A mastectomy is performed to treat breast cancer or to prevent breast cancer in high-risk women. The National Cancer Institute defines a mastectomy as a surgery that removes the breast---or as much of the breast tissue as possible. A mastectomy that is intended to prevent breast cancer is called a prophylactic mastectomy. If both breasts are removed, the procedure is called a bilateral mastectomy or a double mastectomy.
Types
According to BreastCancer.Org, there are five types of mastectomy: simple or total mastectomy, modified radical mastectomy, radical mastectomy, partial mastectomy and subcutaneous mastectomy. Subcutaneous mastectomy removes breast tissue but leaves the nipple intact. This type of mastectomy is controversial; some physicians are concerned that leaving the nipple leaves breast tissue that can develop into cancer. Radical mastectomies, which remove three levels of lymph nodes and chest wall muscles in addition to the breast, are rarely performed today.
Surgery
According to the American Cancer Society, a mastectomy with an axillary lymph node dissection typically takes two to three hours. An axillary lymph node dissection is often performed with a mastectomy. This procedure checks the underarm lymph nodes to see if the cancer has spread to the lymph nodes. If immediate breast reconstruction surgery is also being performed, the surgery will take longer. A typical hospital stay is one to two days.
Considerations
Some women need to have a breast removed and choose to have the other breast removed. Usually, this decision is made with the hope of avoiding a cancer in the other breast. A study published in 2010 in the Journal of the National Cancer Institute found a clear survival benefit for only a small subset of cases: women 50 and younger who have early-stage breast cancer and a tumor that is estrogen-receptor negative.
Recovery
The incision will be closed with sutures or staples and the chest will be wrapped with a bandage. Most women go home with drains inserted. Drains are plastic tubes with small plastic bulbs on the end. They capture excess fluid and have to be emptied periodically. Post-mastectomy garments have special pouches to accommodate the drains. Nerves are severed by mastectomy surgery, and the healing process usually involves a degree of numbness and tingling.
Reconstruction
Many women choose to have breast reconstruction after a mastectomy. Breast reconstruction is done by a plastic surgeon, and is typically a process rather than a single procedure. A prosthesis is an alternative to breast reconstruction. The Women's Health and Cancer Rights Act of 1998 states that if a woman's group health plan insurance covers mastectomies, "the plan must provide certain reconstructive surgery and other post-mastectomy benefits."
