Mastectomy: reasons, process & risks

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What is a Mastectomy?

A mastectomy (ablatio mammae) is the amputation of one or both breasts. In the majority of cases, only parts of the breast, such as the mammary gland, are removed. The surgical procedure is most often carried out as part of treatment for breast cancer (breast cancer). In many cases, the mastectomy is followed by breast reconstruction so that the appearance of the breast is preserved.

When is a mastectomy performed?

Up to 70 percent of all breast cancers can now be treated with breast-conserving surgery. In other cases, removal of the affected breast is necessary for various reasons.

According to the guidelines for the treatment of breast cancer, a mastectomy is necessary if, for example

• there is a very large or inflamed (inflammatory) tumor,

• there are several tumor foci in the breast,

• the breast skin is also affected,

• the tumor could not be completely eliminated by breast-conserving surgery,

• radiation or chemotherapy is not possible,

• the ratio between tumor and breast size is unfavorable or

• the woman expressly does not want breast-conserving surgery.

Doctors also recommend the procedure if the result of breast-conserving surgery would be particularly cosmetically disturbing.

A mastectomy can also be carried out as part of gender reassignment for trans people. In rare cases, the breast is removed as a precaution if there is a genetic increased risk of breast cancer.

A mastectomy may also be considered for men with excessive breast growth (gynecomastia).

Mastectomy: process and procedure

Mastectomy is a complex operation and usually requires general anesthesia. Breast surgery takes approximately two to three hours.

There are various procedures available for breast removal. Which method is used depends, among other things, on the reason for the mastectomy. If breast cancer requires the operation, the size, condition and location are decisive for the choice of surgical technique.

• radical mastectomy: Radical mastectomy involves amputation of the entire breast. The mammary gland, nipple, areola and the covering of the chest muscles are removed. However, the lymph nodes are not removed during radical surgery. The pectoral muscle is also preserved.

• subcutaneous mastectomy: This involves the removal of the mammary gland. If a tumor does not touch the skin, the operation can be carried out in such a way that the skin layer is preserved. Experts also speak of a “skin sparing mastectomy”. If the nipple (nipple) is preserved, this is called a nipple-sparing mastectomy.

• modified radical mastectomy: Modified radical mastectomy involves the removal of the mammary gland and the fascia of the pectoral muscles. In addition, lymph nodes are removed from the armpit. In some cases, the nipples and areola can be preserved.

• partial mastectomy: In the partial procedure, only part of the mammary gland is extracted.

Mastectomy: Possible complications

Like any surgery, a mastectomy carries risks. Possible postoperative complications include:

• swelling
• Pains
• Bruises
• Restriction of mobility in arms and shoulders
• Numbness and loss of sensation in the arms and chest
• scar
• Bleeding
• Inflammation
• thrombosis
• Allergies to anesthetics

In addition, nerve pain in the armpit, arm or chest wall occasionally occurs after a mastectomy. These symptoms usually subside over time. Experts also speak of the so-called post-mastectomy pain syndrome (PMPS).

If lymph nodes in the armpit are also removed as part of the mastectomy, disruption of the lymph flow and, as a result, lymphedema (accumulation of lymph fluid in the tissue) are possible.

Aftercare and recovery after the procedure

The recovery time after a mastectomy is relatively short. A long stay in a clinic is generally not necessary. It is often necessary to insert tubes to drain wound fluid, especially with larger breasts. This can be uncomfortable and require a slightly longer hospital stay. After about two to seven days, patients are usually allowed to go home.

The healing time depends on many factors, including whether breast reconstruction began at the same time. Postoperative pain usually does not last longer than two weeks. Wound healing may require more time. Which wound care is the right one must be agreed upon by a doctor.

If only one breast is removed, the spine may be put under incorrect strain, resulting in back and neck pain. Then physiotherapy can help to alleviate the symptoms.

Surgical breast reconstruction after a mastectomy

A mastectomy can have a significant emotional impact on patients. For some sufferers, the loss of breasts means the loss of femininity. A mastectomy can have a significant impact on self-esteem and body image.

Therefore, in many cases, breast reconstruction is carried out to visually restore the breast. Breast reconstruction is a lengthy process that usually requires several steps. Implants and the patient’s own tissue are used.

Breast reconstruction can either be carried out as an immediate reconstruction: the breast is started to be built up during the mastectomy procedure. However, there is also the option of starting the reconstruction later.

If you want a reconstruction, you should definitely discuss this with your surgeon before the mastectomy in order to make planning the procedure easier. Detailed consultation is also usually necessary in order to implement the patient’s exact wishes and minimize the risk of complications.

If a patient chooses not to have breast reconstruction or if this is not medically possible, breast prostheses in clothing may be a suitable option.

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