Breast Cancer and Mastectomy

Total Mastectomy (Modified Radical Mastectomy)

A total mastectomy involves the removal of the entire breast. Some lymph nodes from under the arm are also removed. Radiation therapy may or may not be required after a total mastectomy, depending on the size of the tumor and whether any cancer was found in the lymph nodes. This type of surgery may be used in some early stages of breast cancer, as well as some later stages.

Simple Mastectomy

This procedure does not include an axillary lymph node dissection and may be offered when patients are interested in a prophylactic procedure to reduce the chances of developing breast cancer. Because all of the breast tissue cannot be removed at the time of a mastectomy, your risk of developing breast cancer (even after surgery) is never 0% because there is always residual breast tissue left behind. A simple mastectomy is often performed in women who:

• Have ductal carcinoma in situ (DCIS)
• Have no risk of lymph node spread
• Are not good candidates for breast conserving surgery

Breast Reconstruction

Women have the option of having breast reconstruction done either at the time of the mastectomy, or some time after the operation. Some women may choose not to have breast reconstruction at all. It will be your decision to determine what you feel most comfortable with.

If you are considering reconstruction, it is best to discuss this option with a plastic surgeon prior to your mastectomy. If you will need radiation therapy because of the size of the tumor or the presence of any disease in the lymph nodes, make sure your plastic surgeon is aware. Sometimes, they prefer to wait for a period of time after the radiation therapy before they perform the reconstruction. Remember, reconstruction is cosmetic, while radiation therapy is part of the curative treatment for your breast cancer.

Read more details about Mastectomy.

Possible Complications

Complications are rare, but no procedure is completely free of risk. If you are planning to have a mastectomy, your doctor will review a list of possible complications, which may include:

• Bleeding and bruising
• 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 skin on upper arm
• Pain after the procedure (burning, stabbing pain where breast was removed)

Some factors that may increase the risk of complications include:

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

Be sure to discuss these risks with your doctor before the surgery.

Call Your Doctor

After you leave the hospital, contact 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
• Nausea and/or vomiting that you cannot control with the medicines you were given after surgery, or which persist for more than two days after discharge from the hospital
• Redness, warmth, swelling, stiffness, or hardness in the arm or hand on the side of the body where the lymph nodes were removed
• Swelling and/or pain in your legs
• New, unexplained symptoms
• Lumps or skin changes in remaining tissue on mastectomy side
• Lumps, skin changes, or nipple drainage in remaining breast
• Depression

In case of an emergency, call 911.

Breast cancer. National Cancer Institute website. Available at: http://www.cancer.gov . Accessed January 27, 2006.

Breast cancer. Womens' Health.gov website. Available at: http://www.4woman.gov . Accessed January 27, 2006.

Susan G. Komen Breast Cancer Foundation website. Available at: http://www.komen.org . Accessed January 31, 2006.

Way LW, Doherty GM. Current Surgical Diagnosis and Treatment . 10th ed. Appleton and Lange; 1994.