Mastectomy
Betterdays.uk.com 2009 Website Design - Websites Built
DID YOU KNOW?
An estimated 19,540 new cases of breast cancer are expected to occur among African American women in 2009.
The overall incidence rate of breast cancer is 10% lower in African American women than white women.
More Facts.....
An estimated 19,540 new cases of breast cancer are expected to occur among African American women in 2009.
The overall incidence rate of breast cancer is 10% lower in African American women than white women.
More Facts.....
Mastectomy involves removing of all of the breast tissue, sometimes along with other nearby tissues.
Possible side effects
Aside from pain after the surgery and the change in the shape of the breast(s), the possible side effects of mastectomy and breast-conserving surgery include wound infection, build-up of blood in the wound, and build-up of clear fluid in the wound. If auxiliary lymph nodes are also removed, other side effects are possible, such as swelling of the arm and chest (lymphedema).
Choosing between Lumpectomy and Mastectomy
Many women with early stage cancers can choose between breast-conserving surgery and mastectomy. One advantage of lumpectomy is that it saves the way the breast looks. A downside is the need for many weeks of radiation after surgery. On the other hand, some women who have a mastectomy will still need radiation. When choosing between a lumpectomy and mastectomy, be sure to get all the facts. You may have an initial gut preference for mastectomy as a way to "take it all out as quickly as possible." Women tend to prefer mastectomy more often than their surgeons do because of this feeling. But the fact is that for most women with stage I or II breast cancer, lumpectomy or partial mastectomy (along with radiation) is as good as mastectomy. There is no difference in the survival rates of women treated with these 2 methods. Other factors, though, can affect which type of surgery is best for you. And lumpectomy is not an option for all women with breast cancer. Your doctor can tell you if there are reasons why a lumpectomy is not right for you.
Other Breast Cancer Surgeries
Auxiliary lymph node dissection:
This operation is done to find out whether the breast cancer has spread to lymph nodes under the arm. Some nodes are removed and looked at under a microscope. Auxiliary dissection is used as a test to help guide other breast cancer treatment decisions. A possible side effect of removing these lymph nodes is swelling of the arm, called lymphedema. This happens in about 3 out of 10 women who have had these nodes removed. Sometimes the swelling lasts for only a few weeks and then goes away. Other times, the swelling lasts a long time. Ways to help prevent or reduce the effects of lymphedema are discussed in the section, "What happens after treatment for breast cancer?" If your arm is swollen, tight, or painful after lymph node surgery, be sure to tell someone on your cancer care team right away.
Sentinel lymph node biopsy:
A sentinel lymph node biopsy is a way to look at the lymph nodes without having to remove all of them. For this test, a radioactive substance and/or a dye are injected near the tumor. This is carried by the lymph system to the first (sentinel) node(s) that get lymph from the tumor. This lymph node (or nodes) is the one most likely to contain cancer cells if the cancer has spread. These nodes (often 2 or 3) are then looked at by the pathologist. If the sentinel nodes contain cancer, more lymph nodes are removed. If they are free of cancer, further lymph node surgery might not be needed. This type of biopsy calls for a great deal of skill, so it is best to have it done by a team who has experience with it.
Reconstructive or breast implant surgery:
After having a mastectomy (or some breast-conserving surgeries), a woman may want to think about having the breast mound rebuilt. These operations are not meant to treat the cancer. They are done to restore the way the breast looks. If you are having breast surgery and are thinking about having breast reconstruction, you should talk to a plastic surgeon before your operation. There are choices to be made, such as when the surgery can be done and exactly what type it will be.
What to expect with surgery
For many people, the thought of surgery can be frightening. But knowing what to expect before, during, and afterwards may help ease your fears.
Before surgery:
A few days after your biopsy you will know whether or not you have cancer, but the extent of the disease will not be known until after surgery. You will most likely meet with your surgeon a few days before the operation to talk about what will happen. You will be asked to sign a consent form giving the doctor permission to do the surgery. This is a good time to ask any questions you might have. You may be asked to donate blood ahead of time in case you need it during the surgery. Your doctor will also ask you about medicines, vitamins, or supplements you are taking. You might need to stop taking some of them a week or 2 before surgery. You will also meet with the health professional who will be giving you the anesthesia (drugs to make you sleep and not feel pain) during your surgery. The type of anesthesia used depends largely on the kind of surgery being done and your medical history.
