Q. I just found out I have to have a mastectomy. It sounds awful; I’m scared. Help!
A. Being told you need a mastectomy is shocking, because all you can think is, “They’re going to cut off my breast!” Yes, it sounds brutal; but if you’re worried about your physical appearance, you can choose to have reconstructive surgery or implants.
Emotionally, it takes some time to internalize that you’re going to lose your breast; but don’t worry, you’ll get there. Millions of women have had this operation and gotten through it just fine.
Q. I’m kind of upset that the surgery isn’t for another 4 weeks. Isn’t that dangerous? Won’t the cancer keep growing?
A. Especially if you’re having reconstruction, it takes time to schedule two surgeons (one to take off your breast, another to rebuild a new one), plus find an open operating room. So yes, it can be awhile between diagnosis, your decision to have a mastectomy, and the actual operation.
But don’t fret; cancer, unless it’s inflammatory breast cancer, is relatively slow-growing. A typical tumor grows for 8 years before it’s large enough to be felt or detected on a mammogram. An extra few weeks shouldn’t make any difference.
Q. So, what exactly is involved in the surgery? I listened to what the surgeon said, but it was upsetting and he kind of lost me along the way.
The simplest type of mastectomy, which some women choose when they’re diagnosed with DCIS (non-invasive cancer), removes just your breast skin and tissue, without any of your chest wall or muscles, and without any underarm lymph nodes. It takes one surgeon up to 2 hours or so, and is done under general anesthesia.
A modified radical mastectomy without reconstruction, which takes 2 to 3 hours, is also performed by one surgeon. This operation removes your breast tissue, as well as lymph nodes from under the arm, so the pathologist can determine if your cancer has spread outside the breast.
A modified radical mastectomy with reconstruction can take up to 7 or 8 hours, possibly more, depending on the complexity of the reconstruction. Typically, a reconstruction that uses tissue from another part of your body (as opposed to an implant) takes longer, as the two surgeons working on you (one to remove your breast, and a plastic surgeon to rebuild it) will be working on two different sites: your breast, and the place from which the healthy tissue is harvested.
As with any serious surgery, you’ll be admitted to the hospital, asked to change into a gown, and be assigned a bed in the waiting area. You may be asked to “X” or sign the affected breast with a marker; a nurse may also draw on the breast to show the surgeon where to start the incision. You’ll be prepped with a drug to relax you before you go to the operating room.
Once in the operating room, you’ll be anesthetized, and the operation performed. All of your breast tissue will be removed; your breast skin may or may not be removed, as well, depending on whether you’re having an immediate reconstruction. The surgeon will either continue on and perform the reconstruction; or, if you’re not having an immediate reconstruction, (s)he will insert some drainage tubes into the wound, close up the incision, and apply a loose bandage.
You’ll wake up in the recovery room. Expect discomfort, both from the operation itself, and from the anesthesia. You’ll be given anti-pain drugs, and may be given drugs to deal with any nausea, as well.
You may not want to—for some women, this is very hard—but look at your chest. You’ll see a bandage, probably blood, and perhaps a flat place where your breast used to be (if you didn’t have reconstruction). It’s an odd sensation. Take a deep breath, and move on; you’ll get used to this “new you” in time.
Q. I have to decide right away if I want reconstruction done, is that right?
A. Not necessarily. You can always go back and have reconstruction done later. And sometimes your surgeon and oncologist will recommend that you do wait till later, if they feel it’s important for you to start chemotherapy quickly, without waiting for a reconstruction to heal. Or if you’re going to need radiation, which can sometimes negatively affect a reconstruction. In either of those cases, you’d probably be advised to have reconstruction down the road sometime.
If you do decide to have reconstruction done immediately, you also have to decide whether you want implants (saline or silicone); or an autologous reconstruction, which means your breast is rebuilt using another part of your body, usually tissue from your belly or back.
