Mastectomies As Treatment and Prevention

Mastectomies are the primary treatment for some types of breast cancer, including infiltrating lobular or ductal carcinoma, triple-negative breast cancer, and inflammatory breast cancer.

Sometimes, this is a relatively minor surgery, but it can also be quite extensive, depending on how much of the breast tissue is involved and how aggressive the cancer is.

Sometimes, mastectomies are a form of breast cancer prevention. Some genetic mutations predispose people to breast cancer, giving them as much as an 85 percent chance of developing breast cancer during their lifetimes.

If genetic testing reveals this risk, a prophylactic mastectomy can reduce breast cancer risk by as much as 90 percent.

There are three types of mastectomies, and they are classified by how much breast tissue is removed. A total or simple mastectomy removes the entire breast and most of the overlying skin.

In a modified radical mastectomy, the whole breast is removed in addition to the lining over the chest muscles and lymph nodes under the arm. The surgeon may remove parts of the chest wall muscle if needed.

The third type is a radical mastectomy, which removes the entire breast, overlying skin, lymph nodes under the arm, and the entire chest muscle. Radical mastectomies used to be the standard, but they are not as common today.

Surgeons have recently developed some additional matestomy methods: skin-sparing mastectomies and nipple-sparing mastectomies. Skin-sparing mastectomies save most of the skin over the breast and are as effective as a radical mastectomy.

Nipple-sparing mastectomies preserve the skin of the areola and nipple. A pathologist examines this tissue to ensure it does not contain cancer cells. If cleared, the nipple and areola are used during reconstruction.

Mastectomies are usually safe and straightforward, but some factors may eliminate them as a possibility. Mastectomies are not recommended for people who have distant metastasis or are too elderly or sick to withstand the surgery.

Surgeons may also be reluctant to operate on patients who have advanced local diseases with skin or chest wall involvement as they may not be able to close the wound or get clean cancer-free margins. In this case, chemotherapy, radiation, or other treatments may reduce the size of the tumors and open the door for surgery at a later time.

While radical mastectomies were once the standard, modern surgical techniques lean toward breast conservation. With the increase in effective breast cancer treatments, including radiation, chemotherapy, and endocrine therapy, mastectomy rates have declined.

Studies show no difference in survival over twenty years in patients receiving lumpectomies with lymph node removal (with or without radiation) and modified radical mastectomies that support the practice of breast conservation.

As doctors develop new techniques and effective cancer treatments, breast reconstruction is an option for more and more women. Surgeons only perform skin-sparing and nipple-sparing mastectomies when breast reconstruction is occurring immediately afterward, but things do not always go according to plan.

Cancer concerns always outweigh reconstruction. If the surgeon needs to remove more tissue than initially thought, breast reconstruction may not be an option.

All surgeries have risks. Complications of mastectomies include temporary swelling, scarring, infection, bleeding, and phantom breast pain.

If the surgeon removed lymph nodes, the arm on that side might swell. Sometimes, the space under the skin can fill with clear liquid after a mastectomy. This collection of fluid is called a seroma, and treatment involves draining and compression to prevent the fluid from returning.

Everyone has a different experience, so anyone considering or preparing for a mastectomy should talk to their doctor to know what to expect. All patients are under general anesthesia for mastectomies. They are asleep throughout the procedure with a machine breathing for them, and they get one or more IVs.

Often, the doctor injects dye or a tracer to highlight the lymph nodes during the surgery. They remove the breast tissue and any necessary surrounding tissues, sending any lymph nodes and tissue to a lab for testing. The surgeon may insert a temporary drain to help pull excess fluid out of the wound as it recovers, but the doctor usually removes the drain within two weeks after surgery.

After the procedure, the surgical site will have a dressing over it. Patients receive instructions on caring for the drain and incision at home and learn about any activity restrictions and signs of infection to look for. Doctors usually prescribe pain medication and a preventative antibiotic.

Results of tissue biopsies sent to the lab during the procedure are typically available in a week or two, if not sooner. Patients who need more treatment may receive radiation, chemotherapy, hormone therapy, or a combination of the three.