Mastectomy Surgery in Brisbane by Dr. Green
The type of surgery performed on your breast for breast cancer treatment can largely be broken into two categories:
- Mastectomy surgery.
- Breast conservation surgery (wide local excision, lumpectomy).
What is a mastectomy?
A mastectomy is the total removal of a breast and its covering skin, including the nipple. This is the most extensive type of surgery performed on the breast for breast cancer.
A mastectomy surgeon aims to remove ALL of the breast tissue and leave only the skin covering your chest wall muscles. Mastectomy accounts for approximately 20% of the types of breast surgery performed.
Unfortunately not all people can undergo breast-conserving surgery and will be advised that mastectomy surgery is ideal for treatment of their breast cancer.
Why should you have a mastectomy?
There are several reasons why a mastectomy may be recommended as the ideal surgery for your breast cancer. These include:
- Large cancers – Tumours that are large (bigger than 5 cm) or are large enough that they cannot be removed without leaving a breast with a poor cosmetic appearance. In these cases some patients may benefit from neoadjuvant chemotherapy (chemotherapy before surgery) to shrink the cancer and make it suitable for breast conservation.
- Aggressive character – Some types of breast cancer have a high chance of recurring (coming back) if a lumpectomy is performed.
- Failed breast conservation – Sometimes after a lumpectomy a clear margin of normal healthy tissue cannot be obtained. In this circumstance a mastectomy will be advised, as the tumour is larger that first thought.
- Multiple cancers – Some people develop a cancer that is made up of multiple small spots. These are best removed by a mastectomy to ensure all the cancer spots are removed.
- Unable to have breast radiotherapy (XRT) – If you have had XRT to the breast before or have a reason why XRT cannot be given then a lumpectomy is not suitable. A lumpectomy performed for cancer without XRT in most cases has a very high and unacceptable risk of recurrence.
- Risk reduction mastectomy – If you carry a gene (BRCA 1 or BRCA 2 gene) or have an extensive family history your lifetime risk of developing a breast cancer is up to 80%. In this case a mastectomy is recommended to reduce your risk of cancer to as close to zero as possible. This problem commonly affects young women and the mastectomy is combined with a reconstruction.
Not all mastectomies are the same
There are a number of variations of mastectomy surgery that may be offered to you. Not everyone is suitable to have all of the options available. Ben will discuss the pros and cons of each type with you.
The different types of mastectomy include:
- Total mastectomy – Removal of the entire breast including the nipple.
- Subcutaneous mastectomy – Removal of the entire breast and nipple, leaving all or the majority of the skin covering the breast. Performed in conjunction with a breast reconstruction.
- Nipple sparing subcutaneous mastectomy – this is a variation of a subcutaneous mastectomy where the nipple is left behind.
What is involved in the surgery?
A mastectomy is performed under a general anaesthetic. You will come into hospital on the day of your operation. There is no special pre-op preparation you need to undergo.
Once you have completed the hospitals admitting paperwork you will head the operating suite where your mastectomy surgeon Dr. Ben and the anaesthetist will meet you.
Once you are off to sleep the operation will take round 60-90 minutes.
The operation involves an incision of an ellipse of skin around your breast and then removing all of the breast tissue underneath. The procedure may be combined with surgery to your lymph nodes (Sentinel Node biopsy, Axillary Lymph node Clearance). The skin will then be closed flat on the chest wall leaving a straight scar on average 8-10cm long. There will be one and occasionally two drains attached to you when you wake up.
Once in recovery you will be attached to several monitors that are keeping a close eye on you. There will be a waterproof dressing on and dissolving stitches underneath.
Once the recovery nurses are happy you will be transferred to your ward.
What happens after my operation?
You will be in hospital usually for two nights. It is quite likely that you will go home with a drain still in place. The nursing staff will teach you how to look after this (it is very simple) and to record how much is coming out each day.
The drain will fill with a yellow fluid. If there were no drain this fluid would collect under your wound and be called a ‘seroma’ and need draining with a needle and syringe. Usually the drain is removed after 1-2 weeks.
See the mastectomy surgery post op advice section for further details.
Once you are recovered you will return in a week to the rooms for a discussion about your pathology, any further treatments that may be required and to remove your dressings.
Can I have a breast reconstruction?
As your mastectomy surgeon, Dr. Green will also provide information about breast reconstruction. There are many options including having an immediate reconstruction (at the same time as your mastectomy) or delayed.
There are various types of reconstruction that can be offered. It is important to note that some patients are not suitable for an immediate reconstruction or some forms of reconstruction, especially if you are going to need radiotherapy after. Dr. Green will provide you with information about this at the time of your consultation.
What are some of the possible complications?
Mastectomy surgery is a common operation performed by Dr. Green for which he has been well trained. The vast majority of patients will follow the “usual” path of recovery and be discharged from hospital feeling well within 1 -2 days following their operation.
Despite this things may not always go according to plan and a small number of patients may experience a significant complication.
The information below will help you understand some of the possible problems that can result from having an operation on your breast. “Complications” are listed below. Some are common and others are less common but very important if they happen. While the following list is a guide, it is not comprehensive.
If you would like more information after your consultation and reading this page please feel free to discuss any issues with Dr Green.
Uncommon (up to 5% of cases)
Rare but important (up to 1% of cases)