Removing Cancer, Restoring Confidence
Patients who have very large cancers or cancer cells scattered over a large
portion of the breast are not candidates for breast conservation and therefore require a
mastectomy. Some patients may prefer a mastectomy even if they are a candidate for breast
conservation. Radiation is usually not necessary after a mastectomy.
Mastectomy options
include:
Skin-sparing mastectomy with immediate reconstruction
Most of the breast skin
is preserved but the nipple-areolar complex is removed. After the mastectomy and
sentinel lymph node biopsy is completed the Plastic Surgery team comes into the
operating room and performs the first phase of the immediate reconstruction.
You
may meet with a Plastic Surgeon prior to the day of surgery if you require complex
techniques for breast reconstruction (TRAM/DIEP). Options for breast reconstruction
include temporary expander followed by permanent implant, immediate permanent
implant, TRAM (DIEP) flap, or latissimus dorsi flap.
Nipple-sparing mastectomy
Patients may be candidates for nipple-sparing
mastectomy if they have small breasts (A or B cup), it is a prophylactic mastectomy, or
the cancer is small and not close to the nipple. If the breast is large, the blood supply
to the nipple-areola complex may be inadequate and the nipple may not survive.
If the
cancer is too close to the nipple area there may be a higher risk of recurrence. As in
all forms of mastectomy there is permanent numbness over the central breast and no
sensation to the nipple if it is preserved.
Traditional mastectomy without reconstruction
If a patient chooses this option, she
will have a flat chest on the side of the mastectomy and can wear a prosthesis that fits
inside her bra.
What to Expect After Mastectomy Surgery
When a mastectomy is performed, postoperative radiation is generally not necessary unless
the cancer is quite large, lymph nodes are involved with cancer, or margins are close or
positive. The recommendation for chemotherapy is the same whether one chooses breast
conservation or a mastectomy.
A mastectomy without reconstruction or with expander
reconstruction generally requires an overnight stay in the hospital. When the reconstruction
is performed with your own tissue (TRAM flap or latissimus flap) the hospital stay is generally
several days.
Comparing Outcomes: What the Research Shows
The overall survival is exactly the same whether breast conservation or a mastectomy is
performed. The risk of the cancer returning within the affected breast or on the chest wall is
approximately 5-6% for breast conservation and 2-3% for a mastectomy.
If the cancer recurs
in the breast after a lumpectomy and radiation, a mastectomy is generally required to treat the
recurrence.
