Mastectomy

During a mastectomy, a breast tumor is removed along with the rest of the breast tissue, with preservation of some of the overlying skin. It is typically recommended if the tumor is larger in size relative to your breast size, if the cancer involves the skin or muscle underneath the breast, or if you have multiple tumors in different parts of the same breast. Some of your lymph nodes may also be removed at the same operation to make sure the cancer has not spread.

You and your surgeon will create a treatment plan together. Your surgeon will perform your surgery to remove the cancer. Some surgeons may also complete procedures to help diagnose cancer, such as a biopsy. 

At GenesisCare, we have general surgeons, surgical oncologists and breast surgeons who perform mastectomies. Our surgeons are all board certified, which means that they have been specially trained in surgical cancer care according to defined national criteria for certification and they continuously maintain the highest quality standards through participation in continuing medical education. This provides them with training on the latest treatment techniques and advances. Some have also completed extra training called a fellowship, which is additional specialized training in the surgical management of cancer patients.

There are several types of mastectomies, and your surgeon will discuss the most appropriate one for your individual situation including:

• Total mastectomy: During a total mastectomy, also known as a “simple mastectomy,” your entire breast, including the nipple, areola, the lining over the chest muscles and overlying skin are removed.
• Double (bilateral) mastectomy: This is when both breasts are removed. A double mastectomy is often recommended for women at high risk of developing breast cancer in the second breast, or who have tested positive for gene mutation (like BRCA or PALB2).
• Modified radical mastectomy: Similar to a total mastectomy, the entire breast, including the nipple, areola and overlying skin are removed. Additionally, the lymph nodes in your armpit (axilla) are removed.
• Skin-sparing mastectomy: This is when the breast tissue, nipple and areola are removed, but much of the skin is spared. It is typically performed when breast reconstruction is planned. The reconstruction can be completed directly after the mastectomy or at a later date (delayed).
• Nipple-sparing mastectomy: This is most appropriate when there is no cancer found near or in the nipple. The breast tissue, including the ducts, are removed, but the nipple and areola are spared. Like a skin-sparing mastectomy, this is typically performed when breast reconstruction is planned. The reconstruction is most often performed immediately after surgery but can also be delayed. Your surgeon may sample the tissue underneath the nipple during surgery to make sure this surgical technique is best in your case.

During any mastectomy procedure, your surgeon may perform a sentinel lymph node biopsy (SLN) or full axillary lymph node dissection (ALND) to make sure the cancer has not spread to other areas.

Once your breast has been removed, one or more drains, which are small tubes with a bulb attached to the end of it, will be placed to collect excess fluid as you heal. Drains are usually removed at about 10 days to 2 weeks in the office as part of your post-operative visit. 

Breast reconstruction may be completed either at the time of mastectomy (immediate reconstruction) or delayed to a later date. Sometimes delayed reconstruction is done to help with healing, to allow time for post-mastectomy radiation therapy, or to help coordinate operating room schedules with your surgeon and the plastic surgeon. If reconstruction is done at the time of initial surgery, either a space-saving balloon (expander) is placed underneath the skin or muscle to help make room for the final implant, or the final implant is placed. 

Sometimes, healthy tissue from other parts of your body including your abdomen, back or buttocks can be used to recreate your breast. This is called a free flap reconstruction (autologous reconstruction). 

Your surgeon will work with a plastic surgeon if reconstruction is planned in your case.

Your care team will advise you on the appropriate after-care instructions following surgery. In most cases, you can go home the same day, but your surgeon will discuss whether or not you need to be in the hospital overnight after your operation.

If you notice increasing redness around or fluid coming out of the incisions where your drain tubes have been placed, call your surgeon’s office to see if an appointment is needed sooner than your scheduled follow-up visit.

Typically, your surgeon will want to meet with you within one to two weeks after surgery to check on the incision site, make sure you are healing well, remove any surgical drains and discuss any new post-operative instructions. During this appointment, your surgeon will discuss your final pathology report in detail, including if the margins and lymph nodes were positive or negative. Whether visits with other cancer doctors are needed, as well as if additional testing is recommended (genomic testing of the tumor that was removed), will also be discussed.

In general, our surgeons will follow you for five years or more after your surgery, even if you continue treatment with other specialties, to help address any concerns and watch for any signs of recurrence. 

Following your post-operative appointment, your surgeon will help coordinate with other physicians who specialize in medical oncology and radiation oncology to obtain an opinion about those options and determine if additional therapy is needed for your individual situation. In some areas, your unique case may be discussed at a group meeting of cancer doctors called a tumor board to determine next steps and whether additional testing or treatments are needed.

Typically, breast cancer surgery is covered by insurers. However, coverage varies by insurance carrier and plan. Contact your insurance carrier to learn more about your individual coverage.