• Mastectomy 

A mastectomy is an operation to remove the entire breast. It is usually done to treat breast cancer. A double mastectomy involves the removal of both breasts.

Breast cancer is a group of cancer cells that starts in the cells of your breast. The cancer cells can grow and in some cases, spread to other parts of your body. 

The two main types of surgery for breast cancer are:

  • breast-conserving surgery, which involves removing the part of your breast affected by cancer

  • mastectomy, where your whole breast is removed

Mastectomy may be recommended if your breast cancer is large compared with your breast size or there is more than one cancer in your breast.

Some women with a high risk of breast cancer may choose to have a mastectomy to reduce their risk. This is called preventive, or, 'prophylactic' mastectomy.

What happens during a mastectomy?

The procedure is usually performed under general anesthetic, which means you are asleep during surgery. The surgeon will make a cut around your breast to remove the breast tissue. The skin covering the breast and nipple may also be removed. The operation usually takes 1 to 2 hours. It may take longer if you have a breast reconstruction right after the mastectomy.

 

What to expect after the procedure

After a mastectomy, you may need to stay in the hospital a day or a week, depending on your situation. You may feel some pain, discomfort or numbness in your breast or armpit while your wound heals. There may be fluid build-up around the scar (seroma), which may need to be drained. Speak to your doctor about the possible side effects of the surgery. Most side effects can be managed or reduced.

Side effects after the Surgery

Everyone responds differently to mastectomy. Some side effects happen to most people, others happen only occasionally. Some side effects happen straight after surgery, others take longer to develop.

Most side effects can be reduced or managed with appropriate care.

 

Common side effects of mastectomy:

pain, discomfort or numbness in the breast and/or armpit while the wounds are healing – this usually settles after a few weeks

  • fluid may collect in or around the scar in the breast or armpit – this is called a seroma and may need to be drained using a fine needle and a syringe; this can be done by a breast care nurse or another health professional in the clinic or by a GP

  • stiffness in the arm or shoulder – it may be helpful to do some approved exercises after surgery

  • numbness or tingling in the arm or shoulder if lymph nodes have been removed – this may improve with time, but feeling in these areas may change permanently

  • mild pain in the armpit or upper arm – this can last a year or more after surgery if lymph nodes have been removed

 

Side effects that sometimes develop after mastectomy:

  • swelling or bruising around the wound in the chest or armpit – this usually settles in a few weeks

  • if lymph nodes have been removed, there may be swelling in the arm, breast, hand or chest that lasts after the initial side effects of surgery are over; this is called lymphoedema and can develop a few months or years after surgery.

 

Rare side effects of breast-conserving surgery:

  • infection or bleeding in the scar on the chest; some women might need further surgery.

 

 

*For more info about mastectomy, Please visit the Cancer Australia Website  

**Sources:

Breast Cancer Network  (Surgery), National Breast Cancer Foundation (About breast cancer), Medline Plus (Mastectomy), Cancer Australia (Mastectomy), Cancer Australia (Breast reconstruction), Mayo Clinic (Mastectomy: How you prepare), AustraliaSourcesMyVMC (Mastectomy), Mater Private Breast Cancer Centre (Mastectomy and Breast Cancer Information), Cancer Australia(Psychosocial impact in the areas of body image and sexuality for women with breast cancer),Cancer Council (Changes to appearance)

  • Breast Lumpectomy

Breast-conserving surgery may also be called a lumpectomy, complete local excision, partial mastectomy or wide local excision.

 

Lumpectomy surgery involves removing the breast cancer and a small amount of healthy tissue around it (called the surgical margin). Some women also have one or more lymph nodes removed from the armpit.

Lumpectomy surgery is an option if the breast cancer is small enough compared to the size of the breast to allow removal of cancer and some healthy tissue around it and still give an acceptable appearance.

Radiotherapy to the breast is usually recommended after Lumpectomy surgery. Sometimes radiotherapy is also given to lymph nodes in the armpit and/or lower neck.

 

How long does Lumpectomy surgery take?

Lumpectomy surgery usually takes up to one-and-a-half hours. There will also be preparation time and time to recover from the general anesthetic. A woman could be hospital anywhere between 1 day and 1 week, depending on her situation.

 

What happens after Lumpectomy surgery?

After the surgery, a pathologist will look at the breast tissue and lymph nodes that have been removed. The results will help the woman and her doctors decide what other treatments are best. If there are cancer cells in the surgical margin around the breast cancer, the woman may need more surgery. For some women, this may mean having a mastectomy.

 

What does Lumpectomy surgery look like?

After Lumpectomy surgery, there will be a scar on the breast. The scar will become less evident with time. The size and shape of the breast are also likely to change. The position of the scar and the shape of the breast after surgery will depend on where the breast cancer is and how much breast tissue is removed.

In some cases, the shape and size of the breast may be different to the other breast and may affect symmetry. Some women choose to use an external breast prosthesis or have further surgery to improve symmetry (ie breast reconstruction or reducing the size of the other breast).

 

Side effects of breast conserving surgery

Everyone responds differently to breast conserving surgery. Some side effects happen to most people, others happen only occasionally. Some side effects happen straight after surgery, others take longer to develop. Most side effects can be reduced or managed with appropriate care.

 

Common side effects of breast conserving surgery:

  • pain, discomfort or numbness in the breast and/or armpit while the wounds are healing – this usually settles after a few weeks

  • bruising or swelling around the wound in the breast (or under the arm if lymph nodes have been removed)

  • stiffness in the arm or shoulder – it may be helpful to do some approved exercises after surgery

  • tingling in the arm or shoulder if lymph nodes have been removed – this may improve with time, but feeling in these areas may change permanently

  • fluid may collect in or around the scar in the breast or armpit – this is called a seroma and may need to be drained using a fine needle and a syringe; this can be done by a breast care nurse or another health professional in the clinic or by a GP

  • mild pain in the arm and/or armpit – this can last a year or more after surgery if lymph nodes have been removed.