Surgery:
For your surgery, you may be offered the choice of an outpatient procedure or you may be admitted to the hospital. General anesthesia, when drugs are used to put you into a deep sleep, is usually given for a mastectomy or an auxiliary node dissection, and is most often used during breast-conserving surgery, too. You will have an IV line put in (usually into a vein in your arm). It will be used to give medicines that may be needed during the surgery. You will be hooked up to an electrocardiogram (EKG) machine and have a blood pressure cuff on your arm, so your heart rhythm and blood pressure can be checked during the surgery. How long the surgery will take depends on the type of surgery being done. For example, a mastectomy with lymph node removal will take from 2 to 3 hours. After your surgery, you will be taken to the recovery room, where you will stay until you are awake and your vital signs (blood pressure, pulse, and breathing) are stable.
After surgery:
How long you stay in the hospital depends on the type of surgery you had, your overall state of health, whether you have any other medical problems, how well you do during the surgery, and how you feel after the surgery. You and your doctor should decide how long you need to stay in the hospital -- not your insurance company. Still, it is important to check your insurance coverage before surgery. As a rule, women having a mastectomy stay in the hospital for 1 or 2 nights and then go home. But some women may be placed in a 23-hour, short-stay unit before going home. Less involved operations such as lumpectomy and sentinel lymph node biopsy are usually done on an outpatient basis and an overnight hospital stay is not needed. After surgery you may have a bandage over the surgery site that wraps snugly around your chest. You may have one or more tubes (drains) from the breast or underarm area to remove fluid that collects during the healing process. Most drains stay in place for 1 or 2 weeks. Once the flow has gone down to about 1 ounce a day, the drain will be removed. Most doctors will want you to start moving your arm soon after surgery so that it won't get stiff. Many women who have a lumpectomy or mastectomy are surprised by how little pain they have in the breast area. But they are less happy with the strange feelings (numbness, pinching/pulling) in the underarm area. Talk with your doctor about what you should do after the surgery to care for yourself. You should get written instructions that will tell you about the following:
» How to take care of the wound and dressing
» How to take care of the drain
» Know if you have an infection
» When to call the doctor or nurse
» When to begin using the arm and how to do arm exercises to prevent stiffness
» When to start wearing a bra again
» When and how to wear a breast form (sometimes called a prosthesis)
» What to eat and what not to eat
» What medicines to take (including pain medicines and maybe antibiotics)
» What activities you should or should not do
» What feelings you might have about how you look
» When to see your doctor for a follow-up appointment
» How to contact a Reach to Recovery volunteer -- these specially trained women have had breast cancer and can offer information, comfort, and support.
Most patients see their doctor about 7 to 14 days after the surgery. Your doctor should explain the results of your pathology report and talk to you about whether you will need more treatment.
Pain after a mastectomy
Nerve pain after a mastectomy or lumpectomy is called post-mastectomy pain syndrome or PMPS. The signs of PMPS are chest wall pain and tingling down the arm. Pain may also be felt in the shoulder, scar, arm, or armpit. Other common complaints include numbness, shooting or pricking pain, or unbearable itching. It is important to talk to your doctor about any pain you are having. PMPS can cause you to not use your arm the way you should and over time you might not be able to use it normally. PMPS can be treated. Medicines commonly used to treat pain may not work well for nerve pain. But there are other medicines and treatments that do work for this kind of pain. Talk to your doctor to get the pain control you need.
Radiation Therapy
Radiation therapy is treatment with high-energy rays (such as x-rays) to kill cancer cells or shrink tumors. This treatment may be used to kill any cancer cells that remain in the breast, chest wall, or underarm area after breast-conserving surgery. Radiation therapy can be given in 2 main ways.
External Beam Radiation
Most often, external beam radiation is used for treating breast cancer. It is much like getting a regular x-ray but for a longer time. Radiation therapy may be used to kill cancer cells remaining in the breast, chest wall, or underarm area after surgery or, less often, to shrink a tumor before surgery. Treatment is usually given 5 days a week (Monday through Friday) in an outpatient center. It starts about a month after surgery and lasts about 6 weeks. Each treatment lasts a few minutes. The treatment itself is painless. Ink marks or small tattoos may be put on your skin. These will be used as a guide to focus the radiation on the right area. You may want to talk to your health care team to find out if these marks will be permanent. If it is used along with chemotherapy, radiation is usually given after chemotherapy is finished.
Accelerated Breast Irradiation:
Newer methods now being studied involve giving radiation over a much shorter period of time. This is called accelerated radiation. In one approach, larger doses of radiation are given each day, but the course of radiation is shortened to only 5 days. In another approach, one large dose of radiation is given in the operating room right after lumpectomy (before the skin is closed). Most doctors still consider accelerated radiation to be experimental at this time.
