By Dr Ananya Mandal, MD
Mastectomy is an operation to remove one or both breasts. In many cases, mastectomy not only involves removing breast tissues, but also the axillary lymph nodes so they can be examined to provide clues about cancer spread.
Why is mastectomy performed?
Mastectomy is performed in cases of ductal carcinoma in situ where large or multiple areas of a breast are affected and in cases of invasive breast cancer. Some patients choose to have the remaining healthy breast removed along with the affected one in a procedure called double mastectomy in order to avoid the risk of a new cancer developing in the healthy breast.
In some patients who have a high risk of malignancy due to a strong family history of breast cancer or the presence of mutations in the BRCA1 and BRCA2 genes, a prophylactic mastectomy may be opted for, to remove the breasts before cancer develops.
Preparation before surgery
After a diagnosis of breast cancer is made, the appropriate types of mastectomy available are explained to the patient as well as the options for post-surgical breast reconstruction.
For the operation, the patient is given a general anesthetic. The patient’s arm on the affected side is fixed at a right angle to the body to allow clear access to the armpit as well as the breast. The skin is cleansed with antiseptic and an incision is made, which may be designed to spare or include the nipple and the areola depending on which type of mastectomy is being performed. Breast reconstruction may be carried out in the same sitting as the mastectomy or at a later stage after the surgical wound has healed.
Post- operative care and return to work
The rate and extent of recovery varies from patient to patient. The incision is usually dressed after surgery and fitted with a tube for the drainage of subcutaneous fluid form the surgery site. After a few days, the drain becomes dry and may be removed. The incision is usually covered with a waterproof dressing for the initial 7 to 10 days after surgery. Most mastectomy incisions have dissolvable stitches that do not need to be removed. If the sutures are the type that do not dissolve, they are removed about 7 to 10 days after surgery.
If the surgical wounds seem to have healed, do not seem infected and are not causing pain or bleeding, the patient may be able to return to work. However, they are advised to avoid straining or lifting heavy weights for the initial 6 to 8 weeks after surgery.
Reviewed by Sally Robertson, BSc