What is a Mastectomy?
Mastectomy is the general name given to the operations performed to remove cancer tissue in the breast. Mastectomy is preferred for patients with tumors that have been widespread in the past, but today breast-conserving surgery is not suitable and has a widespread distribution in the large breast.
The operation of the patient who was diagnosed with breast cancer is performed by the general surgery team. Cancerous tissue is taken according to the size and type of cancer in the breast. Since the types of cancer in the breast are different, the method and process of breast cancer surgery may also vary.
What are The Types of Mastectomy?
Mastectomy operation is divided into different types according to the technique of the procedure and which tissues are removed.
These are as follows:
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Total (Simple) Mastectomy:
It is a type of mastectomy in which the axillary lymph nodes and under-breast muscles are left in place while the breast tissue is completely removed.
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Double Mastectomy:
Especially preferred in preventive treatment is the removal of both breasts.
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Radical Mastectomy:
It is a mastectomy operation in which all of the breast tissue, lymph nodes in the armpit and the muscles under the breast are removed.
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Modified Radical Mastectomy:
It is a mastectomy technique in which the chest muscles are left in place while all breast tissue and axillary lymph nodes are removed.
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Nipple Sparing Mastectomy:
It is an innovative mastectomy technique in which the skin, nipple and peripheral breast tissue are left intact.
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Skin Sparing Mastectomy:
It is a mastectomy operation in which the breast is restructured and the skin is left intact while the breast tissue and nipple are removed.
To Whom is Mastectomy Operation Applied?
Mastectomy operation is a surgical procedure that is applied to individuals who need to have a part or all of their breasts removed due to breast cancer. Mastectomy can be performed on patients of any age after diagnosis of breast cancer.
This is an operation that should be performed in people whose cancer diagnosis has been established. At the same time, it can be done with the aim of protecting the breast in patients with high risk. This prevention is called Prophylactic Mastectomy.
In order to prevent the risk of cancer that may occur in the future, the breast is emptied. And the breast is reshaped and reconstructed by plastic surgeons. (Breast Reconstruction).
In Which Situations Is Mastectomy Performed?
In patients diagnosed with breast cancer or at high risk of developing breast cancer, a mastectomy should be performed to remove breast tissue as a treatment.
Removal of one breast is called unilateral mastectomy, and removal of both breasts is called bilateral mastectomy.
In lumpectomy, another breast cancer treatment method, only the tumor and a small healthy area around it are removed, not the entire breast.
Which of these operations should be preferred is completely determined by the patient’s health status and the stage of the cancer.
Some of the situations in which mastectomy may be considered necessary as a method of treatment include:
- Treatment of early stage (Stage 1 and 2) and advanced stage (Stage 3) breast cancer
- Preventive (prophylactic) treatment of patients with a first degree relative with a history of breast cancer and a high probability of developing breast cancer
- Inflammatory breast cancer
- Paget’s disease
Total mastectomy is the only treatment method for patients for whom breast-conserving surgery is not suitable.
Apart from this, the cases where mastectomy is preferred instead of lumpectomy are as follows:
- Presence of more than one tumor in different parts of the breast
- Recurrence in patients who have received radiotherapy before
- Extensive microcalcification (calcium accumulation) throughout the breast, which is determined to be cancer
- Inability to receive radiation therapy due to pregnancy
- Presence of cancer in the breast after lumpectomy
- High probability of re-development of cancer in the breast
- The tumor is larger than the breast size
- The presence of different health problems in the patient where the side effects of radiation cannot be taken into account.
What are The Imaging Techniques Performed Before the Mastectomy Operation?
Before mastectomy surgery, the patient undergoes a detailed examination and control process.
Some imaging techniques requested by the doctor in this process are as follows:
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Mammography:
It is of great importance in the early diagnosis of breast cancer. In this procedure, a breast x-ray is taken with a scanning tool.
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Breast USG:
It is the imaging of the breast with an ultrasound device. This method is different from mammography, it is applied with an ultrasound device.
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Magnetic Resonance (MR):
It is done by using special breast coils (coils) in MR devices. In order to better reveal the masses and cancer in the breast, the patient is given a drug (contrast agent) intravenously.
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PET-CT (Positron Emission Tomography-Computed Tomography):
By using two imaging systems at the same time, the breast area is seen in detail.
It is frequently preferred in high-risk breast cancer patients in the progression of cancer, in the detailed examination of the lesions that occur as a result of follow-up, and in determining the effectiveness of the treatments applied to the patient with metastases.
These imaging tests give information about whether there is cancer in the breast. In addition, a breast biopsy is performed to determine whether the tumor is benign or malignant. Breast biopsies help make a definitive diagnosis of the tumor.
What are The Risks of Mastectomy Surgery?
Mastectomy surgery is not a life-threatening surgery. If the patient has risks related to his or her general condition, these risks may increase some anesthesia complications. However, with today’s technology, it is extremely possible to cope with and prevent these complications.
