What to Expect When You Have a Bi Mastectomy

Overview

A mastectomy is surgery to remove all chest tissue from a breast equally a manner to treat or prevent chest cancer.

For those with early-stage breast cancer, a mastectomy may be one treatment pick. Breast-conserving surgery (lumpectomy), in which simply the tumor is removed from the breast, may be another option.

Deciding between a mastectomy and lumpectomy can be hard. Both procedures are equally effective for preventing a recurrence of chest cancer. Only a lumpectomy isn't an selection for everyone with chest cancer, and others prefer to undergo a mastectomy.

Newer mastectomy techniques can preserve breast skin and allow for a more natural chest appearance post-obit the procedure. This is also known as pare-sparing mastectomy.

Surgery to restore shape to your chest — called breast reconstruction — may exist done at the same time as your mastectomy or during a second operation at a later date.

Why information technology'due south done

A mastectomy is used to remove all breast tissue if you lot have breast cancer or are at very loftier gamble of developing it. You lot may have a mastectomy to remove ane breast (unilateral mastectomy) or both breasts (bilateral mastectomy).

Mastectomy for breast cancer treatment

A mastectomy may be a handling selection for many types of chest cancer, including:

Ductal carcinoma in situ (DCIS), or noninvasive breast cancer
Stages I and 2 (early-stage) breast cancer
Stage III (locally avant-garde) breast cancer — subsequently chemotherapy
Inflammatory breast cancer — after chemotherapy
Paget's disease of the breast
Locally recurrent chest cancer

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

You have two or more than tumors in split areas of the breast.
You have widespread or cancerous-appearing calcium deposits (microcalcifications) throughout the breast that have been determined to exist cancer after a chest biopsy.
Yous've previously had radiations treatment to the breast region and the chest cancer has recurred in the breast.
You're significant and radiation creates an unacceptable run a risk to your unborn child.
You've had a lumpectomy, simply cancer is even so present at the edges (margin) of the operated area and at that place is business organization nigh cancer extending to elsewhere in the chest.
Y'all acquit a gene mutation that gives you a high risk of developing a 2d cancer in your breast.
Y'all have a big tumor relative to the overall size of your breast. You may non have enough healthy tissue left after a lumpectomy to achieve an acceptable corrective consequence.
You have a connective tissue disease, such as scleroderma or lupus, and may not tolerate the side effects of radiation to the skin.

Mastectomy to prevent breast cancer

You might too consider a mastectomy if you lot don't have breast cancer, only accept a very high take a chance of developing the disease.

A preventive (prophylactic) or risk-reducing mastectomy involves removing both of your breasts and significantly reduces your risk of developing breast cancer in the future.

A safe mastectomy is reserved for those with a very loftier hazard of breast cancer, which is determined by a stiff family history of breast cancer or the presence of certain genetic mutations that increase the risk of breast cancer.

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Risks

Risks of a mastectomy include:

Bleeding
Infection
Pain
Swelling (lymphedema) in your arm if you have an axillary node dissection
Formation of hard scar tissue at the surgical site
Shoulder pain and stiffness
Numbness, particularly under your arm, from lymph node removal
Buildup of claret in the surgical site (hematoma)

How you prepare

Run across with your surgeon to discuss your options

Before your surgery, yous'll come across with a surgeon and an anesthesiologist to discuss your operation, review your medical history and determine the plan for your anesthesia.

This is a good time to ask questions and to brand sure you understand the process, including the reasons for and risks of the surgery.

Ane issue to discuss is whether you'll accept chest reconstruction and when. 1 pick may be to have the reconstruction washed immediately after your mastectomy, while yous're notwithstanding anesthetized.

Breast reconstruction may involve:

Using breast expanders with saline or silicone implants
Using your trunk's own tissue (autologous tissue reconstruction)
Using a combination of tissue reconstruction and implants

Breast reconstruction is a complex procedure performed by a plastic surgeon, too called a reconstructive surgeon. If you're planning breast reconstruction at the same fourth dimension as a mastectomy, y'all'll meet with the plastic surgeon before the surgery.

Preparing for your surgery

Yous'll exist given instructions most whatsoever restrictions before surgery and other things you need to know, including:

Tell your doctor about whatsoever medications, vitamins or supplements you're taking. Some substances could interfere with the surgery.
Stop taking aspirin or other blood-thinning medication. A week or longer before your surgery, talk to your provider nearly which medications to avoid because they can increase your 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).
Don't swallow or drink 8 to 12 hours before surgery. You lot'll receive specific instructions from your health care team.
Prepare for a infirmary stay. Enquire your doctor how long to wait to stay in the hospital. Bring a robe and slippers to help brand you more than comfy in the hospital. Pack a handbag with your toothbrush and something to help you laissez passer the time, such every bit a book.

