A mastectomy is performed under general anesthesia, which means a person is unconscious during the procedure. The surgeon removes all of the breast tissue, including the nipple and tissue around the nipple. The lining of the chest muscles may also be removed.
Some women choose to have breast reconstruction to help restore the look and feel of the breast that was removed. This may be done at the same time as the mastectomy ('immediate') or later ('delayed'). For some women who choose immediate reconstruction, surgeons may use a special skin-sparing technique during the mastectomy, which saves much of the skin of the breast. The plastic surgeon can then use this skin to help form the reconstructed breast. For more on reconstructive procedures, visit the Breast Reconstruction section.
If a woman is not having breast reconstruction or is choosing to do it later, the surgeon will close the incision with stitches and attach a temporary drainage tube so that fluid from the wound can drain out.
Assessing Lymph Nodes (Has the cancer spread to the lymph nodes?)
During surgery for invasive cancer, some of the lymph nodes in the armpit (axillary nodes) are removed to learn if cancer has spread there. The presence or absence of cancer in these nodes is one of the most important factors affecting prognosis.
To see if cancer has spread to the axillary nodes, most people have a procedure called sentinel node biopsy. During this procedure, the surgeon injects a radioactive substance and/or blue dye into the breast near the tumor. Then, using the radioactivity and/or dye as a guide, he/she locates the first node(s) that filters lymph fluid from the tumor site (the sentinel node). Sometimes more than one node is labeled as a sentinel node. The node is removed and checked by the pathologist for cancer cells. If cancer is not found in the sentinel node (the sentinel node is “negative” for cancer), it is unlikely that other lymph nodes in the armpit have cancer and no further surgery is needed. If the sentinel node does contain cancer cells (the sentinel node is “positive”), then more nodes are taken out with a procedure called axillary dissection. This makes sure the cancer in this area has been removed. Axillary dissection is more invasive than a sentinel node biopsy. It disrupts more of the normal tissue in the armpit and is more likely to affect function in the arm and cause lymphedema . This has made sentinel node biopsy the preferred first step to assessing lymph nodes.
Not everyone is a candidate for sentinel node biopsy, however. Certain factors can lower the accuracy of the procedure. And, sometimes, the sentinel node cannot be found. Sentinel node biopsy is also not done if suspicious lymph nodes are found on a physical examination. In these cases, an axillary dissection is done.
For more on sentinel node biopsy and axillary dissection, see the Diagnosis section.
For more on lymphedema, see the After Treatment section.
Length of Hospital Stay
Most people will stay in the hospital at least overnight after having a mastectomy [3]. If breast reconstruction is done, the stay may be a day or two longer, depending on the procedure. You should discuss the expected length of stay with your surgeon and insurance provider. For more on insurance issues related to mastectomy and breast reconstruction, visit the Insurance and Financial Issues section.
Assessing Margins (Was the entire tumor removed?)
After breast cancer surgery, a pathologist looks at the tumor and determines the amount of normal tissue around it (called margins). These margins of normal tissue help decide whether or not the entire tumor was removed. Clean (uninvolved or negative) margins mean that there is only normal tissue (and no cancer cells) at the edges of the tissue removed. In this case, no more surgery is needed. If normal tissue does not completely surround the tumor (involved or positive margins), more surgery is usually done to get clean margins.
 |
For more information on mastectomy, visit the American Society for Clinical Oncology’s Web site (www.cancer.net).
|
Transportation
You may not live near the hospital where you will have your surgery. There are many programs that offer help with local or long-distance transportation and lodging. Many of these programs also offer transportation and lodging for a friend or family member going with you. Learn more about these programs.
Updated 02/01/10
