Mastectomy

Mastectomy Treatment in Koramangala, Bangalore

A mastectomy is defined as the surgical removal of one or both breasts in men and women. It is performed as a preventative and treatment procedure for cancer in the breast(s) or is chosen when a person experiences body dysmorphia and wants a gender reassignment surgery.

What is a Mastectomy?

A mastectomy is a breast surgery that involves removing one or both breasts in whole or partially. Performed under general anesthesia, it is relatively safe due to minimal invasion. This breast surgery is carried out to prevent and permanently remove cancer in either or both breasts or convert a female body to a male.

What are the Types of Mastectomies?

• Total or Simple Mastectomy - Removal of tissue of a single breast 
• Double Mastectomy - Removal of tissue of both breasts 
• Radical Mastectomy - Removal of either or both breasts along with axillary (underarm) lymph nodes and corresponding thoracic pectoral (chest) wall muscles under the breast(s).
• Modified Radical Mastectomy - Removal of tissue of either or both breasts along with axillary lymph nodes 
• Skin Sparing Mastectomy - Removal of tissue and nipples of either or both breasts along with immediate reconstruction surgery 
• Nipple Sparing or Subcutaneous Mastectomy - Removal of tissue of either or both breasts leaving the skin and nipple(s) untouched followed by immediate reconstruction
• Prophylactic Mastectomy - Removal of all breast tissue between the skin and chest wall muscles along with milk ducts and lobules 

What are the Indications for a Mastectomy?

• Removal and preventative spread of various cancers of the breast 
• When radiation and chemotherapy to the diseased breast fails 
• When there are more than two areas of cancerous tissue in either breast
• For those who cannot undergo radiation therapy due to skin ailments and require treatment of cancerous tissue
• When a pregnant woman needs treatment for cancerous tissue and cannot undergo radiation therapy 
• When those positive for BRCA1 or BRCA2 gene mutation want to prevent any possible occurrence of cancer
• When men suffering from gynecomastia (pronounced breasts) choose to undergo a breast reduction
• For those who wish to undergo gender reassignment surgeries 
• For those suffering from severe chronic breast pain
• For those suffering from any fibrocystic disease of the breast
• For those who present with dense breast tissue 

When Do You Approach a Doctor Regarding a Mastectomy?

It is important to feel and check for the presence of lumps, discoloration, pitting of the skin, indentation, and pain in each quadrant of both breasts regularly. If any exist, it is important to see your doctor immediately to rule out suspicion.

If you have a family history of breast cancer or experience any symptoms, it is important to undergo genetic screening for the mutations of the BRCA (BReast CAncer) genes, BRCA1 and BRCA2. These genes are tumor suppressor genes that are hereditary in nature. The presence of these mutative genes is a strong sign and precursor for the manifestation of cancer in the breast and ovaries. Do meet your doctor and inform them of your family history and concerns as early as possible to create a preventative plan best suited to your needs.

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What are the Important Preparations Before a Mastectomy?

The type of breast surgery chosen as the treatment plan involves a personal decision and the informed recommendation of your doctor. Removal of a breast is stressful mentally as it is viewed as a physical symbol of womanhood. For males, there is a lot of stigma. It is not an easy decision to make if a personal perspective lies heavily on the female anatomy, and the bodily aesthetics are important. Therapy and support from family and friends play a vital role in the final decision, as they will be the ones to help post-surgery. Choosing health over a body-altering surgery is difficult, but one that must be made in the best interests of the patient.

What is the Post Operative Care for a Mastectomy?

The patient will have dressing bandages around the surgical site with drains that will aid in getting rid of the excess fluid (blood and lymph) buildup. Diligent care for the wounds is vital. It is important to record and measure the drained fluid, which indicates the status of recovery. Symptoms like phantom pain are a concern, along with highly sensitized nerves, giving rise to tingling or numbing with the limited range of motion of both arms.

Once the wound heals sufficiently, it is vital for the patient to start exercises and physiotherapy to prevent the formation of edema and begin the rehabilitation process.

The doctor will assess if chemotherapy or radiation is required to rid the body of any remaining cancer cells.

If reconstruction surgery is not performed as a requirement during breast surgery, your doctor will suggest reconstruction surgery as an option for you to consider.

What are the Possible Complications of a Mastectomy?

• Phantom pain
• Infection at the site of surgery
• Spread of cancer cells to sentinel (first axillary lymph node that the cancer cells drain into) lymph nodes and more
• Seromas caused due to the buildup of lymph 
• Hematoma (blood clot) formation
• Change in shape of the chest
• Swelling of the arms
• Numbness and tingling in the chest and arms

Conclusion

A mastectomy is the best option to rid the body of cancer cells not responsive to chemotherapy or radiation. It is also the easiest way to reduce the risk of breast cancer drastically. With advancements in technology in the medical field, this is a surgery that has minimal side effects, is harmless, and highly effective.

Therefore, if you have breast cancer or carry the BRCA genes, a mastectomy is the best chance for full recovery from cancer. 

References

Robbins and Cotran Pathologic Basis of Disease Seventh Edition - Abbas, Kumar

Guyton and Hall Textbook of Medical Physiology

Textbook of Pathology - A.K.Jain

Sabiston and Spencer Surgery of the Chest

Hamilton Bailey’s Demonstration of Physical Signs in Clinical Surgery

S.Das Textbook of Surgery

Bailey and Love’s Short Practice of Surgery

B.D. Chaurasia’s Human Anatomy Sixth Edition

Gray’s Anatomy for Students Second Edition by Elsevier

https://www.webmd.com/breast-cancer/mastectomy

https://en.wikipedia.org/wiki/BRCA_mutation

https://www.mayoclinic.org/diseases-conditions/breast-cancer/symptoms-causes/syc-20352470

https://en.wikipedia.org/wiki/Mastectomy#Side_effects

https://www.medicalnewstoday.com/articles/302035#recovery

https://www.breastcancer.org/treatment/surgery/mastectomy/what_is