Over the past decade, the number of women electing to undergo a mastectomy — the surgical removal of the entire breast to treat breast cancer — or a double mastectomy — the removal of both breasts — in the United States has been on the rise.
Studies have sought to understand why some women make the drastic choice to remove one or both breasts when a lumpectomy would likely result in the same medical outcome, but no clear answer has emerged. High-profile cases may be fueling the rise, such as the very public decision by A-list actress and director Angelina Jolie to undergo a prophylactic bilateral mastectomy after learning she had a BRCA gene mutation that put her at elevated risk for developing breast cancer. Fear of recurrence is also a driver for many women who worry that a second breast cancer could develop in the other breast if they only remove the one breast where the cancer is found.
[See: Breast Pain? Stop Worrying About Breast Cancer.]
Dr. Tari King, chief of breast surgery at Dana-Farber/Brigham and Women’s Cancer Center, says many patients don’t always have the right information regarding their risks or how drastic the surgery needs to be to prevent them from having a recurrence or a second bout with breast cancer. “The bigger surgery is not always better,” she says. King says in many circumstances, the survival rates for women undergoing a lumpectomy and radiation therapy are the same as undergoing a mastectomy. And undergoing a prophylactic double mastectomy has not been shown to increase survival rates in patients who have normal risk rates for developing breast cancer.
Regardless of why mastectomy surgeries are on the rise, the fact is many more women are choosing them to deal with a breast cancer diagnosis. If you’re considering having a mastectomy, it’s important to know what to expect before you go under the knife.
Major Surgery
First, a mastectomy is considered major surgery. It will be performed under general anesthesia, and you’ll be in the hospital for some length of time depending on how you respond to the anesthesia, how quickly you recover and whether you elected to have an immediate breast reconstruction.
Most mastectomies involve removing all or nearly all of the breast tissue and several nearby lymph nodes. Breastcancer.org reports that “mastectomy with axillary dissection (modified radical mastectomy) can take 2 to 3 hours.”
Dr. Mary Gemignani, attending surgeon at Memorial Sloan Kettering Cancer Center and the program director for surgical fellowship, says there are “quite a few varieties of mastectomy,” that can be performed depending on your medical need and preferences. In “a conventional mastectomy, you remove the breast tissue and the nipple with an incision,” and this may be performed “in conjunction with a plastic surgeon to conduct an immediate reconstruction,” she says.
[See: 7 Innovations in Cancer Therapy.]
Some women may also have the option for a nipple sparing mastectomy, “depending on location and size of cancer.” In this procedure, Gemignani says, “we save the entire envelope of skin and the nipple through different incisions underneath the breast to get the tissue out through there.” She says interest has increased in this type of procedure over the past several years because it allows the patient to have “a more natural look than if you have to do the whole reconstruction including the nipple. But not everyone is a candidate because of their breast size and other factors.”
No matter which approach your doctor takes, once the skin has been cut, the surgeon separates and removes the breast tissue from the skin and chest wall. Depending on your particular situation, your surgeon may also remove some of the chest muscle, and in virtually every mastectomy, some or all of the axillary lymph nodes — the nodes near the breast where cancer cells could spread — will be removed from under your arm.
If you’re having an immediate reconstruction, your surgeon will begin that process after the tissue is removed.
Electing to have an immediate reconstruction will lengthen the time you’re in surgery and your recovery, but it means you won’t have to have a second surgery specifically for the reconstruction at a later date. Speak with your doctor about which approach is best for you.
Lastly, your surgeon will insert surgical drains into your chest before stitching and bandaging the area. Breastcancer.org explains that these drains are “long tubes that are inserted into your breast area or armpit to collect excess fluid that can accumulate in the space where the tumor was. The tubes have plastic bulbs on the ends to create suction, which helps the fluid to exit your body.” Removing the fluid that can build up is important for reducing the risk of infection at the surgery site, and you’ll need to keep the drains clean and follow your doctor’s instructions for removing the fluid that collects in the siphon bulbs.
[See: What Not to Say to a Breast Cancer Patient.]
Danielle Chase, now 38, of Collingswood, New Jersey, says she found the drains to be problematic after her prophylactic double mastectomy in 2008. “I was sleeping, and there was this grossness everywhere. I didn’t know what it was,” she says of waking up to find that one of the drains had leaked. She says she wished her doctor had been more forthcoming about the drains and how they worked. “No one told me, ‘you’ll have six drains coming out of you, by the way.’ That’s something they should be a lot more up-front about.” Chase says her mother sewed her a special apron to help keep the drains from getting in the way and tangled, and some companies offer drain management garments to help you deal with these devices. The drains are typically removed within two weeks of surgery.
Most patients can get back to their normal routine within a couple weeks of a mastectomy, King says. “The surgery is, in general, very safe and a relatively short surgery in terms of a couple hours and short hospital stay on the order of one or two nights.” Most patients can return to normal activities in one to two weeks, she says. Patients electing to undergo an immediate breast reconstruction can expect a longer recovery period. King says barring any complications, most patients can return to normal activities within two to four weeks if the reconstruction was done with an implant, and four to six weeks after surgery if their own body tissue was used to reconstruct the breast or breasts.
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What Should I Expect From a Mastectomy? originally appeared on usnews.com
