What is a mastectomy and when is it necessary?

A Mastectomy: Understanding the Procedure and Its Types

A mastectomy is a surgery in which one or both breasts are removed, either partially or completely, to treat or prevent diseases, primarily breast cancer.

The Main Indications for Mastectomy

The main indications for mastectomy are:

• Breast cancer, as previously mentioned, is the most common reason. It may be necessary if the tumor is large relative to the size of the breast, if there are multiple cysts in different areas of the breast, if the person prefers a mastectomy over a lumpectomy or breast-conserving surgery, or if there is a recurrence of cancer after previous treatment.
• High risk of breast cancer, some individuals with genetic mutations or a strong family history of breast cancer choose a preventive (prophylactic) mastectomy to reduce the risk of developing cancer.
• Benign diseases, although less common, a mastectomy may also be performed in cases of benign (non-cancerous) diseases that severely impact quality of life or pose a high risk of becoming cancerous.

The decision to perform a mastectomy depends on several factors, such as the size and type of tumor, the stage of the cancer, the patient’s overall health, and personal preferences.

What Types of Mastectomy Exist?

There are different types of mastectomies, depending on the extent of the surgery and the tissue being removed. At Hospital del Guadalentín, we perform all types and explain their differences:

• Total or simple mastectomy, in which all breast tissue, including the nipple, is removed, but not the lymph nodes.
• Modified radical mastectomy, in which all breast tissue and the lymph nodes in the armpit are removed, but the chest muscles are preserved.
• Radical mastectomy, in which breast tissue, lymph nodes, and chest muscles are removed (less common nowadays).
• Partial mastectomy, in which only part of the breast is removed, typically in cases of smaller or localized tumors.

Indications for a Mastectomy

Before surgery, a member of your medical team will inform you about the time and place for the procedure. If necessary, you may start in one area and be transferred to another for the intervention. Mastectomy without reconstruction usually lasts between 1 and 3 hours and is often performed as an outpatient procedure, allowing most patients to return home the same day.

If a sentinel lymph node biopsy is required, a radioactive marker and a blue contrast agent will be injected near the affected area before surgery. These elements travel to the sentinel nodes, allowing the surgeon to locate and remove them during the procedure.

During the mastectomy, general anesthesia is typically used, meaning you will be in a deep sleep. The procedure begins with an incision around the breast, followed by the removal of breast tissue. Depending on your case, other parts of the breast may also be removed. Both the removed breast tissue and lymph nodes will be sent to a laboratory for analysis.

If breast reconstruction is being performed at the same time as the mastectomy, the plastic surgeon will begin reconstruction after the breast tissue has been removed.

At the end of the surgery, the incision is closed with stitches, which in many cases are absorbable. However, in some cases, they will need to be removed at a later appointment. One or two small drains may be placed in the area to drain accumulated fluids, connected to a drainage bag.

Most patients return home the same day as the surgery, although some may require an overnight stay in the admission area of Hospital del Guadalentín for quicker recovery.

After the operation, it is common to be moved to a recovery room to monitor blood pressure and pulse. You will also have a bandage over the area and may experience some pain, numbness, or a feeling of tightness under the arm.

It is important that the medical team advises you on at-home care, including how to care for the incisions, manage the drains, recognize signs of infection, and limitations on physical activity. It is also important to seek advice on the use of bras or breast prostheses.

What is a Unilateral Simple Mastectomy?

A unilateral simple mastectomy is a surgical procedure in which one breast (unilateral) is removed to treat or prevent breast cancer. This type of mastectomy differs from other variants because it does not involve extensive removal of lymph nodes or the muscles underlying the breast, as in a radical mastectomy.

The main advantage of this type of mastectomy is the removal of cancerous tissue and the reduction of the risk of cancer recurrence in that area. In the case of individuals at high genetic risk, this procedure significantly reduces the likelihood of developing breast cancer.

However, like any major surgery, there are risks, such as infections, bleeding, complications with healing, and changes in breast sensitivity or aesthetics. It can also have an emotional impact on individuals, making psychological support crucial.

What is a Bilateral Mastectomy?

A bilateral mastectomy is a surgery in which both breasts are removed, either to treat breast cancer in both breasts or as a preventive measure in people at high risk of developing the disease. It is a more extensive procedure than a unilateral mastectomy, as it affects both sides of the body.

Many people who undergo a bilateral mastectomy opt for breast reconstruction, which can be done immediately after surgery or at a later date. This reconstruction may involve implants or the use of autologous tissue (tissue from other parts of the body). This process is handled by a plastic surgery professional.

In this case, a bilateral mastectomy significantly reduces the risk of cancer recurrence in both breasts or of developing cancer in people with a high genetic risk.

However, like other mastectomies, it carries risks such as infections, bleeding, healing problems, and changes in skin or breast sensitivity. It may also have a significant emotional and psychological impact, as it alters the body’s appearance significantly.

What is a Prophylactic Mastectomy?

A bilateral prophylactic mastectomy is a preventive surgery in which both breasts (bilateral) are removed to significantly reduce the risk of developing breast cancer. This procedure is chosen by people who are at high risk of breast cancer due to genetic factors or family history. It is not a treatment for cancer but a preventive measure.

One of the most well-known figures who underwent a bilateral prophylactic mastectomy is actress Angelina Jolie, who announced in 2013 that she had the procedure after discovering that she carried the BRCA1 gene mutation, which significantly increased her risk of developing breast and ovarian cancer. Her decision brought significant public attention to this type of intervention and the role of genetics in cancer prevention.

This is an important personal decision that is usually made after a thorough analysis of the clinical situation and with the support of doctors and genetic counselors. From our Hospital in Murcia, we provide you with all the necessary advice.

Count on Professionals

After a mastectomy, many patients find reconstruction to be a way to regain their body image and self-esteem. By using implants or autologous tissue, it is possible to recreate a breast that resembles the natural one in shape and size. Hospital del Guadalentín has professionals in plastic surgery who will be with you until you look and feel well.

If you need to learn more about plastic surgery, our professionals have provided an article on: what is plastic surgery?.