 

Side effects that sometimes develop after breast conserving surgery:

  • if lymph nodes have been removed, there may be swelling in the arm, breast, hand or chest that lasts after the initial side effects of surgery are over; this is called lymphoedema and can develop a few months or years after surgery.

 

Rare side effects of breast conserving surgery:

  • infection or bleeding in the scar in the breast or armpit; some women may need further surgery.

 

 

 

  • Sentinel Node Biopsy

Sentinel node biopsy involves removing the first lymph node (or nodes) in the armpit to which cancer cells are likely to spread from the breast.

What is the sentinel node?

The sentinel node is the first lymph node to which breast cancer cells may spread outside the breast. Although some women may have one sentinel node, some may have two or three sentinel nodes. Usually the sentinel node is in the armpit (axilla). Sometimes the sentinel node is in another part of the body — for example, in the chest between the ribs under the breast or above or under the collarbone. View a picture of lymph nodes near the breast.

 

What does the procedure involve?

The radioactive fluid (usually about 1–2 ml) is injected into the breast around cancer or under the areola before surgery. A special scan is done to find out to which lymph node(s) the radioactive fluid has traveled. During surgery, the blue dye is also injected into the breast. The blue dye will travel to the lymph nodes via the lymphatic vessels and the sentinel lymph node(s) should turn blue.

The surgeon can see the blue sentinel node(s) and detect the radioactive substance using a type of Geiger counter called a gamma probe. The surgeon can then remove the sentinel node(s). If more than one sentinel node is found, all the sentinel nodes are removed. If another enlarged lymph node is found in the armpit without dye in it, the surgeon will usually remove this node as well. If the sentinel node is not in the armpit, the surgeon will remove it if this can be done safely.

 

Is sentinel node biopsy always accurate?

In a small number of women, the sentinel node doesn’t have cancer cells, even though there are cancer cells in other lymph nodes in the armpit. This is called a ‘false-negative result’.

A false-negative result sometimes occurs because lymphatic vessels running to the lymph nodes that have cancer cells in them are blocked by cancer cells. This means that the dye goes into other normal lymph nodes instead.

To minimize the chance of a false-negative result, the surgeon may remove any enlarged nodes that are found at the time of surgery, even if they do not contain the dye.

 

Side effects of sentinel node biopsy

Clinical trials have shown that sentinel node biopsy is associated with a lower risk of arm problems than axillary dissection. This means that the risk of numbness, shoulder stiffness and lymphoedema is lower than with axillary dissection.

There’s a small risk of allergic reaction to the radioactive fluid or blue dye used to find the sentinel node. Allergic reactions are usually mild and easily treatable.

Rarely, women may experience a severe allergic reaction (less than 1 in 5000 cases). A doctor may decide not to use the blue dye for sentinel node biopsy if there’s reason to think a woman may be at significant risk of allergy to the blue dye.

If blue dye is used to find the sentinel node, the urine may turn blue for 24 hours after surgery. The skin of the breast may also become blue but this will fade with time.

There will be some pain associated with sentinel node biopsy, and injection of the radioactive isotope sometimes stings.

 

  • Axillary Clearance Surgery

Axillary dissection involves removing several or all of the lymph nodes from the armpit.

If possible, this will be done during breast surgery (Lumpectomy surgery or mastectomy) and may be done through the same incision as the breast surgery itself. However, it may be done as a separate operation.'

 

 

Because the number of lymph nodes in the armpit varies from person to person, the number of lymph nodes removed and the length of the operation will be different for each woman.

 

 

After axillary dissection, the lymph nodes are examined by a pathologist. The number of lymph nodes that have cancer cells in them will help the doctors decide what other treatments are best.

Treatment may involve systemic therapies (therapies that treat the whole body), such as chemotherapy or hormonal therapy, and less commonly, radiotherapy to the armpit.

 

Side effects

 

Clinical trials have shown that sentinel node biopsy is associated with a lower risk of arm problems than axillary dissection. This means that the risk of numbness, shoulder stiffness and lymphoedema is lower than with axillary dissection.

There’s a small risk of allergic reaction to the radioactive fluid or blue dye used to find the sentinel node. Allergic reactions are usually mild and easily treatable.

 

Rarely, women may experience a severe allergic reaction (less than 1 in 5000 cases). A doctor may decide not to use the blue dye for sentinel node biopsy if there’s a reason to think a woman may be at significant risk of allergy to the blue dye.

If blue dye is used to find the sentinel node, the urine may turn blue for 24 hours after surgery. The skin of the breast may also become blue but this will fade with time.

There will be some pain associated with sentinel node biopsy, and injection of the radioactive isotope sometimes stings.

 

 

 

**Sources:

Breast Cancer Network  (Surgery), National Breast Cancer Foundation (About breast cancer), Medline Plus (Mastectomy), Cancer Australia (Mastectomy), Cancer Australia (Breast reconstruction), Mayo Clinic (Mastectomy: How you prepare), AustraliaSourcesMyVMC (Mastectomy), Mater Private Breast Cancer Centre (Mastectomy and Breast Cancer Information), Cancer Australia(Psychosocial impact in the areas of body image and sexuality for women with breast cancer),Cancer Council (Changes to appearance)

 

 Cancer Australia 

© 2019 by Thair Mb chB General Surgeon

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