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  • Mastectomy

    (Breast Surgery; Surgery for Breast Cancer; Surgery to Remove a Breast)

    Click here to view an animated version of this procedure.

    Definition

    A mastectomy is a surgery done to remove breast tissue. A number of different mastectomy procedures exist, including:
    • Partial mastectomy or lumpectomy—a tumor and a small margin of surrounding breast tissue is removed
    • Simple mastectomy—the entire breast is removed
    • Modified radical mastectomy—entire breast and some lymph nodes in the armpit are removed, but chest muscles are left in place
    • Radical mastectomy—entire breast, lymph nodes, and chest muscle are removed (rarely done)
    Mastectomy
    IMAGE
    Copyright © Nucleus Medical Media, Inc.

    Reasons for Procedure

    A mastectomy is done:
    • To treat breast cancer
    • To prevent breast cancer if you have a family history of the disease and are at very high risk for breast cancer (occasionally done)
    • To treat severe side effects from previous treatment for breast cancer (rarely done)

    Possible Complications

    Complications are rare, but no procedure is completely free of risk. If you are planning to have a mastectomy, your doctor will review a list of possible complications, which may include:
    • Bleeding and bruising
    • Seroma (accumulation of clear fluid in the incision)
    • Infection
    • Swelling of the arm caused by accumulation of fluid in lymph nodes (lymphedema)
    • Limited arm and shoulder movement
    • Numbness of skin on upper arm
    • Pain after the procedure (burning, stabbing pain where breast was removed)
    Some factors that may increase the risk of complications include:
    • Obesity
    • Poor nutrition
    • Smoking
    • Recent or chronic illness
    • Use of certain medicines or dietary supplements
    Be sure to discuss these risks with your doctor before the surgery.

    What to Expect

    Prior to Procedure

    Your doctor may do the following:
    • Physical exam
    • Mammogram—a test that uses low-dose x-rays to make a picture of breast tissue
    • Fine needle biopsy of the breast—a thin, hollow needle is used to remove a small tissue sample from the breast
    • Blood tests
    Leading up to the surgery:
      Talk to your doctor about your medicines and supplements. You may be asked to stop taking some medicines up to one week before the procedure like:
      • Aspirin or other anti-inflammatory drugs
      • Blood thinners, such as clopidogrel (Plavix) or warfarin (Coumadin)
    • Arrange for a ride home. Ask someone to help you at home.
    • Eat a light meal the night before the surgery. Do not eat or drink anything after midnight.

    Anesthesia

    General anesthesia will be used in most cases. It will block any pain and keep you asleep through the surgery. It is given through an IV in your hand or arm.

    Description of the Procedure

    The doctor will make an oval-shaped incision in the breast. The breast tissue, including the nipple and areola, will be removed. This will be done by cutting the tissue off of the underlying muscle. Nearby lymph nodes (toward the underarm) may also be removed. The doctor will then insert a tube to drain blood and fluids. Lastly, the area will be closed with stitches.

    How Long Will It Take?

    1-3 hours

    Will It Hurt?

    Anesthesia will prevent pain during the procedure. You may have pain while recovering. You may also have numbness and a pinching or pulling feeling in the underarm area. Your doctor will give you pain medicine to help control this pain. If you are having a small area removed, you may not have much pain.

    Average Hospital Stay

    1-3 days

    Post-procedure Care

    At the Hospital
    • If you had cancer and it has spread, chemotherapy and/or radiation may be needed.
    • The drainage tubes may be removed in 1-2 days.
    • Managing pain and nausea—You might require anti-nausea and pain medicines. You may be nauseated for a few hours after surgery and may not be able to eat normally. Therefore, you may continue to receive fluids and sugar through an IV. For several days after surgery, you may need to eat a lighter, blander diet than usual.
    • Preventing blood clots—You may be given special compression stockings to wear after surgery. These help to decrease the possibility of blood clots forming in your legs.
    • Improving lung function—You may be asked to use an incentive spirometer. This is a device that helps you breathe deeply. It is important to breathe deeply and cough frequently to improve lung function after general anesthesia.
    At Home
    When you return home, do the following to help ensure a smooth recovery:
    • Keep the area clean and dry.
    • If you have drainage tubes, empty the drains and measure the fluid. Tell your doctor if you have any problems.
    • Avoid vigorous activity for about six weeks.
    • Work with a physical therapist. Therapy may involve shoulder and arm exercises.
    • Ask your doctor about when it is safe to shower, bathe, or soak in water.
    • Be sure to follow your doctor's instructions.
    • If you have had lymph nodes removed, take these precautions to avoid fluid accumulation and infection:
      • Elevate the affected arm.
      • Perform range of motion activities with the arm. Start slowly.
      • Do not have blood pressure taken, blood drawn, or shots given in that arm.
      • Wear gloves to do dishes, household scrubbing, and yard work.
      • Do not wear anything tight on that arm, including elastic in sleeves.
      • Do not carry anything heavy with that arm.
      • Use moisturizer on that arm.
      • Use an electric shaver to shave your armpits.
      • Do not get a sunburn.
    Recovery will take about six weeks. You will see your doctor within 7-14 days after the surgery. Your doctor will discuss the results and further treatment. About a month after surgery, you can begin wearing a light-weight prosthetic breast. You can be fitted for a more permanent one when the incision area has healed. If you want breast reconstruction surgery, talk to your doctor.

    Call Your Doctor

    After you leave the hospital, contact your doctor if any of the following occurs:
    • Signs of infection, including fever and chills
    • Redness, swelling, increasing pain, excessive bleeding, or discharge from the incision site
    • Cough, shortness of breath, chest pain
    • Nausea and/or vomiting that you cannot control with the medicines you were given after surgery, or which persist for more than two days after discharge from the hospital
    • Redness, warmth, swelling, stiffness, or hardness in the arm or hand on the side of the body where the lymph nodes were removed
    • Swelling and/or pain in your legs
    • New, unexplained symptoms
    • Lumps or skin changes in remaining tissue on mastectomy side
    • Lumps, skin changes, or nipple drainage in remaining breast
    • Depression
    In case of an emergency, call for medical help right away.

    RESOURCES

    American Cancer Society http://www.cancer.org

    Breastcancer.org http://www.breastcancer.org

    CANADIAN RESOURCES

    Canadian Breast Cancer Foundation http://www.cbcf.org

    Canadian Cancer Society http://www.cancer.ca

    References

    Axillary lymph nodes. Breastcancer.org website. Available at: http://www.breastcancer.org/pictures/breast%5Fanatomy/axillary%5Flymph%5Fnodes. Updated May 2008. Accessed July 22, 2008.

    Surgery for breast cancer. American Cancer Society. Available at: http://www.cancer.org/cancer/breastcancer/detailedguide/breast-cancer-treating-surgery. Updated September 2007. Accessed July 23, 2008.

    Treatments and side effects. Breastcancer.org website. Available at: http://www.breastcancer.org/treatment. Updated July 2008. Accessed July 22, 2008.

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