When a lump is detected in the breast, or in some preventative cases, a surgeon may elect to remove the breast tissue in a procedure called a mastectomy. This surgery is always performed while the patient is under general anesthesia, and can include the removal of the nipple and areola, as wells as portions of the lining of the chest muscles. After the incision is closed, patients can expect to have temporary drainage tube for a little while following the procedure.
Assessing Lymph Nodes
One of the most significant detectors of the severity of cancer as well as a predictor of long-term outcomes is the lymph nodes. When treating more aggressive forms of cancer, such as ductal carcinoma in situ, it’s common practice to remove some of these nodes from the underarm area during a mastectomy or breast conserving procedure.
This can also be done during a separate procedure called a sentinel node biopsy, which is preferred to the more-invasive axillary node dissection. The surgeon uses a radioactive liquid as a tracer to detect the nodes which are most likely to be affected by cancer. The surgeon can then remove the affected nodes (usually one to five) so they can be evaluated by a pathologist. If the pathologist finds no signs of cancer, no further procedures will be needed. However, if cancer is present, removal of the rest of the nodes will be required.
An axillary node dissection will affect more of the underarm area, and carries an increased likelihood of disruption to function, as well as lymphedema – swelling of the arm or other nearby areas.
What to Expect After Surgery
Patients can expect to experience soreness in areas of the chest, underarm and shoulder, along with numbness across the chest. While the soreness will improve, the numbness is often permanent. Numbness may also be present in the underarm area if lymph nodes were removed.
Mastectomy with and without reconstruction
Breast Reconstruction
Since a breast (or both breasts) is removed during a mastectomy, some patients elect to have their breast(s) surgically reconstructed. This can be done at the time of the mastectomy or at a later scheduled date. If the patient chooses to pair the procedure with the mastectomy, the surgeon may be able to preserve existing breast skin to help build the new breast.
Breast Prosthesis
For post-mastectomy procedures, patients can get a breast prosthesis, which
can either be fitted to the skin or held in a special bra. The prosthesis is usually made of foam, silicone or some other soft, marginally pliable material.