Mastectomy - Simple, Skin Sparing and Nipple Sparing

Introduction

Mastectomy is a surgery performed to remove the breast, usually to treat or prevent breast cancer.

The goals of breast cancer surgery are to remove all or most of the cancer, prevent its return, and avoid disfigurement as much as possible. With these goals in mind, there are 3 types of mastectomy:

• Simple or total mastectomy is removal of the breast tissue including the nipple and areola.
• Skin sparing mastectomy is the removal of breast tissue including the nipple and areola complex with preservation of the skin envelope.
• Nipple sparing mastectomy is the removal of breast tissue with preservation of the skin envelope and the nipple and areola complex.

Disease Overview

Breast cancer generally begins in the lobules or milk ducts of the breast but can also occur in the fatty and fibrous tissues. Left untreated, the tumour cells may invade the nearby healthy breast tissue or lymph nodes in the underarm from where they can spread to other parts of the body.

During a mastectomy, the lymph nodes, the lining over the chest muscles and the chest muscles themselves may also be removed depending on the extent and type of the cancer.

Indications

Mastectomy is recommended when your breast is affected with cancer or you have a high risk of developing breast cancer. A simple, skin sparing or nipple sparing mastectomy is usually indicated for patients with non-invasive or early stage breast cancer, Paget's disease of the breast, or recurrent breast cancer.

Surgical Procedure

Prior to your surgery, the nurse or surgeon will mark the area where the cut will be made. The procedure is performed under general anaesthesia.

• Simple or Total Mastectomy: Your surgeon will remove the entire breast and sometimes the lymph nodes from the armpit by making a 6 to 7-inch long elliptical cut starting from the inside of the breast, close to the breast bone, and continuing up and out toward the armpit.

• Skin-Sparing Mastectomy: Your surgeon will cut an opening around the nipple and areola to remove the breast tissue. Most of the breast skin is preserved with this technique, which is generally lost in traditional mastectomy. It offers the advantage of negligible scarring and provides the best option for immediate breast reconstruction.

• Nipple-Sparing Mastectomy: Your surgeon will make an incision in the fold of skin under or to the side of the breast, or around the areola, where the cut cannot be easily seen after healing, and will spare the nipple.

Besides the lymph nodes, the lining over the chest muscles and the chest muscles themselves may also be removed depending on the extent and type of the cancer. The surgeon then inserts surgical drains to collect excess fluid and closes the incision.

Post-Operative Care

Mastectomy without the dissection of the lymph nodes is an outpatient procedure, where you will be discharged on the same day of the surgery. When dissection is involved, you will be required to stay in the hospital for a few days.

You will be prescribed medicines to relieve pain. A drain is placed to collect fluid from the surgical site. You should keep the incisions clean and dry for a week after the surgery. A special surgical bra can be used to hold the bandages in place. You may experience tingling, numbness or discomfort in the armpit. You will be instructed to begin arm exercises the day following surgery to prevent stiffness. You will be able to get back to your regular activities after a few weeks of healing.

Following the removal of breast tissue, the breasts can be rebuilt to achieve a similar shape and size of the original breasts. The nipple can also be constructed. Your doctor may perform reconstruction either during the surgical procedure or a few months after the procedure.

Risks and Complications

As with any surgery, breast cancer surgery involves potential risks and complications. They may include:

• Accumulation of blood or fluid at the wound site
• Excessive bleeding
• Accumulation of lymphatic fluid in the arm
• Wound infection
• Nerve pain
• Scar formation in the armpit