Mastectomy Procedure: Types and Post Care Guide

Mastectomy is the surgery done to remove a breast or a part of the breast as a treatment option for breast cancer. It is also performed prophylactically to prevent breast cancer in individuals who are at extremely high risk for it. It is recommended for people who have been diagnosed with breast cancer. The existence of certain genetic mutations raises the chances of breast cancer.

1. Removal of the whole breast means: you might feel more confident that your cancer won't come back.
2. You usually won't need radiotherapy after the surgery. you can have radiotherapy to the area if your cancer comes back in the future

A mastectomy is a treatment option for the following types of breast cancer:

1. Ductal carcinoma in situ (DCIS), or non-invasive breast cancer
2. Stages I and II breast cancer (early stage)
3. Stage III breast cancer (locally advanced) – after chemotherapy
4. Inflammatory breast cancer – after chemotherapy
5. Breast cancer that is locally recurrent
6. Paget's disease of the breast.
7. Both breasts are removed in a preventative (prophylactic) or risk-reducing mastectomy. It lessens the chances of cancer spreading in the future.

Procedure description

1. During a mastectomy, an elliptical incision is made over the breast, depending on the type of mastectomy being performed. 
2. The underlying tissue is cut free and removed.
3. If the lymph nodes are removed, they are dissected carefully to preserve the important surrounding structures.
4. In case the breast reconstruction is to be done at the same time, the plastic surgeon (who will perform the breast reconstruction surgery) places tissue expanders or silicone implants.
5. For individuals who need radiation therapy after surgery, one option is to place temporary tissue expanders to hold the breast skin in place. This allows for final breast reconstruction until after radiation therapy.
6. After the surgery is done, the incision is closed with sutures, which either dissolve or are removed later. 
7. One or two small plastic tubes called surgical drains are placed where the breast was removed to drain any fluids that accumulate after surgery. The tubes are sewn in place, and the ends are attached to a small drainage bag.

What to expect after the surgery?

1. Following the surgery, the patient is made conscious again and moved to a recovery room.
2. The patient is monitored for their vitals along with any post-surgical complications and the wearing off of the anaesthesia.
3. The patient is given pain medication as there is pain and tenderness at the incision site and a pinching sensation in the underarm region. The patient is also given prophylactic antibiotics.
4. Recovery from mastectomy usually takes two weeks. Patients are given the following advice:
5. Keep the surgical site clean and dry.
6. Take care of the surgical drains placed.
7. Wait 48 hours to bathe after surgery.
8. Don’t rub the incision; pat on it gently.
9. During the surgery, if the lymph nodes were removed, the doctor will advise some light exercises to help limber up the arm and shoulder region. It helps prevent swelling. 
10. Avoid any strenuous exercise or activity until advised by the doctor.
11. Avoid wearing a bra. The doctor will recommend when to start wearing a bra or a bra prosthesis.
12. Any previous medication that was stopped should only be resumed after consulting with the doctor.
13. After a mastectomy, chemotherapy or radiation therapy may be needed.

First follow-up appointment

The first follow-up appointment is after two weeks.

Consult a doctor if there is any complication.

When to consult a doctor?

1. A doctor should be consulted at the earliest sign of any complications or possible side effects, which include:
2. Bleeding or infection at the surgical site 
3. Pain or tenderness at the surgical site (more than expected)
4. Swelling (build-up of blood or clear fluid) at the surgical site 
5. Limited arm or shoulder movement
6. Numbness in the chest or upper arm area
7. Neuropathic pain in the chest, armpit, or arm area that does not go away, also called post-mastectomy pain syndrome