Decoding mastectomy: Understanding choices, recovery, and reconstruction

The decision to undergo a mastectomy, the surgical removal of one or both breasts, is a complex and deeply personal choice often influenced by various medical, personal, and genetic factors. In her latest online article, Ms Gael MacLean explores the circumstances under which a mastectomy is advised, delving into the reasons behind this recommendation, the effectiveness of the procedure in eliminating cancer, and the factors that may lead to choosing a mastectomy over other surgical options.

When is a mastectomy advised?

A mastectomy is recommended under various circumstances. If the size of the disease in the breast is significant, removing only the affected area might leave minimal breast tissue. Additionally, it is advised when cancer penetrates the skin, particularly in inflammatory breast cancer cases. Patient preference is crucial; if an individual opts for a mastectomy, it should be seriously considered.

Furthermore, mastectomy is recommended for patients who previously had breast cancer in the same breast, underwent cancer removal and radiotherapy, and now face a recurrence or new cancer. Since radiotherapy can't be administered twice to the same breast, mastectomy becomes the recommended course of action.

Genetic analysis revealing gene carrier status can lead to risk-reducing mastectomy. This procedure, often coupled with breast reconstruction, involves removing all breast tissue to lower the individual's lifetime risk of developing breast cancer.

Does a mastectomy remove all cancer?

A mastectomy ensures the removal of all visible and palpable breast tissue, effectively eliminating the detected cancer. However, it's important to note that it cannot eliminate every single cell of breast tissue. In the context of risk reduction surgery, it is termed as such because complete elimination of every breast tissue cell is unattainable. Conversely, in mastectomy for treating breast cancer, the procedure succeeds in removing the cancerous tissue.

When would a mastectomy be necessary instead of a lumpectomy?

A sizable breast hosting a small breast cancer may not typically necessitate a mastectomy. However, if the same size of cancer is found in a small breast, a mastectomy might be recommended due to the limited amount of remaining breast tissue. In certain types of breast cancer, such as inflammatory breast cancer, a mastectomy becomes imperative as the removal of skin is required in this specific disease.

What is the recovery period of mastectomy like?

Many patients are pleasantly surprised by the swift recovery following a mastectomy since the operation does not involve the muscles. The breast is positioned in front of the pectoral muscle, which remains unaffected. Contrary to anticipated pain levels, patients often find the process less painful than expected, facilitating a speedy recovery.

Ensuring shoulder function is crucial, and patients are provided with information about shoulder exercises. The body tends to instinctively protect the operated side after a mastectomy, emphasising the importance of consistent shoulder movement for optimal function.

Recovery duration varies among individuals. While some may return to work after just two or three weeks, others may require a more extended recovery period. The development of a seroma, a common side effect of mastectomy, might necessitate more frequent medical attention and potentially delay recovery. Despite these factors, patients typically resume normal activities soon after the operation. Most mastectomies I perform are conducted as day case surgeries, allowing patients to return home on the same day.

Who can have breast reconstruction surgery after a mastectomy?

Surgery following a mastectomy is typically presented as an option for the majority of patients, involving a discussion between the surgeon and the patient regarding potential risks, complications, and the recovery process associated with reconstruction. However, breast reconstruction may not be generally recommended for individuals with a history of smoking, as smoking can compromise the small blood vessels, increasing the risk of poor outcomes. The conversation between the surgeon and the patient revolves around the various reconstruction options, including using implants only or utilising tissue from other areas of the patient's body, possibly combined with an implant. This discussion aims to provide patients with a thorough understanding of the available choices and their associated risks.

Ms Gael MacLean is a respected breast and oncoplastic surgeon. You can schedule an appointment with Ms MacLean on her Top Doctors profile.