Possible side effects of external beam radiation:
The main side effects of radiation are swelling and heaviness in the breast, sunburn-like changes in the skin over the treated area, and feeling very tired. The changes to the breast tissue and skin usually go away in 6 to 12 months. In some women, the breast gets smaller and firmer after radiation therapy. Radiation of auxiliary lymph nodes also can cause long-term arm swelling called lymphedema..
Brachytherapy
Another way to give radiation is to place radioactive seeds (pellets) into the breast tissue next to the cancer. It may be given along with external beam radiation to add an extra "boost" of radiation to the tumor. It is also being studied as the only source of radiation. So far the results have been good, but more study is needed before brachytherapy alone can be used as standard treatment. One method of brachytherapy being used is called Mammosite®. It uses of a balloon attached to a thin tube. The balloon is put into the lumpectomy space and filled with salt water. Radioactivity is added through the tube. The radioactive material is added and removed twice a day (on an outpatient basis) for 5 days. Then the balloon is deflated and removed. This type of brachytherapy can also be thought of as a form of accelerated breast irradiation. At this time there are no studies comparing outcomes with this type of radiation directly with standard external beam radiation. It is not known if the long-term outcomes will be as good.
Possible side effects
Aside from pain after the surgery and the change in the shape of the breast(s), the possible side effects of mastectomy and breast-conserving surgery include wound infection, build-up of blood in the wound, and build-up of clear fluid in the wound. If auxiliary lymph nodes are also removed, other side effects are possible, such as swelling of the arm and chest (lymphedema).
Choosing between Lumpectomy and Mastectomy
Many women with early stage cancers can choose between breast-conserving surgery and mastectomy. One advantage of lumpectomy is that it saves the way the breast looks. A downside is the need for many weeks of radiation after surgery. On the other hand, some women who have a mastectomy will still need radiation. When choosing between a lumpectomy and mastectomy, be sure to get all the facts. You may have an initial gut preference for mastectomy as a way to "take it all out as quickly as possible." Women tend to prefer mastectomy more often than their surgeons do because of this feeling. But the fact is that for most women with stage I or II breast cancer, lumpectomy or partial mastectomy (along with radiation) is as good as mastectomy. There is no difference in the survival rates of women treated with these 2 methods. Other factors, though, can affect which type of surgery is best for you. And lumpectomy is not an option for all women with breast cancer. Your doctor can tell you if there are reasons why a lumpectomy is not right for you.
Other Breast Cancer Surgeries
Auxiliary lymph node dissection:
This operation is done to find out whether the breast cancer has spread to lymph nodes under the arm. Some nodes are removed and looked at under a microscope. Auxiliary dissection is used as a test to help guide other breast cancer treatment decisions. A possible side effect of removing these lymph nodes is swelling of the arm, called lymphedema. This happens in about 3 out of 10 women who have had these nodes removed. Sometimes the swelling lasts for only a few weeks and then goes away. Other times, the swelling lasts a long time. Ways to help prevent or reduce the effects of lymphedema are discussed in the section, "What happens after treatment for breast cancer?" If your arm is swollen, tight, or painful after lymph node surgery, be sure to tell someone on your cancer care team right away.
Sentinel lymph node biopsy:
A sentinel lymph node biopsy is a way to look at the lymph nodes without having to remove all of them. For this test, a radioactive substance and/or a dye are injected near the tumor. This is carried by the lymph system to the first (sentinel) node(s) that get lymph from the tumor. This lymph node (or nodes) is the one most likely to contain cancer cells if the cancer has spread. These nodes (often 2 or 3) are then looked at by the pathologist. If the sentinel nodes contain cancer, more lymph nodes are removed. If they are free of cancer, further lymph node surgery might not be needed. This type of biopsy calls for a great deal of skill, so it is best to have it done by a team who has experience with it.
Reconstructive or breast implant surgery:
After having a mastectomy (or some breast-conserving surgeries), a woman may want to think about having the breast mound rebuilt. These operations are not meant to treat the cancer. They are done to restore the way the breast looks. If you are having breast surgery and are thinking about having breast reconstruction, you should talk to a plastic surgeon before your operation. There are choices to be made, such as when the surgery can be done and exactly what type it will be.
What to expect with surgery
For many people, the thought of surgery can be frightening. But knowing what to expect before, during, and afterwards may help ease your fears.
