�Diagnostic and Surgical Procedures

Mastectomy

En Espa�ol (Spanish Version)

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Definition

Mastectomy refers to one of several operations in which some part of the breast is removed. A number of different mastectomy procedures exist, including:

Partial mastectomy or lumpectomy - the tumor and a small margin of surrounding breast tissue is removed
Simple mastectomy - the entire breast is removed
Modified radical mastectomy - entire breast and some axillary lymph nodes are removed, but chest muscles are left in place
Radical mastectomy - entire breast, axillary lymph nodes, and chest muscle are removed (this type used to be common, but now is rarely performed)

Parts of the Body Involved

This depends on the specific procedure followed, and may include some part or all of the breast, axillary lymph nodes, and (rarely) chest wall muscle

Reasons for Procedure

Treatment of breast cancer
Rarely (and somewhat controversially) done to prevent breast cancer in a woman with a very high family history of breast cancer

Risk Factors for Complications during the Procedure

Obesity
Poor nutrition
Smoking
Recent or chronic illness
Use of certain medications or dietary supplements

What to Expect

Prior to Procedure

Your doctor will likely do the following:

Physical exam
Mammogram
Fine needle biopsy of the breast
Blood and urine tests

In the days leading up to your procedure:

Discuss any medications or dietary supplements you are taking with your surgeon
Arrange for a ride to and from the procedure
Do not eat or drink anything for 8 to 12 hours prior to surgery, unless your surgeon tells you otherwise

During Procedure - IV fluids, anesthesia, intubation (a tube is inserted down the throat so that a ventilator can assist with breathing)

Anesthesia - General

Description of the Procedure - An oval-shaped incision is made in the breast. The breast tissue, including the nipple and areola, are removed by cutting the tissue off of the underlying muscle. Nearby lymph nodes (toward the underarm) may also be removed. A tube may be inserted for fluid drainage, which will be removed in the surgeon's office 1-2 days later. The area is closed with stitches.

Simple Mastectomy

After Procedure - Removed tissue is examined by a pathologist. Chemotherapy and/or radiation may be necessary if the cancer has spread.

How Long Will It Take? 1-3 hours

Will It Hurt? Anesthesia prevents pain during the procedure

Possible Complications:

Hematoma (accumulation of blood in the wound)
Seroma (accumulation of clear fluid in the wound)
Infection
Swelling of the arm caused by accumulation of fluid in lymph nodes (lymphedema)
Limited arm and shoulder movement
Numbness of upper inner arm skin
Post-mastectomy pain syndrome (burning, stabbing pain where breast was removed; thought to be due to nerve damage)

Average Hospital Stay: 1-2 days

Postoperative Care:

Keep the surgical area clean and dry.
You will have a bandage over the surgery site and may have one or more tubes to drain blood and fluids that collect during the healing process. You must empty the drains, measure the fluid, and report any problems that your doctor may tell you to watch out for.
Avoid vigorous activity for about 6 weeks, or as directed by your doctor.
You may have physical therapy to learn special exercises that will help you to regain shoulder and arm mobility.

If you've had lymph nodes removed, your arm is at risk of fluid accumulation and swelling (lymphedema) and/or serious infection (lymphangitis). You'll need to take some special precautions:

Don't have blood pressure taken, blood drawn, or shots given in that arm
Wear gloves to do dishes, household scrubbing, and yard work
Don't wear anything tight on that arm, including elastic in sleeves
Don't carry heavy packages, purses, suitcases, grocery bags, etc. with that arm
Keep the skin of that arm well moisturized with a lanolin-containing product
Use an electric shaver if you wish to shave your armpits
Do not get a sunburn

Outcome

The average time for complete recovery is about 6 weeks.

There is usually little pain after a lumpectomy, but there may be temporary unpleasant sensations, including numbness and a pinching or pulling feeling in the underarm area. You may be prescribed pain medication or antibiotics.

You'll see your doctor for a follow-up appointment within 7 to 14 days after the surgery. Your doctor should explain the results of your pathology report and talk to you about the need for further treatment. If more treatment is needed, you will be referred to a medical oncologist and/or radiation oncologist.

About a month after surgery, you can begin wearing a light-weight prosthetic breast. You can be fitted for a more permanent prosthesis when your surgeon says your incision is well healed. If you wish to have breast reconstruction performed, discuss this with your surgeon.

Call Your Doctor If Any of the Following Occurs

Signs of infection, including fever and chills
Redness, swelling, increasing pain, excessive bleeding, or discharge from the incision site
Cough, shortness of breath, chest pain, or severe nausea or vomiting
Redness, warmth, swelling, stiffness, or hardness in the arm or hand on the side of the body where the lymph nodes were removed
New, unexplained symptoms
Lumps or skin changes in remaining tissue on mastectomy side
Lumps, skin changes, or nipple drainage in remaining breast

RESOURCES:

American Cancer Society
www.cancer.org

Breastcancer.org
www.breastcancer.org

REFERENCES:

American Cancer Society. Available at: http://www.cancer.org.

Triage Reviewed by EBSCO Medical Review Board in September 2005