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Mastectomy

A mastectomy aims to remove all the breast tissue on the affected side. There are different types of mastectomy depending upon whether a breast reconstruction is being performed at the same time.

Simple mastectomy

This operation is performed when no breast reconstruction is being undertaken at the same time. All the breast tissue and the nipple are removed.

The aim is to achieve a flat surface on that side of the chest and a neat scar. Both of these aims are important as they make wearing an external prosthesis in a bra easier and more comfortable. Sometimes it is necessary to branch or otherwise modify the scar at the side of the chest to avoid an excess flap of tissue (sometimes called a dog ear) being left. Liposuction may be performed for the same reason.

The scar is kept low wherever possible so that it is not visible in low-cut clothing. If a breast reconstruction is planned at a later date, the scar will be designed to make this as easy as possible.

Occasionally, some skin and fatty tissue can be preserved and buried behind the skin to produce a small breast reconstruction. This is a so called "Goldilocks mastectomy" taking "not too much and not too little" tissue.

Admission and Aftercare

You are generally admitted on the day of surgery, occasionally the day before. You will be re-examined and the site of the cancer marked on the breast. The operation takes about 40 minutes to one and a half hours depending on the extent of surgery required. Dissolvable stitches are used and a waterproof dressing of special glue applied. This dressing can be left alone and the glue flakes off after 2 or 3 weeks. A drain, which is tunnelled away from the wound, is left in for between 2 and 7 days. It is possible to go home with the drain and so hospital stay also varies from 2 to 7 days. Occasionally, fluid collects in the wound (seroma) even after the drain has been removed and this is drained at the clinic, painlessly.

Recovery

Simple mastectomy is an operation that is not associated with a lot of pain. Most of the discomfort after the operation is related to the surgery performed to remove nodes from under the arm, in the axilla, which usually settles after a few days. Most women are able to perform normal activities within a few days of this operation. Overall recovery and return to work will depend upon a variety of factors including what after-treatment is necessary.

Making Life Easier After Simple Mastectomy

In addition to a flat surface, a neat scar placed low on the chest and avoidance of flaps of excess tissue at the side of the chest can make life easier and an external prosthesis and bra more comfortable to wear. Women with large breasts may benefit from a breast reduction of the opposite breast. This can allow a smaller, lighter prosthesis to be worn in the bra. Very occasionally for a variety of reasons some women may even chose a double mastectomy (afterwards 2 prostheses of any size, or even no prostheses, can be worn).

Prostheses that can be worn in the bra come in all sizes. Some can also adhere to the chest to minimise independent movement of the prosthesis. A wide variety of lingerie and swimwear is available to make disguising the fact that you have had a mastectomy as easy as possible.

Skin-sparing Mastectomy

This type of mastectomy is performed if a breast reconstruction is being carried out at the same time. It aims to remove all the breast tissue whilst preserving as much of your own skin over the breast. It also removes the nipple with the breast tissue. This operation is just as safe as simple mastectomy as far as treating the cancer is concerned in suitable cases.

Subcutaneous Mastectomy

This type of mastectomy aims to remove all the breast tissue whilst preserving all the skin and the nipple. It is usually used in women with a relatively modest sized breast who are having a prophylactic (risk-reducing) double mastectomy but can occassionally be used in cancer cases.

FAQ's

Q. I have seen a mastectomy scar that looks quite ugly. What will mine look like?
Answer - Some surgeons do not attach much importance to the appearance of a simple mastectomy scar. I believe, if you are unlucky enough to require a mastectomy, the least you can expect is a good scar and a flat surface that is comfortable for wearing an external prosthesis.

Q. If I have a simple mastectomy, would it be possible to have breast reconstruction at some point in the future?
Answer - Yes, this is usually possible and will be discussed before you undergo a simple mastectomy.

Q. I have had a mastectomy and have an ugly scar. Can anything be done?
Answer - Yes, lots can be done. In fact this situation is fairly common as many breast surgeons do not attach as much importance as they should to the appearance of mastectomy scars. Scars can be revised and flattened. Any flaps of skin that are bothering you or making it difficult or uncomfortable to wear a bra or prosthesis can be corrected. Reconstruction can be discussed if you wish.

Complications - What can go wrong?

Any operation can be associated with infection or bleeding. Wound healing can be particularly affected by infection and smoking. Any operation can be associated with anaesthetic problems (nausea in particular), venous thrombosis (although precautions are taken routinely) and allergic reaction to drugs or dressings. Every effort is taken to minimise the risk of these problems.

For any mastectomy (but particularly skin-sparing and subcutaneous mastectomies), the blood supply to the skin that is preserved can very occasionally fail. This is more common in smokers, which is why a subcutaneous mastectomy may not be an option if you are a smoker. In otherwise fit ladies who don't smoke, this problem is very uncommon.

Dr. Tasmia Tahmid

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