A mastectomy is a surgical procedure to remove all breast tissue, most commonly performed to treat or prevent breast cancer. It may involve removing the nipple, areola, and sometimes nearby lymph nodes. The goal is to eliminate cancer cells and reduce the risk of the disease spreading or recurring. In some cases, additional treatments such as chemotherapy or radiation therapy are recommended. Reconstruction may be performed at the same time as surgery or later. Recovery is a gradual process that typically involves a hospital stay of one to two nights. Patients often go home with surgical drains to remove fluid buildup, which remains in place until drainage decreases. Pain, tightness, swelling, and limited arm mobility are common in the early weeks. Rest is essential, and heavy lifting, driving, and strenuous activity should be avoided for about six weeks. Emotional recovery is equally important, and support from loved ones, counselling, or survivor groups can help patients adjust physically and psychologically.
A mastectomy is the surgical removal of all the breast tissue from a person’s breast. It is most often performed to treat or prevent breast cancer. The mastectomy procedure may also entail removing the nipple and the skin of the breast. A unilateral mastectomy involves removing only one of the breasts, while a bilateral mastectomy removes both breasts. The purpose of a mastectomy is to remove cancer cells from the body to prevent it from spreading to other parts of the body. Your surgeon may recommend allied cancer treatments like radiation therapy or chemotherapy after the mastectomy to kill any remaining cancer cells in surrounding tissues. The decision to have a mastectomy is a difficult one, and your surgeon will help you understand your options so you can make an informed decision. Losing a breast is a traumatic experience for a woman, but reconstructive surgery has seen significant advancements in the last decade and your surgeon will advise you about this too.
Mastectomies are usually performed to treat breast cancer in patients with large tumours or multiple areas of cancer in the breast. In such cases, removing only the tumour without removing the surrounding breast tissue is risky and can result in recurrence. Patients with a high risk (due to family history and genetic predisposition) can also have an elective mastectomy (also called a prophylactic mastectomy) to prevent breast cancer. This is because certain types of breast cancer can be aggressive and may grow or spread if not treated adequately.
There are different types of mastectomy procedures, depending on the extent of tissue removed:
Simple Mastectomy – Also referred to as a Total Mastectomy, this procedure involves removal of the whole affected breast. This includes all the breast tissue, the nipple, the areola and skin on the breast. The surgeon may also remove any lymph nodes that they suspect may be affected by the cancer. These are usually located in the under-arm region. During a simple mastectomy, chest muscle tissue will not be removed.
Modified Radical Mastectomy – During this procedure, all the breast tissue, the nipple, the areola, the skin covering the breast and the lining over the chest muscle will be removed. Lymph nodes in the under arm may also be removed if they are affected by the cancer.
Radical Mastectomy – Radical mastectomy is rarely performed now, but it was the standard protocol for many years. In this procedure, the breast tissue, the nipple, the areola, the skin over the breast, affected lymph nodes, the lining over the chest muscle and the chest muscles under the breast are removed.
Skin-sparing Mastectomy – This is a newer procedure that is used often when breast reconstruction is done right after the mastectomy. During this procedure, the breast tissue, the nipple and the areola are removed, but the skin covering the breast is retained as a flap and used in the reconstruction.
Nipple-sparing Mastectomy – This procedure is similar to a skin-sparing mastectomy. Only the breast tissue is removed, retaining the nipple, the areola and the skin covering the breast. The surgeon uses the skin pocket to perform a very natural-looking reconstruction. The surgeon will ascertain if the patient is eligible for this procedure depending on how advanced the cancer is.
Once a patient has been diagnosed with breast cancer and mastectomy has been identified as the best course of treatment, the oncologist will walk them through the type of mastectomy and their reconstructive options. This is a good opportunity for the patient to clarify all their doubts regarding risks and the outcome of the reconstruction. The reconstructive surgery will be performed by a plastic surgeon.
Prior to surgery, the patient’s detailed medical history will be put down, including a list of all the medicines and supplements they are currently taking and any allergies they may have. The patient will be advised to discontinue any medications that could interfere with the anaesthesia. The patient will also need to quit smoking. Smoking affects blood flow, and this can cause vascular complications during and after surgery. The patient will also need to plan for their hospital stay and arrange for a family member or friend to stay with them for the first few days of their recovery. Pack a bag with clothes and comfort items for you to use during your hospital stay. A few hours before surgery, the patient will have to stop eating, as advised by the medical team.
