Mastectomy - what is it, and when is it performed?

A mastectomy is a procedure that involves the surgical removal of one or both of the breasts. It is used as part of the treatment of breast cancer, and in some cases as a method of preventing this disease.

Mastectomy — what is it?

The procedure involves the removal of the breast gland. In some cases, it is necessary to remove the tissues that are near the breast. This is especially true of lymph nodes, to which cancer cell can metastasize. Mastectomy is most commonly used as a treatment for breast cancer. However, it is also performed prophylactically in people at high risk (e.g., due to the presence of the BRCA mutation). Removal of the breast is tantamount to removing any potential cancerous focus, thus minimizing the risk of developing breast cancer.

Types of mastectomy

Years of surgical development in this field allowed for the implementation of several different mastectomy techniques. The type of method chosen depends on many factors, such as the size of the tumor, its location or nature. It also important to consider patient preferences and indications for the procedure– whether the person udergoing surgery will want to have breast reconstruction, or whether the operation itself is prophylactic or therapeutic. Currently, the following techniques are distinguished:

Simple mastectomy

Involves the removal of all breast tissue while preserving the contents of the armpit. Sometimes the so-called sentinel node is also excised, which is a likely place for metastasis.

Modified radical mastectomy

It is a procedure involving the removal of the mammary gland together with removing the lymph nodes located on the same side as the breast. Within its framework, the pectoral muscles are preserved.

Radical mastectomy

It’s an operation to remove the entire breast, including the lymph nodes and chest muscles.

Mastectomy with reconstruction

During mastectomy it may be possible to perform breast reconstruction. Such a procedure consists of removing the gland while leaving the skin, and then - depending on the chosen technique - placing the implant or replacing the gland with the patient's own tissues (e.g. adipose tissue collected during liposuction).

Mastectomy – what are the indications?

As mentioned above, mastectomy is one of the treatments for breast cancer. It may be recommended by a doctor if the tumor is large or covers more than one area of the breast. The indications for a mastectomy are also:

• relapse after lumpectomy (surgery to remove the tumor itself);
• connective tissue diseases, incl. scleroderma;
• relapse after lumpectomy (surgery to remove the tumor itself);
• connective tissue diseases, incl. scleroderma;
• pregnancy, in the case of patients who would require radiation therapy that would be harmful to the fetus;
• large tumor in relation to the size of the breast;
• tumor size greater than 5 cm, which does not decrease despite the use of pharmacological therapy;
• the presence of 2 or more distant cancer lesions in one breast, the removal of which would result in breast deformity.

One of the recommendations that is being talked about more and more often is the detection of a genetic mutation that is associated with an increased risk of breast cancer. In this case, the procedure is performed before the disease appears in the body (prophylactic mastectomy).

Prophylactic mastectomy — when is it performed?

Mastectomy is a procedure that is also carried out preventively - known as a "preventive mastectomy" or "prophylactic mastectomy". Thanks to its implementation, the risk of the appearance and development of the disease in the future is greatly reduced. Prophylactic mastectomy is especially recommended for women in very high-risk groups. In such patients, the risk of developing breast cancer is up to 10 times higher than in the rest of the population. This group includes people with detected mutations in genes that are responsible for the development of breast cancer – mainly BRCA1 and BRCA2 gene mutations, as well as several other mutations. However, it should be noted that procedures performed prophylactically do not offer a 100% guarantee of avoiding the disease.

Post mastectomy – how long does it take to recover?

In addition to post-operative pain and the obvious change in the shape of the breasts, the most common possible side effects of a mastectomy include:

• Swelling;
• Hematomas;
• Soreness of the operated area;
• Palpable lumps due to scar formation;
• Wound infection or bleeding;
• Removed breast pain (phantom breast pain).

If the lymph nodes are also removed, additional side effects, such as lymphedema in the arm, are possible. Serum exudate (seroma) often appears after the mastectomy. Many women experience pulling in or directly under the armpit area after surgery. It usually takes 4 to 6 weeks for the body to regenerate. However, both the occurrence of these symptoms and the regeneration process largely depend on the overall health of the patient. The regeneration time may also be longer due to the simultaneous conduct of the breast reconstruction procedure. On the other hand, breast pain after surgery, in many cases, lasts up to 3 months.