A large part of the treatment in breast cancer consists of surgical treatment, and the treatment is carried out by applying the mastectomy, which is performed in the form of removal of the breast tissue.
In mastectomy, which has different types, only the tumor, some breast tissue with the tumor or all of the breast tissue, in addition to the lymph nodes can be completely removed. In terms of prevention of breast cancer, all women over the age of 20, especially women between the ages of 40-69, should regularly perform breast self-examination and undergo breast cancer screening at intervals recommended by their physicians.
WHAT IS MASTECTOMY ?
Mastectomy is the Latin name given to "removal of the breast". It is a surgical procedure that is mostly done for the treatment of breast cancer. This surgical procedure involves the complete removal of the breast with its skin through a wide incision, as well as the removal of the fascia layer of the pectoral muscle under the breast. The reason for this is that the lymphatic channels in this layer are eliminated and local recurrence rates are reduced.
Mastectomy operations are included in the class of operations that must be performed under general anesthesia. One of the most important things to do during the surgery should be not to keep the skin and subcutaneous thickness too much. This thickness should vary between 7 and 8 mm on average. This surgery has the lowest recurrence rate in breast cancer if performed in experienced hands. Average recurrence rates range from 3 to 5%.
IN WHICH SITUATIONS IS MASTECTOMY PERFORMED ?
In patients diagnosed with breast cancer or at high risk of developing breast cancer, mastectomy should be performed to remove the breast tissue as a treatment. Removal of one breast is called unilateral mastectomy, and removal of both breasts is called bilateral mastectomy. In lumpectomy, another breast cancer treatment method, only the tumor and a small healthy area around it are removed, not the entire breast. Which of these operations should be preferred is completely determined by the patient's health status and the stage of the cancer. Some of the situations in which mastectomy may be considered necessary as a method of treatment include:
Treatment of early (stages 1 and 2) and advanced (stage 3) breast cancer
Preventive (prophylactic) treatment of patients with a first-degree relative with a history of breast cancer and a high probability of developing breast cancer
inflammatory breast cancer
Total mastectomy is the only treatment method for patients for whom breast-conserving surgery is not suitable. Apart from this, the cases where mastectomy is preferred instead of lumpectomy are as follows:
Presence of multiple tumors in different parts of the breast
Recurrence in patients who have previously received radiotherapy
Extensive microcalcification (calcium accumulation) throughout the breast, which is determined to be cancer
Inability to receive radiation therapy due to pregnancy
Presence of breast cancer after lumpectomy
High risk of recurrence of breast cancer
Tumor larger than breast size
The presence of different health problems in the patient where the side effects of radiation cannot be taken into account.
TYPES OF MASTECTOMY
There are several different types of mastectomy techniques. The technique of the procedure is determined according to the condition and physiology of the disease.
Breast Conserving Surgery:
In some cases, Mastectomy can also be performed to minimize the risks. In particular, if breast cancer is hereditary in patients with breast cancer in their family - first degree relatives - Mastectomy can also be applied to the disease-free breast for the purpose of minimizing the risk and protecting it. This practice is called breast-conserving surgery.
Skin Conserving Mastectomy:
Sometimes in female patients, the breast can be reconstructed while continuing the intervention. This procedure is called Skin Conserving Mastectomy. Most of the skin above the breast (including around the nipple – areola – and nipple) is left untouched. Skin Conserving Mastectomy can benefit the patient at least as much as Simple Mastectomy. The amount of breast tissue taken can be the same as the amount taken in Simple Mastectomy.
Nipple Sparing Mastectomy:
This type of breast surgery can be performed with skin sparing in early-stage tumors or as Nipple-Sparing Mastectomy in tumors located far from the nipple.
Total (Simple) Mastectomy:
It is also called Simple Mastectomy (Segmentary Mastectomy). In this type of mastectomy, the entire breast, including the nipples, is removed. However, underarm lens glands or muscle tissues under the breast are not removed. In some special cases, both breasts are removed for protection in female patients with a very high risk of breast cancer. Such cases are called Double Mastectomy. Most of the patients who have been hospitalized for this surgery can be discharged the next day. Total Mastectomy is a method that is frequently used in the treatment of breast cancer.
Other Types of Mastectomy
Modified Radical Mastectomy
Lymph Node Surgeries
Sentinel Lymph Node Biopsy
Axillary Lymph Node Dissection
HOW IS MASTECTOMY SURGERY PERFORMED?
In patients who will undergo mastectomy operation, all information about the operation and its risks is conveyed to the patient by the physician. Possible risks include complications such as bleeding, shoulder pain and stiffness, armpit numbness, pain, infection, edema, hematoma, and scarring. Necessary information about these is also given to the patient. In patients who want to have breast reconstruction after mastectomy, the necessary planning should be done with the physician before the operation. Before the operation, if the use of blood thinners is in question at the time recommended by the physician, food and water consumption are stopped. General anesthesia is applied to the patient at the beginning of the operation, then the mastectomy operation is started with the planned technique. An incision is made in the appropriate area and the skin on the breast tissue is separated and removed from the chest muscles. In sentinel node dissection, a number of lymph nodes are removed from the axilla, whereas in patients who will undergo axillary lymph node dissection, only the first few nodes affected by the tumor are removed. This step is skipped in patients who do not require removal of lymph nodes. The removed lymph nodes are tested for cancer and if no problems are found, no further lymph node removal is required. If reconstruction is planned, the plastic surgeon will step in and perform the reshaping of the breast. Then, drains are placed in the chest by the thoracic surgeon to prevent the accumulation of fluid from the armpit to the tumor area. After this procedure, the incision is stitched and bandaged and the operation is terminated. It is an operation that takes 2-3 hours on average, but if breast reconstruction is to be performed, the operation time may be longer. Patients are usually kept under observation in the hospital for a few days.
FREQUENTLY ASKED QUESTIONS
How many hours does the surgery take?
Mastectomy operations usually take 2.5-3 hours. However, this period may be a little longer with the anesthesia and awakening processes. You should discuss with your doctor in detail about the operation process.
How long is the recovery time after mastectomy?
After this procedure, patients are discharged after staying in the hospital for 3 days. In order for the healing process to be faster, the exercises and drug treatments given by the doctor should be applied completely.
When can I move my arms?
After mastectomy, the arm is kept in the arm sling. It is desirable not to move the suspended arm too much in the early period and not to be too far from the body. arm suspension time; It is 4 to 5 days. Your doctor will determine how long this process will be.
What is my risk of getting an infection?
As with any surgery, you have a risk of getting an infection in mastectomy surgery. However, after the mastectomy operation performed under sterile conditions, the risk of infection is very low if clean dressing is performed by specialists and if you use your antibiotics regularly.