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Choosing Mastectomy as Breast Cancer Treatment

Breast cancer is often first detected by an abnormality on a mammogram (an x-ray examination of soft breast tissues used to identify lumps, cysts, tumors, and other abnormalities). Patients are urged to receive a mammogram if they notice any suspicious lumps during breast self-examination (BSE). If an abnormality is seen on the mammogram then additional breast imaging is usually ordered. Breast cancer is confirmed by biopsy.

After biopsy, several factors are evaluated when determining how to treat breast cancer including:

• tumor size
• tumor type
• cancer stage
• histologic grade
• lymph node status
• estrogen and progesterone receptors
• her-2-neu receptors

Click here for more information on staging breast cancer.

While some patients will be clear candidates for mastectomy, other women are faced with the choice between mastectomy or breast conserving therapy (lumpectomy, usually followed by radiation therapy). Though both mastectomy and lumpectomy have equal survival rates, there are advantages and disadvantages to both procedures. Lumpectomy may preserve the physical appearance of the breast but usually requires six to seven weeks of radiation therapy. Mastectomy may reduce local recurrence of breast cancer, but additional decisions about breast reconstruction are introduced. Patients are encouraged to educate themselves on all possible options and to thoroughly discuss treatment and reconstruction with their physicians before deciding on a course of treatment.

Mastectomy and Breast Reconstruction

It is important for women to realize that breast reconstruction is possible for the majority of breast cancer patients after mastectomy. Often modified radical mastectomy patients may undergo breast reconstructive surgery during the same operation to remove the breast.

Advantages to immediate breast reconstruction:

• Patients do not wake up to the "shock" of losing a breast.
• Patients may avoid additional reconstructive surgery.

Disadvantages to immediate breast reconstruction:

• Patients may find it emotionally difficult to weigh all of their reconstructive options while also dealing with their recent breast cancer diagnosis and treatment alternatives.
• Occasionally there may be complications with reconstructive healing that interfere with chemotherapy or radiation treatment, if needed.

Reconstructive surgery usually involves insertion of breast implant or a muscle flap. Click here to learn more about breast reconstruction.

Women who do not wish to have further surgery may be fitted with an external prosthesis (an artificial breast) after healing from mastectomy. Most prostheses are made to resemble the body’s own weight and touch. According to the American Cancer Society, it is essential for women to have their prostheses properly weighed to balance the body and anchor their bra. Women should take their time in determining which prosthesis is right for them as prices vary considerably. Several manufacturers also make special mastectomy bras that have breast pockets sewn into them. Click here to find resources for breast prosthesis and mastectomy bras.

Before Surgery

Most mastectomy patients will meet with their surgeon a few days prior to surgery to ask any questions they may have about the procedure and its risks. Patients must also sign a consent form which they should review carefully. It may also be necessary for patients to donate blood for a possible blood transfusion during surgery.

Patients are encouraged to discuss any medications they may be taking that could interfere with surgery. Patients will typically be instructed not to have any food or drink at least eight hours before surgery.

The Mastectomy Procedure

General anesthesia is administered during mastectomy, and an EKG monitor (electrocardiogram) is connected to the patient to monitor heart rates. Blood pressure and vital signs are also monitored throughout the surgery.

To perform a simple mastectomy, a surgeon makes an incision along the perimeter of the breast (closest to the tumor area), leaving most of the skin intact. Typically, the nipple is not removed during simple mastectomy, although milk ducts leading to the nipple are cut. The underlying tissue is gently cut free and removed. Often a plastic or rubber drainage tube is inserted in the affected area. The skin is carefully closed with stitches or clips, which are usually removed within a week, and a dressing (bandage) normally covers the site. Mastectomy with axillary (armpit) lymph node dissection usually lasts between 2-3 hours. Immediate breast reconstruction will increase the duration of surgery.

The drainage tube placed in the breast or under the arm removes blood and lymph node fluid accumulated during the healing process. Drainage tubes are usually removed within two weeks, when the drainage is reduced to less than 30 ccs (1 fluid oz) per day.

Possible effects of mastectomy include:

• wound infection
• hematoma (blood trapped in the wound)
• seroma (clear fluid trapped in the wound)
• lymphedema: temporary to permanent limitations of arm/shoulder movement (if lymph nodes are removed during the operation)
• numbness in the upper-arm skin
• phantom breast pain

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