What you lot can look

A mastectomy is an umbrella term used for several techniques to remove 1 or both breasts. In add-on, the surgeon may likewise remove nearby lymph nodes to determine whether the cancer has spread.

During an axillary node autopsy, the surgeon removes a number of lymph nodes from your armpit on the side of the tumor.

In a sentinel lymph node biopsy, your surgeon removes only the first few nodes into which a tumor drains (sentinel nodes).

Lymph nodes removed during a mastectomy are then tested for cancer. If no cancer is nowadays, no further lymph nodes need be removed. If cancer is present, the surgeon will discuss options, such equally radiations to your armpit. If this is what you decide to do, no further lymph nodes will demand to be removed.

Removing all of the breast tissue and about of the lymph nodes is called a modified radical mastectomy. Newer mastectomy techniques remove less tissue and fewer lymph nodes.

Other types of mastectomy include:

Total mastectomy. A total mastectomy, also known equally a unproblematic mastectomy, involves removal of the entire breast, including the breast tissue, areola and nipple. A sentinel lymph node biopsy may exist done at the time of a full mastectomy.
Peel-sparing mastectomy. A skin-sparing mastectomy involves removal of all the breast tissue, nipple and areola, simply not the breast skin. A sentry lymph node biopsy as well may be done. Breast reconstruction can be performed immediately later on the mastectomy.

A skin-sparing mastectomy may not be suitable for larger tumors.
Nipple-sparing mastectomy. A nipple- or areola-sparing mastectomy involves removal of only breast tissue, sparing the skin, nipple and areola. A sentry lymph node biopsy besides may be done. Breast reconstruction is performed immediately afterwards.

Before the procedure

Your doctor or nurse volition tell you when to arrive at the hospital. A mastectomy without reconstruction usually takes one to three hours. The surgery is oft done equally an outpatient procedure, and most people go habitation on the same mean solar day of the operation.

If you lot're having both breasts removed (a double mastectomy), look to spend more time in surgery and possibly an additional day in the hospital. If you're having breast reconstruction following a mastectomy, the procedure also takes longer and you may stay in the infirmary for a few boosted days.

If you lot're having a sentinel node biopsy, earlier your surgery a radioactive tracer and a blue dye are injected into the area around the tumor or the skin above the tumor. The tracer and the dye travel to the scout node or nodes, allowing your doctor to see where they are and remove them during surgery.

During the process

A mastectomy is normally performed nether full general anesthesia, so you're not enlightened during the surgery. Your surgeon starts past making an elliptical incision around your breast. The breast tissue is removed and, depending on your procedure, other parts of the breast also may exist removed.

Regardless of the type of mastectomy you take, the breast tissue and lymph nodes that are removed will be sent to a laboratory for analysis.

If you're having chest reconstruction at the same time as a mastectomy, the plastic surgeon will coordinate with the breast surgeon to exist bachelor at the time of surgery.

I option for breast reconstruction involves placing temporary tissue expanders in the breast. These temporary expanders will form the new chest mound.

For women who volition accept radiations therapy after surgery, 1 option is to place temporary tissue expanders in the chest to agree the breast pare in place. This allows y'all to filibuster final breast reconstruction until subsequently radiation therapy.

If you're planning to have radiation therapy after surgery, meet with a radiation oncologist before surgery to discuss benefits and risks, likewise equally how radiation will bear upon your chest reconstruction options.

As the surgery is completed, the incision is closed with stitches (sutures), which either dissolve or are removed afterward. You lot might also accept one or two small plastic tubes placed where your breast was removed. The tubes will drain any fluids that accumulate after surgery. The tubes are sewn into identify, and the ends are attached to a small-scale drainage bag.

After the procedure

Afterwards your surgery, you tin can expect to:

Be taken to a recovery room where your blood pressure level, pulse and animate are monitored
Accept a dressing (cast) over the surgery site
Feel some pain, numbness and a pinching sensation in your underarm surface area
Receive instructions on how to care for yourself at home, including taking intendance of your incision and drains, recognizing signs of infection, and understanding activeness restrictions
Talk with your health intendance team nearly when to resume wearing a bra or wearing a breast prosthesis
Be given prescriptions for hurting medication and possibly an antibiotic

Results

The results of your pathology report should be available within a week or two after your mastectomy. At your follow-upwards visit, your doctor tin can explain the report.

If you need more treatment, your doctor may refer you to:

A radiation oncologist to discuss radiations treatments, which may be recommended if you had a big tumor, many lymph nodes that tested positive for cancer, cancer that had spread into the skin or nipple, or cancer remaining afterwards the mastectomy
A medical oncologist to talk over other forms of treatment afterward the operation, such as hormone therapy if your cancer is sensitive to hormones or chemotherapy or both
A plastic surgeon, if you're considering breast reconstruction
A counselor or back up group to assistance you cope with having breast cancer

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