Q. I heard the term “skin-sparing mastectomy” mentioned. What’s that?
A. If you’re having an immediate reconstruction, you may be offered a skin-sparing mastectomy, which means that the surgeon removes your nipple and breast tissue, but leaves the skin of your breast intact. This kind of surgery makes reconstruction easier, as there’s already a natural pouch there to hold the new breast. It also gives you a better cosmetic result, as the scar is limited to a small circle around your areola.
Unfortunately, some women aren’t eligible for skin-sparing mastectomies. If the tumor was very close to your skin, or you have inflammatory breast cancer, you probably won’t be offered a skin-sparing mastectomy.
Q. How long will I be in the hospital?
A. Hopefully, at least overnight. The Breast Cancer Patient Protection Act, currently working its way through Congress, would outlaw so-called “drive-through mastectomies,” a cost-limiting practice some insurance companies use that categorizes mastectomy as same-day surgery, forcing mastectomy patients to go home in very bad shape: bleeding, woozy, sore, and shaky.
A typical hospital stay for a mastectomy without reconstruction is 2 to 3 days. With reconstruction, it’s more like 4 to 6 days, depending on what type of reconstruction you have.
Q. What’s the recovery like? How long will it take me to get back to normal?
A. Again, it depends on your exact surgery—as well as your definition of normal. Even the simplest type of mastectomy, one without reconstruction, is still a fairly serious surgery.
Count on 1 day of feeling “off” for every hour you’re under general anesthesia. You’ll experience enough pain to take painkillers for at least a day or so; and you’ll certainly be sore for awhile after that. You’ll also be fatigued for awhile; surgery is a real challenge to your system.
You’ll also be dealing with drainage tubes. These flexible tubes, with a collection bulb at the end, drain excess fluid from your wound; you’ll measure and empty this fluid from the bulbs regularly. When the drainage slows to a certain point (that’s why you’re measuring), a nurse will remove the tubes; expect a short, sharp pain, like a shot or bee sting. You may have the tubes in for only a couple of days, or they may be with you for a couple of weeks or more. While they’re in, you can’t shower; so be prepared to have someone help you bathe, either in the tub, or with a sponge and basin.
How quickly you heal will be a reflection of both the length and complexity of your surgery, and how healthy you are in general. Smokers take longer to heal, due to a compromised vascular system. In fact, smokers usually don’t have the option of reconstruction, as there’s such an increased chance of it failing. And a simple mastectomy heals more quickly than one with an accompanying reconstruction.
You should probably plan to take a minimum of 1 week off work for a simple mastectomy; and at least 2 weeks, probably more like 3 weeks, for a mastectomy with reconstruction. If you have a physically challenging job, you’ll need to take longer, in order to let everything heal thoroughly before you put it to the test by lifting, carrying, etc.
Your doctor will give you exercises to do at home, and will tell you when to start doing them. Don’t shirk this responsibility; exercise after surgery, even when painful, will help prevent arm and shoulder problems later on.
As with any surgery, be sensible. Don’t overdo. No lifting or carrying with your affected arm till your surgeon says it’s OK. If you have any signs of infection (fever, swelling, redness), let the surgeon or nurse know. And if your arm and/or trunk swells, you may be experiencing lymphedema; this is another thing to report.
Q. What will it look like afterwards, once everything is healed?
A. Again, depends what surgery you have. A simple mastectomy will leave you with a flat place on your chest bisected by a horizontal scar. A reconstruction will look anywhere from nearly natural to not-so-good, depending on the skill of your surgeon and the size of your breasts; smaller breasts are easier to reconstruct than larger ones. But remember, hardly anyone (maybe only you) will see your reconstruction au naturel; most reconstructions look just fine covered, as they usually are, by a bra and shirt.
Most women go on to have further treatment—radiation, or chemo, or both—after their mastectomy. You’ll soon get past worrying about your surgery, since you’ll have other things to worry about! Good luck, and remember: you’re doing everything you can to prevent cancer form coming back, so it’s all worth it.
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