When I see my patients in the office for their pre-operative visit, we review any additional test results that have come in since the initial consultation and we talk about surgery: What is going to happen on the day of surgery and in the postoperative period.
The following are some of the points we cover and questions I’m frequently asked.
Mastectomy is a type of breast cancer treatment. A Breast Oncology Surgeon is specifically trained to perform mastectomies. With a total/complete/simple mastectomy the entire breast is removed (see Surgery) and sometimes the skin and lymph nodes in the armpit (axilla) are removed also.All of tissue between the collar bone (clavicle) and the fold under the breast (inframammary fold), the breast bone (sternum) and the muscle on the side of the chest (latissimus dorsi) is removed during a mastectomy.
During surgery the anesthesiologist and nurse anesthetist will watch you closely. Your blood pressure, heart rate, body temperature, breathing, etc. will be monitored continuously. They will give you any medication you need to keep you comfortable and safe such as pain medication.
After surgery you will be taken to the Recovery Room or Post-Anesthesia Care Unit (PACU) where you wake up from surgery. After a few hours you will be taken to a hospital room.
At first you will be given fluids to drink and then solid food. Nausea is not uncommon after surgery. Your nurse will give you medication for this. You will also be given pain medication. You will be encouraged to walk on the evening of surgery. This will start with walking to the bathroom and then in the hallway.
On the morning following surgery the nurse will teach you and your family how to care for the drain and give you post-operative instructions. Your surgeon will come visit you and if you’re ready you will be discharged home.
Mastectomy is considered major surgery. It is done using general anesthesia. Having said that, with proper pre-operative evaluation and meticulous surgical technique, a mastectomy is safe. I have operated successfully on women in their 80s, 90s and even women over 100 years old.
Ideally, a Breast Cancer Surgeon should perform a mastectomy.In my experience, with proper preparation, there are not many women who cannot undergo a mastectomy. If done properly a mastectomy is not particularly painful and in the hands of a skilled surgeon there is little blood loss/bleeding. I have operated successfully on women in their 80s, 90s and even women over 100 years of age.
There is a one percent risk of postoperative bleeding. This usually happens in the first 24 hours while the patient is being observed in hospital. The risk is highest in patients on blood thinners such as Coumadin, Plavix, etc.
There is a 3-4% risk of infection. One dose of antibiotics is given intravenously prior to surgery to help prevent infection.
Mastectomy is a type of breast cancer surgery. A Breast Oncology Surgeon performs mastectomy. The breast is separated from the skin and subcutaneous fat in front and from the muscle behind. This is usually done with electrocautery so there is minimal bleeding.
The hospital will call you a few days before surgery to review your health history, the medications you take, allergies, etc.
You must be fasting (nothing to eat or drink) starting at midnight on the day before surgery.
Take all your regular medications as usual on the day before surgery.
If you take regular medication in the morning, such as blood pressure medication, thyroid medication, birth control, etc. you may take it in on the morning of surgery with a tiny sip of water.
Do not take medication that lowers your blood sugar (such as Metformin) on the morning of surgery.
Don’t take Aspirin or non-steroidal anti-inflammatories (NSAIDs) such as Ibuprofen (Motrin, Advil) or Naproxen (Naprosyn, Aleve) for 7 days prior to surgery.
I recommend that patients shower and shampoo with regular Dial Soap or Chlorhexidine on the evening before surgery and shower with Dial Soap or Chlorhexidine on the morning of surgery to lower the bacteria count on the skin and reduce the risk of postoperative infection.
You can expect moderate pain after mastectomy surgery. The pain lasts 3 to 5 days and can be comfortably controlled with mild to moderately strong anti-inflammatory drugs and narcotics.
Simple/total/complete mastectomy takes about 2 hours.
Double mastectomy takes about 4 hours.
Large breasts take longer to remove than small breasts.
Add extra time if lymph nodes are removed, a Portacath is placed or reconstruction is planned.
A drain is placed in the operating room when a simple/complete/total mastectomy is performed. Partial mastectomy does not require a drain. A drain is a long, soft tube that is placed in the area where the breast used to be. It drains natural fluids that accumulate after breast tissue is removed. Patientsare given instructions on how to care for the drain once they go home. Drains stay in for about 10 to 14 days. Removing a drain shouldn’t be painful. It’s done in the office once there is less than 20 to 30 milliliters (1 ounce) in 24 hours.
You will be given postoperative instructions including when to shower, how to take care of the incisions and the drain, and when to follow up in the surgeon’s office for a post-operative visit.
Patients who undergo partial mastectomy go home the same day.
Total/complete/simple mastectomy patients stay overnight and go home the next day.
The recovery time for partial mastectomy is one week.
The recovery time for simple/complete/total mastectomy is 2 weeks. Recovery time is the same for single or double mastectomy.
The answer to this question is different for every patient. It depends on what the pathologist sees once all the tissue has been removed, the stage of the breast cancer at the time of presentation, the tumor markers, whether there was cancer in the lymph nodes, etc.
This varies depending on whether or not lymph nodes were removed, what type of reconstruction, if any, etc. All of my patients who have a lymph node dissection are referred to the Physical Therapist prior to surgery for baseline measurements. After surgery, they follow-up for arm strengthening, range of motion and lymphedema prevention (see Lymphedema).
Patients can usually return to work once the drains have been removed.
All regular activities (no restrictions) can be usually resumed 6 weeks after surgery.
7 to 10 days
My partners and I have compounded a scar gel that helps scars fade and become invisible over time. Take as directed starting about 6 weeks after surgery. If a patient has had keloid scars in the past, I use ultra-sophisticated biological material during surgery to reduce scar formation.Occasionally scars can be painful. I have treated these successfully with scar revision surgery. When patients come to me with pre-existing scars, I consult with my physical therapists who use a combination of massage, focused ultrasound and cold laser to soften and eliminate scars.
Whenever possible I use the techniques of Hidden Scar Surgery.
Breast cancer can come back after mastectomy (local recurrence) but it’s very rare.