In particular, if the patient has diabetes, heart disease, kidney disease or other systemic problems, the anesthesiologist should be warned about this and Consultations from the relevant departments should be completed.
According to the degree of risk given in line with the measures taken by the relevant departments, the anesthesia department is consulted and the surgery approval is obtained. After all these stages, the risk of surgical complications of mastectomy surgery is quite low.
When we look at the risk situation for mastectomy surgeries, it is seen that firstly, there are risks related to the patient, and secondly, there are risks related to the surgery.
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Risks Related to the Patient:
Some diseases present in the patient may increase the risk of surgery. Because these surgeries are in the group of surgeries that are performed under general anesthesia and can take approximately 1-3 hours.
Pre-existing diabetes, hypertension, heart diseases and previous major surgeries or infections are factors that may increase the risk.
Previous lung problems or low respiratory capacity can cause respiratory problems after surgeries.
For this reason, people with additional diseases should be consulted by the relevant departments before the operation.
After the patient’s risk analysis is done correctly, the anesthesia department finally evaluates it. And gives the patient’s consent for the surgery.
If the patient has a problem that needs to be treated, it is included in the surgical program after this problem is quickly resolved.
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Risks Related to Surgery:
These are risks such as bleeding, infection, suture opening or delay in wound healing that may develop after surgery.
In general, mastectomy surgery is not a life-threatening type of surgery.
However, if any of the above-mentioned complications develop after surgery in people with additional diseases, they should be treated without delay.
If there is excessive bleeding from the drains in the chest wall in the early period, it may be necessary to reopen the patient, find the bleeding focus, and evacuate the atom.
For late-stage infections, prophylactic antibiotics are given to patients during surgery.
However, in case of infection, after the necessary cultures are taken, antibiotics and, if necessary, surgical interventions can be performed according to the developing microorganism.
Seam separation is very rare. And it can be corrected with early intervention. As a result, these surgeries should not be seen as high-risk surgeries when performed by “experienced hands”.
How is Mastectomy Surgery Performed?
Before the operation, the patient should be informed about all the risks and possible consequences of the operation. The operation is performed with general anesthesia.
The most common complications after surgery are;
- Bleeding at the operation site,
- Vollection of blood or serum,
- Numbness in the operation area,
- Numbness,
- Armpit numbness,
- Pain,
Ipsilateral arm movement limitation.
- Surgery to the armpit lymph nodes is performed after sampling the so-called ‘sentinel lymph node’.
- The first lymph node reached by the cancer is removed. At the same time, pathological evaluation is made. And if the lymph node is clean, the armpit lymph nodes are left in place.
- If the evaluation is positive, axillary lymph nodes are included in the surgery. The duration of the operation is 1-2 hours on average.
- Breast reconstruction after mastectomy is done in the same session or later.
- In prophylactic mastectomy, breast repair is performed in the same session.
- Breast repair procedures are performed with prosthesis (implant-silicone) or the patient’s own tissue.
- If it will not be done in the same session, it is usually done 6-7 months after radiotherapy-chemotherapy.
What are The Complications After Mastectomy?
Bleeding, wound healing problems, infection etc. belonging to all surgeries. Complications can also occur after mastectomy.
Fluid accumulation (seroma) in the area where the breast was removed after mastectomy is one of the most common complications.
Frozen shoulder can be seen in mastectomy surgery if the side arm movements are not performed at the appropriate time or if the patient does not operate the arm as desired.
Again, depending on the surgical technique or the extent of the tumor, vascular or nerve injuries may occur. Depending on the intensity and level of removal of the armpit lymph nodes, swelling in the arm (lymphedema) may occur in the long term.
What are The Points To Be Considered After Mastectomy Surgery?
- In the postoperative period, there are issues that the patient should pay attention to at home after discharge. One of them is to take care that the drains placed in the surgical field do not come out and to empty the drains every 24 hours on average.
- Before the patient leaves the hospital, the relatives of the patients are taught by the nurses and doctors about how to empty the drains.
24-hour amounts should be recorded. These amounts should be known by the physician when the patient goes for control. - Apart from this, the patient should move on the side of the operation without separating his arm from the body too much.
The reason for this is to ensure that the wings are not separated in the operation where a large area is created. - This arm restriction is lifted in a few days. And the patient begins to use his arm normally.
Patients are usually discharged after 24 hours after mastectomy operations. - In the first 24 hours, it is important that the patient’s drains work well and that the arm on the surgery side is close to the chest.
- Usually after 8 to 10 hours, the patient can start oral fluid intake. After the necessary follow-ups are made in hospital conditions, the patient can be discharged after approximately 24 hours.
We can list some of the issues that should be considered after going home;
- There is no need to make any restrictions on oral intake.
- The patient should be advised to drink plenty of water and have a balanced diet.
- In addition, the movements of the operated arm side should be restricted a little for the first week.
- In other words, the arm should not be opened too much from the shoulder to the outside.
- The amount of drains must be recorded every 24 hours.