After the surgery is complete, patients will spend at least 2 nights in the hospital so the healthcare team can monitor their vitals. The patient will also be given medication to help manage post-operative pain. Patients may feel tightness or pressure in the chest area, if they have had an immediate reconstruction combined with the mastectomy procedure.
After the breast tissue is removed, the surgeon usually inserts a drain to remove the fluid that will build up in the empty space below the skin. The surgeon usually inserts one drain in each breast, but in certain cases they may insert 2. The drain will be left in place until the amount of fluid reduces to about 20ml per day. The drains can be uncomfortable for some patients. They find it difficult to find a comfortable resting position. Using wedge pillows for support may help. Patients are also advised to get a mastectomy bra. This specially designed bra comes with attachments for holding the drains in place, while offering support.
During the recovery process, the patient needs to focus on resting. They should not perform tasks that require heavy lifting or needs them to raise their arms above their heads. This increases the risk of dislodging the drain. Patients are also advised to avoid driving and swimming, until cleared by the oncologist. This usually takes a minimum of 6 weeks, until the surgical incisions are completely healed. While taking a shower, the patient must be very gentle with their arm movements, and pat the surgical incisions dry carefully after. Do not rub the incisions in the shower, or at any other time.
Patients should be aware of their limited arm mobility after their surgery. Consider wearing button-up shirts, so you don’t have to lift your arms up to put them on. You can also switch to slip-on shoes, so you don’t have to bend over to tie any laces. Get someone to help you access things stored in high cabinets. Keep the things you use regularly at waist level in the kitchen, so you don’t have to raise your arms and reach upwards.
For 6 weeks after surgery, chances are patients will need support with everyday tasks. Enlist the help of close friends and family to help you in turn. It is also a good idea to sign up for a meal delivery service, so you don’t have to cook or grocery shop.
Recovery is a long process, and although 6 weeks is typical, it can take a bit longer for some patients. Don’t lose heart if this happens. Take your recovery one day at a time and try to stay positive. The impact of losing a breast on body image can be surprising and if you find yourself struggling with it, seek counselling or join a support group. What you are going through is not unique, and it is not a punishment you must suffer alone. Reach out to your community, and to other breast cancer survivors who are navigating the same feelings as you.
If you or a loved one are facing a mastectomy, compassionate support and expert surgical care are available at Kauvery Hospital. With branches in Chennai, Hosur, Salem, Tirunelveli, and Trichy, our team is here to guide you through every step of your treatment and recovery journey.
What is a mastectomy?
A mastectomy is a surgical procedure that removes all or most breast tissue, usually to treat or prevent breast cancer. Depending on the situation, the nipple, skin, and nearby lymph nodes may also be removed.
When is a mastectomy recommended?
A mastectomy may be recommended for patients with large breast tumors, multiple areas of cancer within the breast, recurrent breast cancer, or a high genetic risk of developing breast cancer. Your surgeon will discuss the most suitable treatment option based on your diagnosis.
What are the different types of mastectomy?
Common types include simple (total) mastectomy, modified radical mastectomy, radical mastectomy, skin-sparing mastectomy, and nipple-sparing mastectomy. The choice depends on the cancer stage, location, and reconstruction plans.
Can breast reconstruction be done at the same time as a mastectomy?
Yes. Many patients choose immediate breast reconstruction during the same surgery. Others may opt for delayed reconstruction after completing treatments such as chemotherapy or radiation therapy.
How long does recovery take after a mastectomy?
Initial recovery typically takes about 4 to 6 weeks, although complete healing may take longer. Factors such as reconstruction surgery, overall health, and additional cancer treatments can influence recovery time.
Will I need additional treatment after a mastectomy?
Some patients may require chemotherapy, radiation therapy, hormone therapy, targeted therapy, or immunotherapy after surgery. The need for additional treatment depends on the cancer type, stage, and pathology results.
When should I contact my doctor after a mastectomy?
Seek medical attention if you develop fever, worsening pain, unusual swelling, redness around the incision, excessive drain output, breathing difficulties, or signs of infection. Early evaluation can help prevent complications.
Kauvery Hospital is globally known for its multidisciplinary services at all its Centers of Excellence, and for its comprehensive, Avant-Grade technology, especially in diagnostics and remedial care in heart diseases, transplantation, vascular and neurosciences medicine. Located in the heart of Trichy (Tennur, Royal Road and Alexandria Road (Cantonment), Chennai (Alwarpet, Radial Road & Vadapalani), Hosur, Salem, Tirunelveli and Bengaluru, the hospital also renders adult and paediatric trauma care.
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