of the surgery. Women may choose to have imme-
diate or follow-up breast reconstructive surgery, or
no reconstruction.
Surgical Procedure
A woman undergoing mastectomy receives gen-
eral ANESTHESIA. The operation generally takes two
to four hours; mastectomy with reconstruction
takes longer than mastectomy alone. There are
three types of mastectomy:
- Segmental mastectomy is when the surgeon
removes the tumor and the quadrant of breast
that contains it. The surgeon may recommend
this operation when the breast cancer tumor is
small and localized though larger than would
be appropriate for lumpectomy (removal of the
tumor and a margin of the surrounding breast
tissue). - Subcutaneous mastectomy, also called SKIN-
sparing mastectomy, is removal of the breast
tissue with the nipple, areola, and surface skin
of the breast remaining. Subcutaneous mastec-
tomy affords the most ideal circumstance for
breast reconstruction. - Total mastectomy, also called simple mastec-
tomy, removes all of the breast tissue including
the nipple and areola. The surgeon may recom-
mend total mastectomy when the cancer is dif-
fuse (lacking clear boundaries) or in more than
one location within the breast. The surgeon
may also perform SENTINEL LYMPH NODE DISSEC-
TION, a method that examines the first LY M P H
NODE in the drainage path from the tumor.
Whether the sentinel contains cancer cells is an
accurate indicator of whether the cancer has
spread from the breast. - Modified radical mastectomy removes all of the
breast, including the nipple and areola, as well
as the axillary LY M P Hnodes (lymph nodes under
the arm), called axillary lymph node dissection.
This is the operation of choice when the cancer
tumor is fairly large or diagnostic scans show
the lymph nodes contain cancer.
After removing the breast the surgeon places
small tubes to drain fluid from the surgical site
during the initial stages of HEALING and then
sutures closed the surgical incision. The surgeon
removes the drains three to seven days after the
operation, usually before the woman leaves the
hospital. The nature and extent of scarring and
deformity depends on the type of mastectomy. If
there are skin sutures, they are usually ready for
removal in five to seven days.Risks and Complications
As with any surgery, the risks of mastectomy
include excessive bleeding, INFECTION, and reaction
to the anesthesia. These risks are slight. The
potential for complications increases with the
complexity of the surgery. Women who undergo
modified radical mastectomy with axillary lymph
node dissection may have significant swelling in
the arm on the side of the surgery in the immedi-
ate postoperative recovery period as well as inter-
mittently over the long term. Many women
undergo adjuvant therapy (follow-up treatment),
such as RADIATION THERAPYor CHEMOTHERAPY, after
mastectomy for breast cancer. These therapies
carry their own risks and do not usually affect the
course of healing from the surgery.Outlook and Lifestyle Modifications
With early detection and treatment, recovery from
both the mastectomy and the breast cancer is
complete. Recovery from modified radical mastec-
tomy can take several months, with restrictions on
lifting and some physical activities until the area
fully heals and swelling (LYMPHEDEMA) is under
control. It is difficult to predict who will have
ongoing lymphedema; this is a significant long-
term risk for any woman whose surgery includes
axillary lymph node dissection. Women who
choose not to have reconstructive surgery may opt
instead for prosthetic bras. Many women have
concerns about body image and sexuality; these
are potentially significant issues that can affect
QUALITY OF LIFE. Some women find SUPPORT GROUPS
helpful.
See also CANCER TREATMENT OPTIONS AND DECI-
SIONS; HORMONE-DRIVEN CANCERS; PAGET’S DISEASE OF
THE BREAST; PLASTIC SURGERY; SURGERY BENEFIT AND
RISK ASSESSMENT.mastitis INFLAMMATION of the BREAST, typically
due to bacterial INFECTION. Mastitis usually begins
as a combination of events: a blocked milk duct inmastitis 299