Why get a mastectomy?
A mastectomy is a surgery to remove the breast. Someone might receive a mastectomy either to treat or prevent breast cancer.
Many breast cancer patients are good candidates for a lumpectomy, or breast lump removal, which is a more conservative therapy. With a lumpectomy, your doctor will remove the tumor and the tissue around it. Patients with small tumors and noninvasive cancer are generally good candidates for lumpectomy.
Some patients might choose to receive a mastectomy rather than a lumpectomy for personal reasons. For example, some patients might choose a mastectomy for fear their cancer will come back. This is not to say receiving a mastectomy offers better results. Recent research has shown that for some women, a lumpectomy might offer better results. Generally, a lumpectomy can cost more than $7,000 whereas a mastectomy can cost more than $10,000.
Another option is to undergo chemotherapy to shrink the tumor and then receive a lumpectomy after the tumor has shrunk to a small enough size. The decision of which option to choose can be difficult to make, and it is important to understand your options and ask any questions you have.
There are few reasons outside of breast cancer that a person would get a mastectomy. Some people who are transgender and are transitioning to men will receive a bilateral mastectomy, the procedure in which both breasts are removed.
In 2013, it's estimated that 232,340 women and 2,240 men will develop breast cancer. Of that, the National Cancer Institute estimates that 39,620 of those women and 410 of those men will die.
What happens when you get a mastectomy?
Each surgeon's technique will differ, but generally, to begin the surgery, you'll fall sleep via anesthesia. Your surgeon will make a series of incisions and attempt to remove most breast tissue. For most mastectomies, the patient's nipple will be removed.
Your surgeon might remove some of your lymph nodes under your arm, depending on how invasive your cancer is. The goal of the surgery is to remove the breast and provide a flat chest with a thin layer of skin. Some women choose to have reconstructive breast surgery while others do not.
What are the risk factors?
Bleeding and infection are risks for any surgery. With a mastectomy, there's risk that the infection site could become infected, along with the lungs, bladder or kidneys. There's a risk that scar tissue will develop where your breasts once were. Also, there's a risk of a hematoma, or a buildup of blood. You might also feel pain or stiffness in your shoulders. There's also a risk of heart attack or stroke during surgery.
Lymphedema is not a common risk, but it can cause ongoing swelling of the arm on the same side of your mastectomy.
Does it hurt?
During a mastectomy, you should be under anesthesia and asleep, not feeling any pain. The amount of pain felt after surgery varies from patient to patient.
You likely will stay at least one night in the hospital. While in the hospital, your doctor might request for you to have a pain-control pump on your bedside. You can use the pump whenever you're in pain to provide yourself with more pain medicine within certain parameters.
Most patients need prescription pain medicine for about a week. You might start to feel an achiness, pressure or mild burning sensation around the surgical site. Also, the area around your incision could stay numb for a while.
For patients who have lymph nodes removed as well, you might experience soreness or numbness under your arms.
What's the recovery time?
If you have a desk-type job, you will likely be able to go back to work in one to two weeks. Patients with a more physically strenuous job might need to wait up to three weeks to return.
At first, you will have to limit yourself on things such as picking up heavy objects or participating in strenuous exercise. However, you should be able to begin walking on a treadmill or swimming after about three weeks, if your drains have been removed.
The drains are probably the most inconvenient part of the surgery, other than the discomfort from the procedure itself. Your surgeon will place those somewhere along your chest to help keep fluid from accumulating. Until your drains are removed, you generally aren't able to shower.
The amount of gauze or wrapping you have after surgery will depend on your physician, and thus, the amount of time you have to wear it will also depend on your doctor.
What's the follow-up?
Your doctor will want to see you shortly after surgery. The number of times you have to go back will depend on the stage of your cancer and how invasive it is, among other things.
After a mastectomy, some patients must undergo additional cancer treatment, such as radiation. This will depend on your specific diagnosis and what you and your doctor decide is best.
Source: Dr. Kertrisa McWhite, surgical breast oncologist; the Mayo Clinic; National Institutes of Health; Reuters.