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Care of the Breast Cancer Patient

Mastectomy

Breast Cancer Surgery
Surgery is usually the first choice of treatment for breast cancer. In the past, most women were treated by a radical mastectomy - the removal of the entire breast and muscles of the chest. Surgical techniques have been refined and studies have shown that it is now possible and safe to conserve most of the breast while treating a breast cancer. However, in some cases lumpectomy may not be an option due to the characteristics of the patient's cancer or history, or a patient may personally choose mastectomy as an option.

Standard Treatments for Breast Cancer
Lumpectomy/Breast Conserving Surgery
Mastectomy
Mastectomy with immediate or delayed reconstruction

What is a mastectomy?
A mastectomy is the surgical removal of the breast tissue. It is done to remove all evidence of breast cancer. Since a mastectomy may not remove all microscopic (too small to be seen by the eye alone) cancer cells that may be beyond the removed area, additional treatments such as chemotherapy, hormonal therapy, or radiation may be recommended.

When is a mastectomy recommended for the treatment of breast cancer?
In general, a mastectomy is recommended if:
The breast tumor is more than 4-5 cm in size.
There are multiple tumors in the breast that cannot be removed by one incision.
There is previous history of radiation therapy to the breast or chest wall.
There is a personal history of connective tissue disease.
The breasts are small and/or the tumor is large causing the breast to be disfigured following the lumpectomy.
The patient does not want to have radiation therapy, which is necessary with lumpectomy.
The patient prefers mastectomy as a personal choice.

Are there different types of mastectomies?
There are a few different types of mastectomies. Your surgeon will explain which mastectomy is being recommended for your diagnosed cancer and why.

A simple mastectomy involves the removal of the entire breast, skin, and nipple.
A modified radical mastectomy involves removal of the entire breast, skin, and lining over the chest muscles and the nipple. Some axillary (underarm) lymph nodes may be removed. Your surgeon may do a sentinel node procedure prior to surgery or a complete axillary dissection. This helps to determine if the cancer has spread beyond the breast area to the lymph nodes.
A skin–sparing mastectomy involves the removal of the entire breast, tissue and nipple. The majority of the breast skin is left. This surgery is usually done at the same time as breast reconstruction. An axillary lymph node dissection may also be performed.
A radical mastectomy involves removal of the entire breast, surrounding lymph nodes, chest wall muscles, and fatty tissue.

What are the risks of mastectomy?
As with any surgery, there is a risk of bleeding, infection, and poor wound healing. Fluid and/or blood can accumulate and require drainage. Numbness and tingling across the arm and chest can occur due to nerves being cut during surgery. If an axillary dissection is performed, then lymphedema (swelling of the arm) can occur.

How long will I be in the hospital?
Most patients are discharged from the hospital one or two days after surgery. If immediate reconstruction is performed, the hospital stay is usually two or three days.

How will I look and feel after the mastectomy?
The chest area will be flat, have a scar, and no longer have a nipple. Initially, there will be some swelling and discomfort. Some drains (thin flat rubber tubes a few inches long) will be in place for a few days to a week to collect fluid. The chest area may be numb and tingling. You will be bandaged for approximately one week. Removal of the breast tissue may cause you to shift your body weight, potentially causing some back and neck pain while you adjust. If an axillary dissection was done, you may have some numbness and tingling of the underarm and arm, which usually lessens with time.

What are my options for breast reconstruction?
There are many issues to consider when deciding if and when you may want breast reconstruction. Some women prefer reconstruction at the same time as their mastectomy and others choose to wait. Medical considerations along with personal feelings lead to a decision that is best for you. Women often choose to have a consultation with a plastic surgeon prior to making a decision. We would be happy to assist you in setting up a consultation with a plastic surgeon to discuss your reconstructive options.

After a mastectomy, you may choose to wear a breast prothesis if you do not have immediate reconstruction. Once your scar has healed, you can obtain a prothesis. A prosthesis is a soft form, shaped like a breast, which is worn under a bra. Most forms are made from silicone or cotton and come in different sizes and weights. A proper fitting can be done by a certified prothesis fitter. Prosthesis are usually covered by insurance when your surgeon writes a prescription. Some insurance companies will cover several special bras for prosthesis each year as well with a prescription. We would be happy to give you a resource list for places you can purchase a prothesis.

For more information, call 847-797-9000.

 
 
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