Mastectomy: Types, Procedures, and Recovery
A mastectomy is a surgical procedure performed to remove one or both breasts, usually to treat or prevent breast cancer.
Types of mastectomy
Single mastectomy
A single mastectomy involves the removal of one breast affected by cancer while preserving the other healthy breast. This procedure is often recommended for patients with early-stage breast cancer or those who are at high risk but wish to retain one breast.
Double mastectomy
Also known as bilateral mastectomy, a double mastectomy involves the removal of both breasts. This option is commonly chosen by patients who have cancer in both breasts or have a high risk of developing cancer in the other breast.
Skin-sparing mastectomy
In a skin-sparing mastectomy, the breast tissue is removed while preserving the breast skin and nipple-areola complex. This technique is often used for breast reconstruction following mastectomy.
Nipple-sparing mastectomy
A nipple-sparing mastectomy involves removing breast tissue while preserving the nipple-areola complex. This option is suitable for select patients with early-stage cancer and favorable tumor location.
How to prepare for mastectomy
Preparing for a mastectomy can be a challenging experience, both physically and emotionally.
To best prepare for the surgery, first schedule a meeting with a surgeon to discuss the procedure, its risks, benefits, and any alternatives. Educate yourself about the surgery by gathering information from reputable sources.
Inform your close family members, friends, or a support group about your decision to have a mastectomy. Having a strong support system can be invaluable during preparation and recovery. It's natural to feel anxious or scared before surgery. Consider talking to a therapist or counselor to help you cope with these emotions and mentally prepare for the procedure.
Try to maintain a healthy lifestyle before the surgery: follow a balanced diet, get enough rest, and quit smoking. Consider purchasing specific clothing or post-surgery bras that you might prefer to wear after the mastectomy. Ensure your living space is clean and organized before the surgery to make your recovery more comfortable.
Adhere to your surgeon's pre-operative instructions carefully. These may include guidelines on eating, drinking, and medications before the surgery. After the surgery, you may need help with everyday tasks. Arrange for a friend or family member to assist you during the initial recovery period.
Discuss post-surgery expectations with your surgeon, including the recovery timeline, potential complications, and necessary post-surgery care. If you're considering breast reconstruction, research the available options and discuss them with your surgeon. Some mastectomy surgeries offer immediate reconstruction, while others may involve delayed reconstruction.
How mastectomy is performed
During a mastectomy, the surgeon removes breast tissue through an incision made in the breast. The extent of tissue removal depends on the type of mastectomy chosen.
The mastectomy may be performed as an open surgery, where a single long incision is made, or as a minimally invasive procedure using a technique called “endoscopic mastectomy” with smaller incisions and specialized instruments.
Breast reconstruction, which can be done immediately or at a later time, is typically considered in conjunction with the mastectomy. Reconstruction options may involve implants or using a patient's own tissue (autologous reconstruction).
The choice of mastectomy technique will depend on the individual's medical condition, cancer stage, personal preferences, and the recommendations of the medical team. The surgical team will discuss the most appropriate approach and address any concerns you may have before proceeding with the mastectomy.
Simple or total mastectomy
In this procedure, the entire breast tissue is removed, including the breast lobules, ducts, fatty tissue, and nipple. The underlying chest muscles are left intact. It is usually performed when the cancer is limited to the breast tissue, or as a preventive measure for individuals at high risk of breast cancer.
Modified radical mastectomy
This procedure involves the removal of the entire breast tissue, including the nipple, and the axillary (underarm) lymph nodes. It is typically performed when breast cancer has spread to the lymph nodes or when there's a risk of cancer spread to the nodes.
Skin-sparing mastectomy
In this procedure, the breast tissue, nipple, and areola are removed, but the breast skin is preserved to facilitate breast reconstruction. It is often used in cases where immediate breast reconstruction is planned.
Nipple-sparing mastectomy
This advanced technique involves the removal of breast tissue while preserving the breast skin, nipple, and areola. It is primarily performed for prophylactic or preventive mastectomies or when there is minimal cancer risk near the nipple.
Subcutaneous mastectomy
In a subcutaneous mastectomy, the breast tissue is removed while preserving the nipple and areola, along with the overlying skin. This procedure is usually reserved for transgender individuals undergoing gender-affirming top surgery.
Can you get fake nipples after mastectomy?
For patients who had their nipples removed during mastectomy, getting fake nipples is possible through a procedure called nipple reconstruction. This surgery recreates the appearance of nipples using the patient's tissue or synthetic materials.
Mastectomy recovery and post-surgery care
After the mastectomy, you will be taken to the recovery room, where medical staff will monitor your vital signs and ensure you wake up from anesthesia safely. You may experience pain and discomfort, but pain medication will be provided to manage it effectively. The hospital stay can vary, but typically lasts a few days, especially if reconstruction was performed simultaneously.
Wound care
Proper wound care is essential to prevent infection and promote healing. Your surgeon or medical team will provide specific instructions on how to care for your incisions and surgical site.
You may have dressings or surgical drains in place to remove excess fluids. The medical team will instruct you on how to manage them and when to have them removed.
Mastectomy scars
Scarring is a natural outcome of mastectomy. The appearance of scars can fade over time, and there are treatments available to minimize their visibility. As scars heal, you can apply scar-reducing creams or silicone sheets to minimize their appearance. Consult your doctor for appropriate scar management options.
Mobility
During the initial recovery, you'll need to limit physical activities, especially those involving the chest and arms, to allow the surgical site to heal. Gradually, with your doctor's approval, you can increase your activity levels, starting with light movements and gradually progressing to more active tasks.
Your doctor may recommend physical therapy to help regain arm and shoulder mobility after surgery, particularly if lymph nodes were removed.
Long-term monitoring
After recovery, regular check-ups and screenings will be important for ongoing breast health and to monitor for any signs of recurrence or complications. Remember that everyone's recovery process is unique, and it's essential to follow your doctor's post-operative instructions closely. Be patient with yourself during the healing process, and don't hesitate to seek medical advice if you have any concerns or unexpected symptoms during your mastectomy recovery.
Wearing a mastectomy bra after the surgery
Wearing a specialized post-mastectomy bra offers support, comfort, and protection to the surgical site during the healing process. These bras are designed to accommodate breast prostheses if needed.
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A mastectomy is a crucial decision in the treatment and prevention of breast cancer. Understanding the various types of mastectomy, preparation, procedure, and recovery can help patients make informed choices regarding their healthcare journey. With advancements in surgical techniques and post-operative care, mastectomy and breast reconstruction offer hope to individuals on their path to healing and recovery.
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