Mastectomy Health Article

Description

There are several types of mastectomies. The radical mastectomy, also called the Halsted mastectomy, is very rarely performed today. It was developed in the late

1800s, when it was thought that more extensive surgery was most likely to cure cancer. A radical mastectomy involves removal of the breast, all surrounding lymph nodes up to the collarbone, and the underlying chest muscle. Women were often left disfigured and disabled, with a large defect in the chest wall requiring skin grafting, and significantly decreased arm sensation and motion. Unfortunately, and inaccurately, it is still the operation many women picture when the word mastectomy is mentioned.

Surgery that removes breast tissue, nipple, an ellipse of skin, and some axillary or underarm lymph nodes, but leaves the chest muscle intact, is usually called a modified radical mastectomy. This is the most common type of mastectomy performed today. The surgery leaves a woman with a more normal chest shape than the older radical mastectomy procedure, and a scar that is not visible in most clothing. It also allows for immediate or delayed breast reconstruction.

In a simple mastectomy, only the breast tissue, nipple, and a small piece of overlying skin is removed. If a few of the axillary lymph nodes closest to the breast are also taken out, the surgery may be called an extended simple mastectomy.

There are other variations on the term mastectomy. A skin-sparing mastectomy uses special techniques that preserve the patient's breast skin for use in reconstruction, although the nipple is still removed. Total mastectomy is a confusing expression, as it may be used to refer to a modified radical mastectomy or a simple mastectomy.

Many women choose to have breast reconstruction performed in conjunction with the mastectomy. The reconstruction can be done using a woman's own abdominal tissue, or using saline-filled artificial expanders, which leave the breast relatively flat but partially reconstructed. Additionally, there are psychological benefits to coming out of the surgery with the first step to a reconstructed breast. Immediate reconstruction will add time and cost to the mastectomy procedure, but the patient can avoid the physical impact of a later surgery.

A mastectomy is typically performed in a hospital setting, but specialized outpatient facilities are sometimes used. The surgery is done under general anesthesia. The type and location of the incision may vary according to plans for reconstruction or other factors, such as old scars. As much breast tissue as possible is removed. Approximately 10 to 20 axillary lymph nodes are usually removed. All tissue is sent to the pathology laboratory for analysis. If no immediate reconstruction is planned, surgical drains are left in place to prevent fluid accumulation. The skin is sutured and bandages are applied.

The surgery may take from two to five hours. Patients usually stay at least one night in the hospital, although outpatient mastectomy is increasingly performed for about 10% of all patients. Insurance usually covers the cost of mastectomy. If immediate reconstruction is performed, the length of stay, recovery period, insurance reimbursement, and fees will vary from mastectomy alone. In 1998, the Women's Health and Cancer Rights Act required insurance plans to cover the cost of breast reconstruction in conjunction with a mastectomy procedure.

Preparation

Routine preoperative preparations, such as not eating or drinking the night before surgery, are typically ordered for a mastectomy. On rare occasions, the patient may also be asked to donate blood in case a blood transfusion is required during surgery. The patient should advise the surgeon of any medications she is taking. Information regarding expected outcomes and potential complications should also be a part of preparation for a mastectomy, as for any surgical procedure. It is especially important that women know about sensations they might experience after surgery, so they are not misinterpreted as a sign of poor wound healing or recurrent cancer.