Mastectomy
Breast cancer represents a very high statistic in Panama and around the world, which has allowed us to gain experience and constantly innovate, to offer the most precise techniques and treatments according to each need; among them, mastectomy.
What is mastectomy?
Mastectomy is a surgery performed on cancer patients to remove all of the breast tissue, as an alternative to treating or preventing the spread of cancer. Depending on the case, mastectomy can be performed in one or both breasts, partially or completely.
Types of mastectomy
From the diagnosis, location and size of the tumor, the surgical technique, as well as other considerations of the specialist; Mastectomy has a broad classification that determines the conditions under which it should be performed. In this sense, the Mastectomy procedures are:
Unilateral mastectomy
First, unilateral or simple mastectomy is surgery in which a single breast is removed.
It is a procedure in which the entire breast tissue is removed (including the skin, areola and nipple), but preserving the other breast that has not normally been affected by the disease.
Bilateral mastectomy
On the other hand, bilateral mastectomy, as its name suggests, consists of the removal of both breasts completely; that is, the entire breast, skin, areola and nipple.
In particular, bilateral mastectomy is performed when cancer is present in both breasts, or there is a high risk of developing a second cancer (family history).
Skin- and/or nipple-sparing mastectomy
At the same time, subcutaneous mastectomy is one of the techniques that achieves the preservation of the nipple and the skin of the breast; although, depending on the case, it may be necessary to include it in the breast tissue that is removed.
Subcutaneous mastectomy is very useful in cases where extensive removal is planned, such as in multicenter breast cancer, in the event of diffuse preneoplastic lesions, or when prophylactic mastectomy is required.
Modified radical mastectomy
In the case of modified radical mastectomy, the removal of the entire breast does not allow for nipple sparing, meaning that the procedure includes skin, areola, mammary gland, and axillary lymph nodes.
In this surgery, the pectoralis major and minor muscles are preserved, or at most only the pectoralis minor is removed to facilitate access to the inner region of the axillary lymph nodes.
Currently, it is the most widely applied type of mastectomy since it is not usually as aggressive compared to classic mastectomy and has fewer functional sequelae.
Total mastectomy
Also known as classic radical mastectomy or simple mastectomy, it is a surgical procedure that performs the removal of the entire mammary gland, including the underlying pectoral musculature (pectoralis major and minor) and the lymph nodes in the armpit.
It is also known as Halsted’s mastectomy, in honor of the American surgeon William Stewart Halsted who popularized it.
Partial mastectomy
Similarly, partial mastectomy, breast-conserving surgery, lumpectomy or segmental mastectomy; This is another surgical technique in which only the part of the breast that has the cancer and some surrounding normal tissue is removed.
In this surgery, the patient preserves most of her breast and it is usually combined with radiotherapy sessions.
Some studies show that when this type of procedure is done in conjunction with radiation therapy, survival is the same as when the patient undergoes a classic mastectomy.
Preventive mastectomy
Prophylactic mastectomy or “preventative,” is a surgical procedure that involves the removal of one or both breasts in people who are at high risk of developing breast cancer. This decision can be made in cases where a genetic mutation has been identified in the BRCA1 or BRCA2 genes, which significantly increase the likelihood of developing breast cancer.
Prophylactic mastectomy It is also considered a viable option to reduce the risk of breast cancer in people with a family history of the disease or with a genetic predisposition. By performing this surgery, breast tissues are removed where a tumor could develop in the future. This measure is taken with the aim of decreasing the risk of developing cancer and increasing the chances of a healthy life free of this disease.
Surgical Technique of Mastectomy
To perform a mastectomy, general anesthesia must be applied and the patient must be demarcated based on the location of the tumor in the breast; selecting the best access route, which in turn allows a subsequent aesthetic reconstruction.
Then, the intervention begins with the first incision by the surgeon. This makes a cut with the scalpel until the entire incision in the epidermis and dermis is completed, continuing with the electric scalpel to the superficial fascia that separates the subcutaneous fat from the breast tissue. In particular, such subcutaneous fat must be preserved, as it has a noticeable impact on the outcome of the reconstruction.
When identifying the fascia superficialis, all that is below it is the mammary gland. A plane of separation should be developed, starting at the lower vertical and developing it circumferentially in a clockwise direction.
Once the circumference in the gland is completed, from the lower portion and with the electric scalpel, the separation of the gland from the pectoral muscle begins. Once the excision is complete, the resection specimen is marked and oriented for study.
Benefits of Mastectomy
Among the benefits of mastectomy procedures, we can mention:
It can be applied preventively when there is a high risk factor for breast cancer.
It prevents the spread of cancer to other parts of the body when it has already been diagnosed.
Who can have a mastectomy?
Mastectomy is a surgical procedure that applies to many types of breast cancer. In particular, specialists recommend one technique or another depending on the specific conditions of each case; having as references:
The woman's preference for a preventive radical mastectomy or bilateral mastectomy, conditioned by her family history.
There are two or more tumors in the breast region.
The patient has previously undergone tumor removal and still has cancer.
Before mastectomy How to prepare?
