A mastectomy is a surgical procedure where one or both breasts are removed, usually as part of breast cancer treatment. It’s a life-saving surgery for those with BRCA1, BRCA2, or other genetic mutations, as well as patients with invasive breast cancer or those at high risk of developing cancer.

Mastectomy is also a procedure of gender reassignment surgery.

We’ll provide an in-depth overview of the types of mastectomy, related medical treatments, and post-surgical care, integrating important factors such as recovery, complications, and long-term health impacts.

Table of Contents

Types of Mastectomy and Surgical Techniques

Radical Mastectomy: In this aggressive form of surgery, the entire breast, nipple, surrounding lymph nodes, and part of the chest muscles are removed. Radical mastectomy is rarely performed today, being reserved for cases where the cancer has spread extensively to the lymphatic system.
Nipple-Sparing Mastectomy: This procedure preserves the nipple and areola, while the breast tissue is removed. It’s a common choice for patients undergoing breast reconstruction, as it provides a more natural appearance post-surgery.
Modified Radical Mastectomy: Similar to radical mastectomy, this surgery removes the breast and some lymph nodes but leaves the chest muscles intact. This surgery reduces the risk of metastasis by removing the nodes where cancer often spreads first.
Preventative Mastectomy: For individuals with the BRCA mutation (either BRCA1 or BRCA2), a preventive mastectomy may be recommended to lower the risk of developing cancer. Many patients with these mutations choose surgery due to the high probability of neoplasm (new tumor) formation.

Mastectomy and Breast Reconstruction

After a mastectomy, many patients opt for breast reconstruction to restore their body’s appearance. There are two main options:

Breast Implant: A prosthesis is used to recreate the breast shape. The surgeon inserts a breast implant (often made of plastic or silicone) beneath the chest muscles.
Tissue Expansion: This involves inserting a temporary tissue expander under the skin, gradually filled with saline over time to stretch the tissue before permanent reconstruction.

The timing of breast reconstruction can be immediate, during the mastectomy, or delayed, depending on the patient’s overall health and the need for additional treatments like radiation therapy or chemotherapy.

Common Complications Post-Mastectomy

As with any major surgery, mastectomy has potential complications. Some of the most common include:

Lymphedema: This is swelling (or edema) caused by the removal of lymph nodes, which can restrict the natural flow of lymphatic fluid. Wearing a compression sleeve may help manage swelling.
Seroma: The buildup of fluid at the surgical site, leading to discomfort and sometimes requiring drainage. This occurs after surgery when tissue and fluid collect near the incision.
Infection: Post-surgery, infection can occur around the surgical incision. Antibiotics are often prescribed as a preventive measure.
Bleeding and Hematoma: Excessive bleeding may lead to hematoma formation, which can cause swelling and pain in the chest area.
Pain Management: Proper management of pain is crucial post-surgery. Physicians typically prescribe analgesics like aspirin, ibuprofen, or stronger pain medications, depending on the severity of discomfort.

Postoperative Care

After mastectomy, patients are closely monitored for signs and symptoms of complications. Proper dressing care, including frequent bandage changes and wound cleaning, helps prevent infection. Post-surgery, many patients are advised to begin light exercise and massage therapy to improve shoulder mobility and prevent stiffness in the arm or hand.

Patients may also experience paresthesia (tingling or numbness) near the surgical incision, particularly in the thorax or axilla (armpit) areas due to nerve damage. Regular follow-ups with the physician are essential to monitor healing and adjust any pain management or physical therapy needs.

Postoperative Health Management

Patients need careful monitoring of their heart rate, blood pressure, and oxygen saturation levels during recovery. Blood tests are often conducted to ensure no signs of systemic infection or clotting disorders such as coagulopathy. During surgery, patients receive intravenous therapy and anesthesia, and postoperatively, they may be prescribed medications like anticoagulants to prevent blood clots.

A key aspect of recovery is improving self-image and mental health post-mastectomy. Body changes can significantly impact a patient’s emotional well-being, and it’s crucial that they receive support through counseling or support groups.

Risks and Long-Term Outcomes

Patients with BRCA mutations may face a higher risk of secondary cancers, even after mastectomy. Cancer treatment through surgery alone may not always be sufficient, and additional treatments like chemotherapy and radiation therapy may be needed, which come with their own side effects, such as hair loss, fatigue, and skin irritation.

Reconstructive surgery outcomes depend on many factors, including the health care provider’s experience, the patient’s age, and general health. Some patients might experience scarring, fluid accumulation, or issues with the prosthesis.

Preventative Care and Physical Well-being

Physical Examination: Regular physical exams are essential post-surgery to check for any signs of recurrence or complications, especially in the breast or lymph nodes.
Exercise and massage can help reduce edema and restore mobility. Wearing a compression bra after surgery helps with healing and maintaining breast shape.
Vitamin supplements and prescription drugs may be recommended to support healing and boost overall health.

Final Thoughts

Mastectomy is a life-changing surgery for many, offering a path to cancer treatment and prevention. With the expertise of experienced surgeons and the support of health care providers, patients can navigate both the physical and emotional challenges of the process.

Post-surgery recovery involves addressing not only physical injuries but also mental and emotional well-being. Managing complications, restoring self-esteem, and following up with health care professionals are vital steps in regaining a fulfilling, cancer-free life.