Mastectomy & Reconstruction

Mastectomy and reconstruction are significant components in the management of breast cancer and, in some cases, prophylactic treatment for those at high risk.

Who is Suitable for Mastectomy and Reconstruction?

The suitability for mastectomy and subsequent reconstruction depends on various factors:

Cancer Stage and Type: For early-stage breast cancer, mastectomy can be a treatment option. For those with more advanced diseases, additional treatments like chemotherapy or radiation may influence the timing and type of reconstruction.
Genetic Factors: Individuals with genetic mutations (e.g., BRCA1 or BRCA2) that significantly increase the risk of developing breast cancer may choose prophylactic mastectomies and reconstruction.
Personal and Psychological Factors: Personal preference, psychological readiness, and lifestyle considerations play crucial roles. Patients should discuss with their surgeons and possibly a counsellor to make informed decisions.
Medical Considerations: Overall health, existing medical conditions, previous breast surgeries, and the presence of other cancers can affect eligibility for surgery and the type of reconstruction chosen.

What is a Mastectomy?

A mastectomy is a surgical procedure to remove one or both breasts, partially (segmental mastectomy) or completely (total mastectomy), to treat or prevent breast cancer.

Benefits of Mastectomy

Cancer Treatment and Prevention: Mastectomy, especially in cases of breast cancer, helps remove cancerous tissues or can be preventive in high-risk individuals.
Peace of Mind: For those with a very high risk of breast cancer (e.g., BRCA mutation carriers), mastectomy can significantly reduce anxiety about developing cancer.
Broadening Treatment Options: Following mastectomy, some patients may have a wider range of options for adjuvant therapy, such as hormonal treatments or chemotherapy, without the complexity of preserving breast tissue.

Types of Mastectomy

Simple or Total Mastectomy: Removes the entire breast but not the lymph nodes.
Modified Radical Mastectomy: Removes the entire breast along with some of the lymph nodes under the arm.
Skin-Sparing Mastectomy: Removes the breast tissue, nipple, and areola while preserving most of the breast skin, suitable for immediate reconstruction.
Nipple-Sparing Mastectomy: Preserves the skin and nipple, with only breast tissue removed. It's often chosen when the cancer is not near the nipple.

Preparation Before a Mastectomy

Medical Evaluations: Undergo necessary pre-operative tests, including blood tests, imaging studies, and heart function tests, to ensure you are fit for surgery.
Consultations: Meet with your breast surgeon, plastic surgeon (if considering immediate reconstruction), and anesthesiologist to discuss the surgery details, risks, and recovery.
Genetic Counseling: If you have a family history of breast cancer, consider genetic testing to understand your risks better.
Mental Health Support: Consider speaking with a counsellor or support group to emotionally prepare for the surgery and its aftermath.
Arrange for Help: Plan to have someone assist you at home post-surgery, especially for the first few weeks.

Mastectomy Procedure

Anaesthesia: General anaesthesia is administered so you will be asleep during the procedure.
The Procedure: Depending on the type of mastectomy:
Total Mastectomy: Breast tissue, nipple, and areola are removed.
Skin-Sparing Mastectomy: Breast tissue is removed, but most of the skin, except the nipple and areola, is preserved.
Nipple-Sparing Mastectomy: All breast tissue is removed while keeping the breast skin and nipple intact.
Lymph Node Evaluation: In some cases, lymph nodes are sampled or removed to check for the spread of cancer.
Reconstruction: If chosen, reconstruction may start immediately after the mastectomy tissue is removed.
Recovery Room: You'll be taken to a recovery room, where nurses will monitor your vital signs as you wake up from anaesthesia.

Mastectomy Recovery Plan

Wound Care: Learn how to care for your surgical site and recognise signs of infection.
Physical Restrictions: Avoid heavy lifting and strenuous activity for at least 4-6 weeks.
Follow-Up Appointments: Attend scheduled appointments for suture removal, checkups, and to discuss further treatment if necessary.

