Breast Cancer Surgery
Austin Breast Surgeon
A mastectomy is a way to treat breast cancer by surgically removing a breast and sometimes nearby tissues. For a while, the standard treatment for breast cancer was a radical mastectomy, with total removal of the breast, lymph nodes in the underarm, and some chest muscles under the breast. But surgical advances have given people more options than ever. Less-invasive breast-conserving treatments are available to many women.
The type of mastectomy that’s best for you depends on several things, including your:
- General health
- Menopause status
- Tumor size
- Tumor stage (how far it's spread)
- Tumor grade (its aggressiveness)
- Tumor's hormone receptor status
- Lymph nodes and whether they’re involved
Women with stage I or stage II breast cancer may have this procedure. It’s a breast-conserving method in which the doctor removes only the tumor and the tissue around it.
The surgery is often followed by 6 to 8 weeks of radiation therapy, with powerful X-rays that target the breast tissue. The radiation kills cancer cells and prevents them from spreading or coming back.
There are two kinds:
- A lumpectomy removes the tumor and a small area of normal tissue surrounding the tumor.
- A quadrantectomy removes the tumor and more of the breast tissue than a lumpectomy.
In some cases, you may need more surgery after a partial mastectomy. Sometimes, if cancer cells are still in breast tissue, your doctor may have to remove the entire breast.
With this procedure, also called simple mastectomy, your doctor removes your entire breast, including the nipple. They may also take out lymph nodes, the small glands that are part of your immune system, from your underarm.
You’re most likely to have a total mastectomy if the cancer has not spread beyond the breast or if you’re having a preventative mastectomy to lower your risk of getting breast cancer.
Studies show that women with a high risk of breast cancer may be as much as 90% less likely to get the disease after preventive mastectomy.
Usually, doctors recommend a total mastectomy. In some cases, women have both breasts removed. This is called a double mastectomy.
Some women who've had breast cancer in one breast will have the other one removed to lower the chance of cancer coming back (called recurrence).
If you plan to have breast reconstruction, it can be done at the time of the preventive mastectomy (immediate reconstruction) or later on (delayed reconstruction). During breast reconstruction, the surgeon may use synthetic implants or tissue flaps from another part of your body to create a breast.
A radical mastectomy is the complete removal of the breast. The surgeon also removes the overlying skin, the muscles beneath the breast, and the lymph nodes. But doctors rarely do radical mastectomy today because it isn't usually more effective than other types. It’s recommended only when cancer has spread to the chest muscle.
A less traumatic and more common procedure is the modified radical mastectomy (MRM). The doctor removes your breast, including the skin, breast tissue, areola, and nipple, and most of the lymph nodes under the arm. The lining over the large muscle in the chest is also removed, but the muscle itself is left in place. This way, you aren’t left with a hollow area in your chest as with a radical mastectomy.
You might get breast reconstruction afterward.
The doctor removes breast tissue, the nipple, and the areola but saves most of the skin over the breast. It’s used only when breast reconstruction follows immediately after a mastectomy. It may not be a good choice if your tumors are large or near the skin’s surface.
You might also hear it called a total skin-sparing mastectomy. The doctor removes all the breast tissue, including the ducts going all the way up to the nipple and areola. But they save the skin of the nipple and areola and cut out tissues under and around them. If these areas are cancer-free, they can be saved. This method also calls for reconstruction right after the mastectomy.
Prior to surgery:
- You’ll change into a hospital gown.
- You’ll wait in a preoperative holding area. Your friends and family can visit, usually a couple at a time.
- A nurse might use a felt-tip marker to draw on your breast where the incision will be.
- You’ll get anesthesia. The nurse will put a needle connected to a long tube of medication into your hand and tape it in place, and you’ll start to relax.
In the operating room:
- You’ll probably be there for 2 or 3 hours, more if you’re getting reconstruction afterward.
- The doctor makes a cut and separates the breast tissue to be removed from the skin above and muscle below it.
- If you’re getting sentinel node dissection or axillary lymph node dissection, those happen next.
- If you’re getting reconstruction, the plastic surgeon takes over.
- If not, your breast surgeon will place drains into your breast and armpit to prevent fluid from collecting where the tumor was.
- The surgeon stitches up the incision and covers the site with a bandage that wraps around your chest.
Once the surgery is over:
- Lymph nodes that were removed will be sent to a lab to see whether the cancer has spread to them.
- You’ll go to a recovery room where staff can keep an eye on your heart rate, body temperature, and blood pressure.
- After you wake up, you’ll be admitted to a hospital room. You’ll probably stay for 1 or 2 days, though it might be longer if you had reconstruction.
- Someone from your health care team will talk to you about:
- Medications. Your doctor will prescribe medication for any pain you feel after surgery. After a week or two, you can usually treat your discomfort with over-the-counter pain relievers.
- How to care for:
- The incision. The bandage will probably stay in until your first follow-up visit.
- Drains. Sometimes, they come out before you leave the hospital, but they might stay in for up to 3 weeks.
- Stitches. Yours will probably dissolve on their own, but non-dissolving types and staples will be removed at your follow-up visit.
- Exercises. They’ll help prevent stiffness on the side where you had surgery. You’ll probably start the morning after surgery.
- When you can wear a prosthesis or bra. Your surgery site needs to heal first. You’ll find out how long you have to wait.
A mastectomy is generally safe and effective, but like all surgical procedures, it can have risks. They include:
- Swelling of the arm (lymphedema)
- Pockets of fluid under the incision (seromas)
- Risks from general anesthesia
Some people have numbness in the upper arm after surgery. It’s caused by damage to small nerves in the area where the lymph nodes are taken out. There’s a good chance that you’ll regain most of the feeling in your arm over time.
Once you’re home, make sure you follow the plan your doctor gave you. Also make sure that you:
- Rest. Get plenty of it the first few weeks after surgery. It takes a lot out of you.
- Take your meds. Don’t tough it out. Take the medication as prescribed. You’ll probably feel a mix of pain and numbness.
- Keep the site dry. Take sponge baths only (no tub baths or showers) until your drains and stitches are out.
- Do your exercises. They’ll keep your arm from getting stiff.
- Ask for help. Don’t be shy. It takes time to get better. Get all the help you can with meal prep, shopping, housework, child care, pet care, rides to doctors’ appointments, and whatever else you aren’t ready to take on by yourself.