Before surgery, there must be prior planning carried out jointly by the surgeon and the anesthesiologist around the intervention. In this review, the plan to be executed is determined and the patient’s medical history is analyzed.
During this preliminary stage, the patient should make sure to ask all the questions and clarify any doubts that may arise in relation to their procedure, including the risks of the surgery and the reasons why it is performed.
In the event that a breast reconstruction procedure is planned, it is the precise time to know how and when it will be carried out (a common option is to do it immediately after the mastectomy).
Additionally, the professionals who will intervene in the surgery must indicate to the patient the previous restrictions so that there are no problems during the operation, including:
Stop taking aspirin or other blood thinners.
Do not drink or consume food between 10 to 12 hours before surgery.
Stop taking supplements and vitamins.
Gather the personal items you will need on the date of your procedure (toothbrush, gowns, slippers, others).
What should I have at home?
Basically, the recovery period after a mastectomy extends to several weeks; so you should take some time to rest.
Consequently, there are some recommendations that you should take into account so that you can recover at home in the best possible way:
Follow your doctor's precise instructions. When bathing, you should be very careful to avoid hurting yourself or risking wound infections.
To take care of all the household duties and your most basic needs, ask for the support of a family member or close friend who can accompany you during this period.
Try to sleep, rest, and relax as much as possible.
Keep the analgesics that have been indicated, in case you have pain or other discomfort.
Exercise with your arms (without abusing it), always following the specialist's recommendations.
Mastectomy Recovery and Postoperative Care
As soon as the patient is discharged, getting home can become a problem if the guidelines set by the doctor regarding medications and care are not followed.
In particular, the wound must be treated with great care to minimize the risk of infections; while the consumption of painkillers and anti-inflammatories must be strictly controlled.
Similarly, the removal of the breast can have severe implications on the patient’s psyche, especially when the nipple is not preserved; which is why it is very important to seek psychological support when necessary.
For the first 3 weeks, you should lead a quiet life, without efforts and minimizing the movement of your arms. After this time, you should continue to have a quarterly checkup, unless your doctor tells you otherwise.
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"My greatest motivation as a Surgical Oncologist in Panama is to have the opportunity to help each patient find multiple reasons to keep fighting."
- Dr. Roberto García
Side effects of mastectomy
As a result of multiple studies, it has been proven that between 20 and 30% of women who undergo mastectomy procedures have post-mastectomy pain syndrome.
After surgery, there is usually nerve (neuropathic) pain in the chest wall, armpit, and arm that does not fade over time. Other common discomforts are:
Tingling
Pain in the surgical scar
Excessive itching
Sharp or sudden pain
Numbness
However, all these effects must be reported to the specialist, so that it is possible to establish the protocols to be followed, according to the stage of recovery in which the patient is.
Can implants be used after a mastectomy?
Undoubtedly, after overcoming surgery and beyond the aesthetic, the breasts are an important part of a woman’s anatomy; so this influences their physical and psychological well-being in many ways.
In this sense, patients who choose breast reconstruction surgery have several options, including saline or silicone implants.
Likewise, another alternative is to reconstruct the breasts using autogenous tissues; that is, parts of the patient’s own body.
In the same way, mixed surgery takes advantage of both autogenous tissue and synthetic implants, to achieve a much more natural-looking breast reconstruction.
Causes and Risk Factors of Breast Cancer
Breast cancer can have several risk factors, some of which are modifiable and some of which are not. Here is a list of the most common risk factors:
Family History
Women who have a family history of breast cancer, especially if it occurs at a young age, have an increased risk of developing breast cancer.
Genetic Mutations
Mutations in certain genes, such as BRCA1 and BRCA2, can significantly increase the risk of breast cancer.
Age
The risk of developing breast cancer increases as you age. Most cases of breast cancer are diagnosed in women over the age of 50.
Personal history of cancer
Women who have already had breast cancer in one breast have an increased risk of developing breast cancer in the other breast or developing it again in the same breast.
Hormone therapy
Using hormone therapy to treat menopausal symptoms (if used for long periods of time) may increase your chances of developing breast cancer.
Lifestyle
Alcohol consumption and being overweight or obese have also been linked to an increased risk of breast cancer.
Previous diagnosis of breast cancer
A previous diagnosis of breast cancer refers to women who have already had the disease in the past and are at a higher risk of developing it again. These women need early detection and careful follow-up to detect any recurrence or new cancer as soon as possible.
Depending on medical history and other factors, the oncologist may recommend more intensive evaluation and monitoring for these women, including additional imaging tests such as breast MRI.
Diagnosing a mastectomy
Mastectomy is a surgery used as a breast cancer treatment in which an entire breast or part of it is removed. Diagnosing a mastectomy involves a medical examination to evaluate the patient’s overall health and determine if surgery is necessary.
Usually, a mammogram is started to detect any abnormalities in the breast. If a suspicious mass is found, a biopsy may be needed to confirm if it is cancerous. Once the diagnosis of breast cancer is confirmed, treatment options are discussed with the patient, including possible mastectomy. If mastectomy is considered the best treatment option for breast cancer, surgery will be carefully planned; as well as their postoperative follow-up.
