Breast Reconstruction: Your Right. Your Choice.
Mastectomy
Mastectomy—surgical removal of breast tissue—is performed to treat breast cancer or to reduce an individual's unusually high risk of developing the disease.
Mastectomy to treat breast cancer
If your tumor is small, appears in only one quadrant of your breast, can be removed with clear margins (pathology shows no cancer cells in the tissue surrounding the tumor), and you don't have a high risk for a recurrence, you will likely have a choice of lumpectomy with radiation or mastectomy.
Mastectomy is usually recommended when:
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a breast tumor is large or disproportionately large compared to your breast volume
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tumors are found in multiple quadrants of the breast
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it isn't possible to remove all of the cancerous tissue with a lumpectomy
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cancer has advanced beyond the breast
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cancer develops or returns in a breast that has already been radiated
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you are unable to have radiation therapy
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cancer is found during pregnancy
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a genetic mutation or strong family history significantly increases your risk of another cancer or recurring cancer in the breast being treated
Other factors and personal preferences may also influence whether you have mastectomy.
Mastectomy to reduce the high risk of breast cancer
The risk for developing breast cancer (and other cancers) can be unusually high for individuals who have a strong family history of breast cancer or an inherited mutation in an ATM, BRCA, BARD1, CDH1, CHEK2, PALB2, PTEN or certain other genes.
Prophylactic (preventive) bilateral mastectomy removes both healthy breasts to reduce a person's high risk of breast cancer. It is the most effective method of addressing a predisposition to the disease: remove the breast tissue and you remove most of the risk. In previvors (people who have a high hereditary risk of cancer but have not been diagnosed with cancer), preventive mastectomy is estimated to reduce breast cancer up to 90%, depending on an individual's personal risk factors. (A small risk remains because it is not possible to eliminate all breast tissue.)
Preventive mastectomy is a deeply personal decision, and because it is irreversible, it is not right for everyone. Most women who choose preventive mastectomy and want to have their breasts reconstructed are candidates for nipple-sparing mastectomy; this minimizes scarring, often resulting in no visible scars on the reconstructed breast. After mastectomy, your missing tissue is replaced with a breast implant or tissue from your abdomen, thighs, buttock, hips,
or back.
Although preventive mastectomy is the most effective method of reducing high risk, chemoprevention (risk-reducing medication) is another option for managing high risk. Increased surveillance is another option, although it doesn't reduce the risk of breast cancer; rather, it helps to detect breast cancer in its early stages when successful treatment is more likely.
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unilateral mastectomy removes one breast.
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bilateral mastectomy removes both breasts.
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contralateral mastectomy preventively removes the healthy breast of someone who has cancer in the opposite breast.
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prophylactic (preventive) bilateral mastectomy removes both healthy breasts to reduce a person's high risk of breast cancer.
Mastectomy is something that no one would truly understand unless they've been there. - Maria, mastectomy patient
Types of mastectomy
A skin-sparing mastectomy removes the entire breast tissue and may or may not include the nipple and areola. This may involve a total mastectomy that does not remove lymph nodes or a modified radical mastectomy that removes some or all of the underarm lymph nodes.
A nipple-sparing mastectomy is a skin-sparing mastectomy that also preserves the nipple and areola. It can be performed safely if you:
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do not have breast cancer in the skin
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do not have cancerous cells in your nipples or areolas
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have a margin of tissue that is free of cancerous cells around the tumor
(A radical mastectomy is more extensive: it removes breast tissue, skin, the chest wall muscles and all underarm lymph nodes. This is rarely performed unless a tumor is found in the chest wall.)
Male Mastectomy
Men have breast tissue, and they too can develop breast cancer and may require a mastectomy. The estimated lifetime risk for men is quite low, about 1 in 1,000 compared to 1 in 8 women of average risk. Preventive or contralateral mastectomy may be recommended for men who have an unusually high risk for breast cancer due to family history and/or an inherited mutation in a high-risk gene.
How long
does it take?
Mastectomy without reconstruction takes 1 to 3 hours.
Mastectomy with immediate reconstruction requires more time, depending on the type of reconstruction performed.
You may stay in the hospital for 1-2 nights, although many people go home the same day when ERAS protocols are used.
How long
is recovery?
You might need up to 3 to 4 weeks or more before you are able to get back to all of your routine activities.
You may need a week or two longer to fully recovery from mastectomy with immediate reconstruction, depending on the type of reconstruction you have.
ERAS Protocols
Many hospitals and surgical centers use Enhanced Recovery After Surgery (ERAS) protocols that:
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control pain during and after surgery without the use
of opioids -
reduce hospital stay
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shorten recovery time
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minimizes the likelihood of nausea and vomiting after surgery
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improve patient satisfaction
