You’ve likely heard the term “mastectomy” at some point, and may even know someone who has had one. What actually goes on when the surgery — involving the removal of one or both breasts — is performed?
“A mastectomy is a surgery where the breast tissue is removed,” explains Winnie Polen, a breast surgeon with the Summit Medical Group MD Anderson Cancer Center in Florham Park, NJ. The procedure will be recommended either when there’s been a cancer diagnosis or when family history or certain genetic mutations (including BRCA-1 and BRCA-2) indicate that it makes sense to consider a prophylactic mastectomy.
There are many types of mastectomies, though, including what’s called a simple or total mastectomy, which is when all the breast tissue is removed, along with the nipple and areola. There’s also a skin-sparing option, which leaves behind pockets of skin that can be used for breast reconstruction, plus a newer technique called the “nipple-sparing” mastectomy, which allows the patient to preserve her “skin envelope” and nipple and areola, Polen explains. Every woman’s situation is different, though, often making only one or two options possible (sparing the nipple, for example, is not possible in cases where cancer is present in or near the areola or nipple).
Polen suggests you make sure you’re comfortable with the option being presented by asking your surgeon questions, including, “What type of mastectomy do I need?” and “What will my recovery time be like?” She adds, “One thing we’re not talking about as much is the recovery time after a mastectomy. … There’s going to be an adjustment period. Your body’s going to feel different.” Immediately after a mastectomy, a patient will most likely be sent home with surgical drains, a system including plastic tubes attached to soft plastic bulbs that draw fluid out of the incision site, which gets removed after about a week.
Another element of the mastectomy process is breast reconstruction, and whether to choose one of the many options that exist or to remain flat-chested. “The topic of mastectomy and reconstruction go hand in hand,” Polen notes. “There is no right or wrong choice. Some women choose to have reconstruction, and some don’t.” Don’t be shy about asking your doctor questions about each technique, recovery time, and possible complications.
Finally, Polen advises anyone who has just received a breast cancer diagnosis to take it slowly, get all your questions asked, and prepare for a slowly unfolding process. “Know that this is a journey,” she says. “Treat this like a marathon, and not like a sprint.”
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