Mastectomy Prognosis

For many patients, a mastectomy can effectively remove the cancer and significantly reduce the risk of recurrence, especially when combined with other treatments such as chemotherapy, radiation, or hormone therapy. For women undergoing prophylactic mastectomy due to a high risk of breast cancer (such as BRCA1 or BRCA2 gene mutations), the procedure can reduce the risk of developing breast cancer by about 90%.

Mastectomy Risks

Infection
Bleeding
Pain
Swelling
Scarring
Numbness
Lymphedema
Psychological Impact

What if a Mastectomy is Delayed?

If mastectomy is delayed in a patient with breast cancer, there is a risk that the cancer may grow or spread to other parts of the body, potentially limiting the effectiveness of surgery and requiring more extensive treatment later. For patients diagnosed with cancer, delays might increase anxiety and stress, impacting overall mental health. Generally, the earlier cancer is treated, the better the outcomes. Delays can affect the prognosis, especially if the cancer is aggressive.

What is a Reconstruction?

Breast reconstruction involves recreating a breast mound to restore the contour of the breast after mastectomy. It can be done at the same time as the mastectomy (immediate reconstruction) or a later date (delayed reconstruction).

Benefits of Breast Reconstruction

Restoration of Body Image: Breast reconstruction can significantly improve self-esteem, body image, and sexual well-being after mastectomy.
Symmetry and Aesthetics: Reconstruction can help achieve symmetry, especially if only one breast is affected and removed.
No Need for External Prostheses: Reconstructed breasts eliminate the need for external prostheses, which some find uncomfortable or inconvenient.

Types of Reconstruction

Implant-Based Reconstruction: Involves placing an implant to form the breast mound. It's less invasive but might require replacement over time.
Autologous Reconstruction (Flap Surgery): This procedure uses the patient's own tissue from another part of the body (like the abdomen or back) to reconstruct the breast. It is more complex but offers more natural results.
Combination: Some opt for combining both techniques to achieve optimal aesthetic results.

Preparation Before Breast Reconstruction

Consultations: Meet with your plastic surgeon to discuss the different types of reconstruction options available, including the benefits and risks of each.
Medical Evaluation: Undergo a thorough medical evaluation to ensure you are a good candidate for reconstruction. This includes assessments of your overall health, breast skin quality, and tissue availability for autologous procedures.
Imaging Studies: Additional imaging, such as MRI or mammography, might be necessary to assess the breast tissue and chest wall structure.
Smoking Cessation: If you smoke, it's crucial to stop, as smoking can significantly impair healing and increase the risk of complications.
Planning for Recovery: Arrange for help at home for the recovery period, as you'll need to avoid strenuous activity for several weeks.

Breast Reconstruction Procedure

Anaesthesia: General anaesthesia is administered so you will be asleep during the procedure.
The Surgical Approach:
Implant-Based Reconstruction: This may occur in stages, starting with the placement of a tissue expander to stretch the skin and then replacing the expander with a permanent implant at a later surgery.
Autologous Tissue Reconstruction: Tissue is harvested from another part of your body (such as your abdomen, back, or buttocks) to create the breast mound. This might be done in conjunction with implant placement.
Closure: The incisions are closed with sutures, and drains are typically placed to remove excess fluid.
Hospital Stay: Depending on the type of surgery, you may stay in the hospital from one to several nights.

Breast Reconstruction Recovery Plan

Physical Restrictions: Avoid lifting heavy objects and strenuous exercise for up to six weeks.
Follow-Up Visits: These are necessary to monitor your healing and remove drains and sutures.
Nipple Reconstruction: This can be done after the breasts have healed, usually in a separate procedure.

Breast Reconstruction Prognosis

Most women who undergo breast reconstruction are satisfied with the results, experiencing improvements in body image, self-esteem, and quality of life.

Aesthetic Outcomes: While reconstructed breasts may not have the exact look or feel of natural breasts, advancements in surgical techniques have significantly improved aesthetic outcomes. Autologous tissue reconstructions tend to yield more natural results compared to implant-based reconstructions.
Durability: Implant-based reconstructions may require revision surgeries over time due to implant rupture or capsular contracture. Autologous reconstructions generally have more lasting results but can change over time due to aging, weight fluctuations, and other health factors.