Newer mastectomy techniques can preserve breast skin and the nipple and allow for a more natural breast appearance and enable a plastic surgeon to reconstruct the breasts if desired. Dr van Schalkwyk will discuss this with you in more detail during your consultation.
A mastectomy is a surgery done to remove all the breast tissue from a breast. It is generally done to treat cancer, but may also be done as a precaution to prevent breast cancer for those with an increased risk of developing breast cancer (this is known as a prophylactic mastectomy). When a breast-conserving surgery such as a lumpectomy is not suitable, a mastectomy may be advised to remove a tumour from the breast. A mastectomy may be done to remove one breast (unilateral mastectomy) or both breasts (bilateral mastectomy).
A mastectomy is done to treat breast cancer by removing the tumour and the nearby tissue, It may be done for the following types of breast cancer:
- Ductal carcinoma in situ (DCIS)
- Early-stage breast cancer
- Locally advanced breast cancer, usually following chemotherapy
- Inflammatory breast cancer following chemotherapy
- Paget's disease of the breast
- Locally recurrent breast cancer
While surgery may remove the tumour, further treatment may involve chemotherapy and radiation therapy.
- A simple or total mastectomy this type of mastectomy involves the removal of the entire breast, including the breast tissue, breast skin, areola and nipple. It excludes the pectoral muscle beneath the breast
- A skin-sparing mastectomy this type involves the removal of all the breast tissue, nipple and areola, but not the breast skin so that breast reconstruction can be done after surgery should it be desired.
- Nipple-sparing mastectomy this type involves removing only the breast tissue, sparing the skin, nipple and areola. Breast reconstruction can then be done thereafter.
In terms of surgery, a mastectomy is done under general anaesthesia and generally takes between 1 and 2 hours. If reconstruction is being done after the mastectomy, surgery will take longer.
Regardless of the type of mastectomy you have, the tissue removed during surgery will be sent to a laboratory for analysis.
Depending on the type of mastectomy, a variety of incisions may be made. For a total mastectomy an oval-shaped incision is made around the nipple and through the breast to remove breast tissue. For a skin or nipple-sparing mastectomy smaller incisions are made to preserve the breast aesthetically to allow for the reconstruction.
In addition to removing the breast tissue, Dr van Schalkwyk may wish to remove the nearby lymph nodes. During an axillary node dissection, your surgeon will remove a number of lymph nodes from your armpit on the side of the tumour-ridden breast. If a sentinel lymph node biopsy is done, Dr van Schalkwyk will only remove the first few nodes into which a tumor drains. These lymph nodes will then be tested for presence of cancer cells. If no cancer is found, no further lymph nodes need be removed, but if cancer is present your oncology team will decide on the treatment plan best suited.
If a breast reconstruction is desired your reconstruction may be done directly after Dr van Schalkwyk has done the mastectomy. Reconstruction can be performed using your own tissue or with a silicon prosthesis. Reconstructive options will be discussed in detail prior to your surgery. . After the plastic surgeon is finished, drainage tubes will be placed in your incisions so that excess fluid can be collected to aid healing. Your surgeon will the close your incisions, cover them and wrap your chest for support during recovery.
After the surgery you will need to remain in the hospital for at least three days for observation. Once you are ready to go home you will need someone to drive you and to help look after you once you are home as recovery may be challenging. You will be given instructions for managing pain, caring for the drains and surgery site, when to resume wearing a bra and showering. Note that rest is vital for recovery, give yourself time.