A Mastectomy is sometimes termed a simple mastectomy. It is the surgical removal of the breast including the nipple and areola and almost all of the overlying skin. The underlying pectoralis muscle is kept intact.
A procedure to the axillary lymph nodes is usually required at the time of surgery and this may be in the form of a sentinel lymph node biopsy or an axillary lymph node dissection, if the lymph nodes are shown to be positive( eg- contain cancer cells) preoperatively.
A simple mastectomy may be required when a women with a small breast presents with a large cancer and it is not possible to perform lumpectomy, it may also be suggested in women with multifocal breast cancer, in patients with wide spread DCIS ( Ductal Carcinoma in situ) or when the overlying breast skin is involved with the breast cancer.
Some women may opt to have a mastectomy for personal reasons and some women that wish to avoid radiotherapy especially those living far from radiation oncology centres may consider a mastectomy to reduce the chance that they would require post operative radiotherapy.
A mastectomy may also be required in palliative situations where there are large ulcerating or fungating tumours.
A simple mastectomy can also be undertaken in the treatment of benign problems such as extremely large phyllodes tumours.
Patients may seek to have a simple mastectomy for prophylaxis as risk reduction surgery especially if they have previously had a history of breast cancer or have a strong family history of breast cancer or carry a genetic abnormality that increases their risk of breat cancer .
Postoperatively, most women recover well from mastectomy. They are usually left with a flat chest wall with an ability to wear a soft form shaped like a breast placed in the bra soon after surgery and then at a later date a prosthesis in the bra. Ladies can live a full and active life after a simple mastectomy.
Postoperative problems can include pain, numbness, and tingling to the wound and if a axillary lymph node dissection has been performed, there is also a risk of lymphoedema to the upper limb. Other sensations such as a phantom breast or phantom breast pain are unusual.
Patients will usually be in hospital for two days after a mastectomy. The procedure will be performed under a general anaesthetic and absorbable sutures will be used to close the wound so that there will be no need for removal of sutures post operatively. A drain will often be inserted at time of surgery and this will be removed by the nurse a few days post operatively. A physiotherapist will see the patient on the ward after the surgery.
Women may decide to undergo a delayed breast reconstruction at a later date. However, in patients that have undergone a simple mastectomy, a delayed breast reconstruction will never be as cosmetically pleasing as an immediate breast reconstruction. Therefore, considerations need to be given to women undergoing simple mastectomy regarding reconstruction. Some women will not want to undergo a reconstruction and therefore, there must be consideration given to how this will affect the patient’s emotional wellbeing, in particular in terms of sexuality and femininity.