Before surgery:
A few days after your biopsy you will know whether or not you have cancer, but the extent of the disease will not be known until after surgery. You will most likely meet with your surgeon a few days before the operation to talk about what will happen. You will be asked to sign a consent form giving the doctor permission to do the surgery. This is a good time to ask any questions you might have. You may be asked to donate blood ahead of time in case you need it during the surgery. Your doctor will also ask you about medicines, vitamins, or supplements you are taking. You might need to stop taking some of them a week or 2 before surgery. You will also meet with the health professional who will be giving you the anesthesia (drugs to make you sleep and not feel pain) during your surgery. The type of anesthesia used depends largely on the kind of surgery being done and your medical history.
Surgery:
For your surgery, you may be offered the choice of an outpatient procedure or you may be admitted to the hospital. General anesthesia, when drugs are used to put you into a deep sleep, is usually given for a mastectomy or an auxiliary node dissection, and is most often used during breast-conserving surgery, too. You will have an IV line put in (usually into a vein in your arm). It will be used to give medicines that may be needed during the surgery. You will be hooked up to an electrocardiogram (EKG) machine and have a blood pressure cuff on your arm, so your heart rhythm and blood pressure can be checked during the surgery. How long the surgery will take depends on the type of surgery being done. For example, a mastectomy with lymph node removal will take from 2 to 3 hours. After your surgery, you will be taken to the recovery room, where you will stay until you are awake and your vital signs (blood pressure, pulse, and breathing) are stable.
After surgery:
How long you stay in the hospital depends on the type of surgery you had, your overall state of health, whether you have any other medical problems, how well you do during the surgery, and how you feel after the surgery. You and your doctor should decide how long you need to stay in the hospital -- not your insurance company. Still, it is important to check your insurance coverage before surgery. As a rule, women having a mastectomy stay in the hospital for 1 or 2 nights and then go home. But some women may be placed in a 23-hour, short-stay unit before going home. Less involved operations such as lumpectomy and sentinel lymph node biopsy are usually done on an outpatient basis and an overnight hospital stay is not needed. After surgery you may have a bandage over the surgery site that wraps snugly around your chest. You may have one or more tubes (drains) from the breast or underarm area to remove fluid that collects during the healing process. Most drains stay in place for 1 or 2 weeks. Once the flow has gone down to about 1 ounce a day, the drain will be removed. Most doctors will want you to start moving your arm soon after surgery so that it won't get stiff. Many women who have a lumpectomy or mastectomy are surprised by how little pain they have in the breast area. But they are less happy with the strange feelings (numbness, pinching/pulling) in the underarm area. Talk with your doctor about what you should do after the surgery to care for yourself. You should get written instructions that will tell you about the following:
» How to take care of the wound and dressing
» How to take care of the drain
» Know if you have an infection
» When to call the doctor or nurse
» When to begin using the arm and how to do arm exercises to prevent stiffness
» When to start wearing a bra again
» When and how to wear a breast form (sometimes called a prosthesis)
» What to eat and what not to eat
» What medicines to take (including pain medicines and maybe antibiotics)
» What activities you should or should not do
» What feelings you might have about how you look
» When to see your doctor for a follow-up appointment
» How to contact a Reach to Recovery volunteer -- these specially trained women have had breast cancer and can offer information, comfort, and support.
Most patients see their doctor about 7 to 14 days after the surgery. Your doctor should explain the results of your pathology report and talk to you about whether you will need more treatment.
Pain after a mastectomy
Nerve pain after a mastectomy or lumpectomy is called post-mastectomy pain syndrome or PMPS. The signs of PMPS are chest wall pain and tingling down the arm. Pain may also be felt in the shoulder, scar, arm, or armpit. Other common complaints include numbness, shooting or pricking pain, or unbearable itching. It is important to talk to your doctor about any pain you are having. PMPS can cause you to not use your arm the way you should and over time you might not be able to use it normally. PMPS can be treated. Medicines commonly used to treat pain may not work well for nerve pain. But there are other medicines and treatments that do work for this kind of pain. Talk to your doctor to get the pain control you need.
Radiation Therapy
Radiation therapy is treatment with high-energy rays (such as x-rays) to kill cancer cells or shrink tumors. This treatment may be used to kill any cancer cells that remain in the breast, chest wall, or underarm area after breast-conserving surgery. Radiation therapy can be given in 2 main ways.
External Beam Radiation
Most often, external beam radiation is used for treating breast cancer. It is much like getting a regular x-ray but for a longer time. Radiation therapy may be used to kill cancer cells remaining in the breast, chest wall, or underarm area after surgery or, less often, to shrink a tumor before surgery. Treatment is usually given 5 days a week (Monday through Friday) in an outpatient center. It starts about a month after surgery and lasts about 6 weeks. Each treatment lasts a few minutes. The treatment itself is painless. Ink marks or small tattoos may be put on your skin. These will be used as a guide to focus the radiation on the right area. You may want to talk to your health care team to find out if these marks will be permanent. If it is used along with chemotherapy, radiation is usually given after chemotherapy is finished.
