cancer at the edges (margin) of the operated area, and there is concern about cancer that has spread to other parts of the breast
• You have a gene mutation in the breast that is at high risk of developing a second cancer.
• If there is a tumor larger than the overall size of the chest. (There may be not enough healthy tissue left to achieve an acceptable cosmetic result after lumpectomy.)
• If you have a connective tissue disease such as scleroderma or lupus and cannot tolerate the side effects of radiation to the skin

Mastectomy to Prevent Breast Cancer

If the patient does not have breast cancer, but the risk of developing the disease is very high, mastectomy may be considered. A preventive (prophylactic) or risk-reducing mastectomy involves removing both breasts, significantly reducing the risk of developing breast cancer in the future. Prophylactic mastectomy is designed for people with a very high risk of breast cancer and this is determined by a strong history of breast cancer or the presence of certain genetic mutations that increase breast cancer risk.

Mastectomy Risks

Risks of a mastectomy include:

• Bleeding
• Infection
• Pain
• If there is axillary node dissection, swelling in the arm (lymphedema)
• Hard scar tissue formation in the surgical area
• Shoulder pain and stiffness
• Numbness, especially under the arm, caused by lymph node removal
• Blood accumulation at the surgical site (hematoma)

How to Prepare for a Mastactomy?

Before the operation, the medical history of the patient is reviewed and the anesthesia plan is determined. The patient should get full information from the doctors about the procedure, including the causes and risks of the surgery, and should clear any concerns in his mind. This is the only way to decide whether and when to have breast reconstruction. While under anesthesia, performing reconstruction immediately after a mastectomy may also be an alternative choice. Breast reconstruction may include:

• Use of breast expanders with saline or silicone implants
• Autologous tissue reconstruction using the body’s own tissue
• Using a combination of tissue reconstruction and implants

Breast reconstruction is a complex procedure performed by a plastic surgeon, also called a reconstructive surgeon. If breast reconstruction is planned at the same time as mastectomy, the plastic surgeon should be consulted before surgery. Any restrictions and things to know before surgery can be listed as follows:

• The doctor should be informed about medications, vitamins or supplements taken. Because some substances can affect and interact with the surgery.

• Taking aspirin or other blood thinners should be stopped. A week or more before surgery should be discussed with the doctor about which medications to avoid, as this may increase the risk of excessive bleeding. These include aspirin, ibuprofen (Advil, Motrin IB, others) and other pain relievers, and blood-thinning medications (anticoagulants) such as warfarin (Coumadin, Jantoven).

• Eating or drinking should not be consumed 8-12 hours before the operation. After the operation, preparation should be made to stay in the hospital. Information about how long to stay should be obtained in advance and should be prepared in a way that helps to be more comfortable in the hospital.

Mastectomy Procedure and Types

Mastectomy is a general term used for a variety of techniques to remove one or both breasts. In addition, the surgeon can also take nearby lymph nodes to see if the cancer has spread. During an axillary node dissection, the surgeon removes a series of lymph nodes from the armpit next to the tumor. In a sentinel lymph node biopsy, the surgeon removes only the first few nodes (sentinel nodes) from which the tumor drains. Lymph nodes removed during mastectomy are tested for cancer. If there is no cancer, other lymph nodes do not need to be removed. If cancer is present, the surgeon can apply treatment options such as radiation to the armpit. If this is the situation it is decided to do, there will be no need for other lymph nodes to be removed.

Removal of all breast tissue and most of the lymph nodes is called a modified radical mastectomy. Currently, relatively new mastectomy techniques involve fewer lymph nodes and tissue removal. Other types of mastectomy include:

• Total mastectomy: Total mastectomy, also known as simple mastectomy, involves the removal of the entire breast, including the breast tissue, areola, and nipple. Sentinel lymph node biopsy can be performed during total mastectomy.

• Skin-sparing mastectomy: Skin-sparing mastectomy involves the removal of all breast tissue, nipple and areola, but does not include removal of the breast skin. Sentinel lymph node biopsy can also be done. Breast reconstruction can be done right after the mastectomy. Skin-sparing mastectomy may not be beneficial for relatively large tumors.

• Nipple-sparing mastectomy: The nipple or areola-sparing mastectomy involves the removal of only breast tissue, while the skin, nipple and areola are preserved. Sentinel lymph node biopsy can also be done. Breast reconstruction is done immediately after.

Before the Mastectomy Procedure

A non-reconstructed mastectomy usually takes one to three hours. The surgery is usually done as an outpatient procedure and most people go home on the same day of surgery. If both breasts are removed (double mastectomy), the surgery can be stayed longer and the hospital can be hospitalized for a long time after the surgery. If he is undergoing breast reconstruction following a mastectomy, the procedure also takes longer and may be in the hospital for a few more days. If a sentinel node biopsy is being performed, a radioactive tracer and blue dye is injected into the area around the tumor or into the skin above the tumor before surgery. The tracer and dye go to the sentinel knot or knots, allowing the doctor to see where they are and remove them during surgery.

During the Mastectomy Procedure

Mastectomy is usually performed under general anesthesia, so the patient is unaware during the surgery. The surgeon starts the operation by making an elliptical incision around the chest. The breast tissue is removed and other parts of the breast may be removed depending on the procedure. Regardless of the type of mastectomy you have, the removed breast tissue and lymph nodes are sent to a lab for analysis. If he is doing breast reconstruction at the same time as the mastectomy, the plastic surgeon will coordinate with the breast surgeon to be appropriate during surgery.

One option for breast reconstruction involves placing temporary tissue expanders in the chest. These temporary expanders form the new breast mound, and one option for women who will receive radiation therapy after surgery is to place temporary tissue expanders in the breast to keep the breast skin in place. This allows the final breast reconstruction to be delayed until after radiation therapy. If radiation therapy is planned after surgery, a radiation specialist should be consulted before the surgery to obtain information about the benefits and risks. When the surgery is completed, the incision is closed with stitches (stitches) that either dissolve or are removed later. He or she may also place one or two small plastic tubes where the breast was removed. Tubes will drain any fluids that have accumulated after surgery. Tubes are sewn in place and ends are attached to a small drainage bag.

After the Mastectomy Procedure

Following the surgery usually follow these steps:

• The patient is taken to an observation room where blood pressure, pulse and breathing are monitored.
• A dressing (bandage) is applied over the operation area.
• Some pain, numbness and tightness may be experienced in the armpit area.
• Provide information on how to take care of at home, including care of incisions and drains, recognizing signs of infection and understanding activity restrictions
• The healthcare team is informed about when the patient can use a bra or continue to wear a breast prosthesis.
• Postoperative pain medication and possibly an antibiotic are prescribed to the patient.

Pathology Results

The results of the pathology report are available within a week or two after the mastectomy. If the patient needs more treatment, the following referrals can be made by the doctor.

• Radiation treatments may be required if the patient has many lymph nodes tested positive for a large tumor or cancer, cancer that has spread to the skin or nipple, or cancer remaining after a mastectomy.
• After surgery, if the patient is susceptible to chemotherapy, a referral may be made to a medical oncologist to discuss other treatment options.
• If breast reconstruction is considered, plastic surgery may be recommended.
• Participation in a counselor or support group to help the patient deal with breast cancer may be offered.

Mastectomy, which is the surgical removal of the breast; It can be applied in several ways depending on the condition of the disease. The patient should be aware of the advantages and disadvantages of this surgery by getting information about the risks of this surgery and alternative treatments with the doctor. In this way, it will be more likely for him to have this procedure done and to be satisfied by removing all his worries about this operation.