A mastectomy is a way of treating breast cancer by removing the entire breast through surgery. It’s often performed when a woman cannot be treated with breast-conserving surgery (lumpectomy), which spares most of the breast. Often a patient may choose a mastectomy over breast-conserving surgery for personal reasons. Women at very high risk of a recurrence, sometimes have a double mastectomy, the removal of both breasts.
A prophylactic mastectomy is reserved for those with a very high risk of breast cancer, which is determined by a strong family history of breast cancer or the presence of certain genetic mutations that increase the risk of breast cancer.
Mastectomy is a surgical procedure to remove your breasts in order to treat breast cancer, Paget’s disease of the breast or gynecomastia. Gynecomastia is a clinical condition in which a male develops abnormally large breasts and the whole breast tissue is removed, known as a complete mastectomy. In a more recent technique, the skin is preserved, known as a skin-sparing mastectomy. With a nipple-sparing mastectomy, only breast tissue is removed; the skin, nipple, and areola are preserved. While in the case of breast cancer, only the affected breast is removed which can be constructed later on by breast reconstruction surgery. In some cases, only the tumor is removed, known as lumpectomy. Mastectomy can be of two types:
- Unilateral mastectomy: in this type of mastectomy, only one breast is removed which contains tumors.
- Bilateral mastectomy: in this, both the breasts are completely removed.
You have to be in fasting conditions for 8 to 12 hours before surgery. The surgeon makes you lay in the supine position and you are given general anesthesia. After this, an elliptical incision is given around your breast. Fat and breast tissue are removed along with lymph nodes according to the purpose of mastectomy. Depending upon the type of surgery, skin or nipple and areola are preserved. Incisions are stitched after the procedure and small drainage tubes are fixed to remove excess fluid and blood. Bandages are applied over these stitches. If the mastectomy is performed for breast cancer, it is followed by radiation therapy and sometimes, reconstruction surgery.
Length of Stay in Destination
Unilateral mastectomy is an outpatient procedure taking between 1 and 3 hours in the operating theatre. After this, you are moved to a recovery room where your vitals are monitored. If everything goes fine, you may leave the hospital on the same day. For complete mastectomy, additional time is needed for the operation. Also, an overnight stay in the hospital is required. If it is followed by reconstruction, 2 to 3 days stay is required. A 14 day stay within the area is necessary after the surgery. In this period, you will have a follow-up. Pain killers are given to help you manage pain. During this duration, your health conditions are monitored regularly and stitches are removed in 10 to 14 days. You can go home when allowed by your doctor.
It can take 4 to 6 weeks to recover from a double mastectomy. This period varies in accordance with the type of mastectomy. You need to recover both physically and mentally and you’ll need at least 2 to 3 weeks off work, longer if your work is physical. Allow 3 weeks before driving again. You can start doing routine chores in 2 to 3 weeks. Your incisions would have swelling, redness, and bruises around them. There will be numbness in the area of wounds. Scarring will take time to fade away and you shouldn’t expect them to disappear completely. You can begin wearing a fitting bra 6 to 8 weeks after the operation.
The survival rate for a breast cancer patient has been found to increase tremendously after a mastectomy. According to a study, 81.2% of women who went through a double mastectomy survived beyond 10 years. Also, 79.9% of the women with single mastectomy lived beyond 10 years. Sometimes, recurrence can occur leading to malignancy, this decreases the success rate. In the case of mastectomy for gynecomastia, a 90% success rate is recorded. Some patients can suffer from post-mastectomy pain syndrome or PMPS.
Following points should be considered:
- Attend regular check-ups after the surgery.
- Take your medicines regularly as and when prescribed by the doctor.
- Follow a healthy diet plan made by an expert.
- Spend less time alone. Someone should be there for you to help you with your chores.
- Do not use padded bras or prosthetics for some time.
- Avoid taking a bath in the early few days. A wet bandage can cause infection.
- Be vigilant, look for the signs of infections, redness, soreness, etc. Consult your doctor immediately if you find any of them.
- Abstain from sexual activity till allowed by your physician.
- Give yourself plenty of time to recover.
- Do some exercises so that your arms may not get stiff.
- Do not lift heavy objects or children, it may remove your stitches before the due time.
- Avoid excessive movement and keep your stuff near you.
Alternatives to a Mastectomy Procedure
Following are some effective alternatives to mastectomy:
- Lumpectomy: in this procedure, only the tumor along with some surrounding tissue is removed. This is suitable for those patients whose cancer has been identified in the early stages. In this way, the whole breast is preserved, removing the tumor only.
- Radiation therapy: in this therapy, ionizing radiations are used to kill malignant cells causing breast cancer. It works by damaging the cellular DNA, hence stopping the cell division and metastasis. This therapy is very effective in case of localized cancer because it can cause the complete destruction of the tumor.
- Cancer Immunotherapy: it works by artificially stimulating the immune system to treat cancer. Cancer cells contain antigenic sites which are detected by antibodies of your immune system. Antibodies combine with antigens to kill and destroy them. Hence, the spread of cancer is prevented.
Before and After Mastectomy
It depends upon the purpose for which you went through a mastectomy. In the case of a breast tumor, if you do not go for an operation, it may metastasize, leading to more malignancy. For gynecomastia, abnormally large breasts can damage your physical appearance. After the surgery, all these problems are resolved. The spread of cancer is stopped and tumors are removed. Excessive breast tissues are excised and your chest is given a normal male like contour.
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