Accelerated Breast Irradiation:
Newer methods now being studied involve giving radiation over a much shorter period of time. This is called accelerated radiation. In one approach, larger doses of radiation are given each day, but the course of radiation is shortened to only 5 days. In another approach, one large dose of radiation is given in the operating room right after lumpectomy (before the skin is closed). Most doctors still consider accelerated radiation to be experimental at this time.
Possible side effects of external beam radiation:
The main side effects of radiation are swelling and heaviness in the breast, sunburn-like changes in the skin over the treated area, and feeling very tired. The changes to the breast tissue and skin usually go away in 6 to 12 months. In some women, the breast gets smaller and firmer after radiation therapy. Radiation of auxiliary lymph nodes also can cause long-term arm swelling called lymphedema..
Brachytherapy
Another way to give radiation is to place radioactive seeds (pellets) into the breast tissue next to the cancer. It may be given along with external beam radiation to add an extra "boost" of radiation to the tumor. It is also being studied as the only source of radiation. So far the results have been good, but more study is needed before brachytherapy alone can be used as standard treatment. One method of brachytherapy being used is called Mammosite®. It uses of a balloon attached to a thin tube. The balloon is put into the lumpectomy space and filled with salt water. Radioactivity is added through the tube. The radioactive material is added and removed twice a day (on an outpatient basis) for 5 days. Then the balloon is deflated and removed. This type of brachytherapy can also be thought of as a form of accelerated breast irradiation. At this time there are no studies comparing outcomes with this type of radiation directly with standard external beam radiation. It is not known if the long-term outcomes will be as good.
Simple or total mastectomy:
In this surgery the entire breast is removed, but not the lymph nodes under the arm or the muscle tissue beneath the breast. Sometimes both breasts are removed, especially when mastectomy is done to try to prevent cancer. If a hospital stay is needed, most women can go home the next day.For some women who are planning on having reconstruction right away, a skin-sparing mastectomy can be done. For this, most of the skin over the breast (other than the nipple and areola) is left intact. This can work as well as a simple mastectomy. The amount of breast tissue removed is the same as with a simple mastectomy. Although this approach has not been used for as long as the more standard type of mastectomy, many women prefer it because there is less scar tissue and the reconstructed breast seems more natural.
In this surgery the entire breast is removed, but not the lymph nodes under the arm or the muscle tissue beneath the breast. Sometimes both breasts are removed, especially when mastectomy is done to try to prevent cancer. If a hospital stay is needed, most women can go home the next day.For some women who are planning on having reconstruction right away, a skin-sparing mastectomy can be done. For this, most of the skin over the breast (other than the nipple and areola) is left intact. This can work as well as a simple mastectomy. The amount of breast tissue removed is the same as with a simple mastectomy. Although this approach has not been used for as long as the more standard type of mastectomy, many women prefer it because there is less scar tissue and the reconstructed breast seems more natural.
Radical mastectomy:
This is a major operation where the surgeon removes the entire breast, underarm (axillary) lymph nodes, and the chest wall muscles under the breast. This surgery was once very common, but it is rarely done now because modified radical mastectomy has proven to work just as well. But this operation may still be done for large tumors that are growing into the muscles under the breast.
This is a major operation where the surgeon removes the entire breast, underarm (axillary) lymph nodes, and the chest wall muscles under the breast. This surgery was once very common, but it is rarely done now because modified radical mastectomy has proven to work just as well. But this operation may still be done for large tumors that are growing into the muscles under the breast.
Partial Mastectomy (also known as breast conserving surgery)
A partial mastectomy or breast conserving surgery involves removing a portion of the breast along with the tumor and varying numbers of lymph nodes. This procedure can also be referred to as lumpectomy, segmentectomy, or quadrantectomy depending on how much tissue is removed. Generally, large tumor to breast size ratio leaves the patient with poor cosmetic results.
A partial mastectomy or breast conserving surgery involves removing a portion of the breast along with the tumor and varying numbers of lymph nodes. This procedure can also be referred to as lumpectomy, segmentectomy, or quadrantectomy depending on how much tissue is removed. Generally, large tumor to breast size ratio leaves the patient with poor cosmetic results.
Modified radical mastectomy:
This operation involves removing the entire breast and some of the lymph nodes under the arm. This is the most common surgery for women with breast cancer who are having the whole breast removed.
This operation involves removing the entire breast and some of the lymph nodes under the arm. This is the most common surgery for women with breast cancer who are having the whole breast removed.
