Overview
In case of breast cancer or a high risk of developing it, a mastectomy is used to remove all breast tissue. Mastectomy may be done on one or both of the breasts. A masculinizing chest surgery (top surgery), involves removing the breast tissue, which is known as subcutaneous mastectomy.
About Mastectomy
The mastectomy procedure removes all or some of your breast tissue. This surgery may be done to treat or prevent breast cancer. For those with breast cancer, surgery will be a part of their treatment plan. If you have a high risk of developing breast cancer, your healthcare provider may recommend a preventative mastectomy to help halt the development of breast cancer in the future.
What is a Mastectomy?
A mastectomy is a surgical procedure that involves the removal of one or both breasts, typically to treat or prevent breast cancer. This operation can be life-saving for those diagnosed with breast cancer and can also serve as a preventive measure for individuals at high risk of developing the disease. The procedure can vary in complexity and extent, ranging from the removal of breast tissue alone to the removal of breast tissue along with nearby structures, such as lymph nodes and sometimes chest wall muscles.
The decision to undergo a mastectomy is often a difficult one, influenced by various factors including the stage and type of breast cancer, the size of the tumor relative to the size of the breast, previous treatments, and personal preferences. In some cases, a mastectomy may be the most effective way to remove all cancerous tissue and provide the best chance for a cure. There are several types of mastectomies, each tailored to the patient's specific needs:
Simple (or total) mastectomy: The entire breast is removed, including the nipple, areola, and often some of the overlying skin.
Modified radical mastectomy: This combines a simple mastectomy with the removal of lymph nodes under the arm for examination and possible cancer cells.
Radical mastectomy: An extensive procedure where the entire breast, underarm lymph nodes, and chest wall muscles under the breast are removed. This is less common today due to its extensive nature and the availability of less invasive options.
Skin-sparing mastectomy: Most of the skin over the breast is preserved, making reconstruction easier and more natural-looking.
Nipple-sparing mastectomy: The breast tissue is removed, but the nipple and areola are left intact, provided they are not affected by cancer.
Post-mastectomy, many patients opt for breast reconstruction, which can be done at the same time as the mastectomy or at a later date. Reconstruction can involve the use of implants or the patient's own tissue to rebuild the breast shape.
What are the reasons for having a Mastectomy?
There are several reasons why a mastectomy, the surgical removal of one or both breasts, may be performed. This procedure is primarily associated with the treatment and prevention of breast cancer. Here are some of the key reasons for undergoing a mastectomy:
Breast Cancer Treatment: A mastectomy is often necessary when a person has been diagnosed with breast cancer. It is a way to remove cancerous tissue and prevent the spread of the disease. It might be the first treatment option for various stages of breast cancer, including ductal carcinoma in situ (DCIS), which is a non-invasive form of the disease, as well as stages 1 and 2, which are considered early-stage breast cancer.
Preventive Measure: For individuals at high risk of developing breast cancer due to genetic factors, such as mutations in the BRCA1 or BRCA2 genes, a prophylactic mastectomy may be recommended. This is a preventive surgery to remove one or both breasts to significantly reduce the risk of developing breast cancer in the future.
Large Area of Cancer: A mastectomy may be advised if the cancer is spread over a large area of the breast, making breast-conserving surgery, like a lumpectomy, less feasible.
Widespread Cancer: If cancer has spread throughout the breast or there are multiple areas of cancer within the breast, a mastectomy may be the most effective way to remove all cancerous tissue.
Recurrent Breast Cancer: For breast cancer that comes back after initial treatment, known as locally recurrent breast cancer, a mastectomy may be necessary to control the disease.
Paget's Disease of the Breast: This rare form of breast cancer that affects the skin of the nipple and areola may require a mastectomy for treatment.
Presence of Pre-cancerous Cells: If the breast contains a significant number of pre-cancerous cells, which indicates a high risk of developing into invasive cancer, a mastectomy may be performed as a precautionary measure.
Personal Choice: Some individuals may choose to have a mastectomy over breast-conserving surgery for personal reasons, including peace of mind or to avoid radiation therapy.
Mastectomy Procedure
Types of mastectomy procedures
Mastectomy procedures are varied and tailored to the individual needs of patients, primarily based on their medical condition, the extent of breast cancer, and personal preferences. Here's an overview of the different types of mastectomy procedures:
Total Mastectomy: Also known as a simple mastectomy, this procedure involves the removal of the entire breast, including the nipple, areola, and most of the overlying skin. It's often recommended when the cancer is confined to one area of the breast.
Skin-Sparing Mastectomy: This technique preserves most of the breast skin, which can be beneficial for immediate or future breast reconstruction. The breast tissue, nipple, and areola are removed, but the remaining skin provides a natural skin envelope for reconstruction.
Nipple-Sparing Mastectomy: In this procedure, all of the breast tissue is removed, but the nipple and areola are preserved. This option is suitable for patients with a small tumor that is not near the nipple area. It provides a more natural-looking result post-reconstruction.
Modified Radical Mastectomy: This surgery involves removing the entire breast along with the axillary lymph nodes under the adjacent arm. It's typically performed when the cancer has spread to these lymph nodes.
Radical Mastectomy: Once the standard treatment for breast cancer, radical mastectomy is now rarely performed. It involves the removal of the entire breast, all of the axillary lymph nodes, and the chest wall muscles under the breast. This extensive surgery is now usually reserved for cases where the cancer has spread to the chest muscles.
Partial Mastectomy: Though not a full mastectomy, a partial mastectomy removes the cancerous part of the breast tissue and a margin of surrounding healthy tissue. It's more commonly referred to as a lumpectomy or segmental mastectomy.
Each type of mastectomy has its indications and potential benefits. The choice of procedure depends on several factors, including the stage and type of breast cancer, the size and location of the tumor, the patient's health, and personal preferences regarding reconstruction. The goal is to remove the cancer effectively while providing the best possible cosmetic and functional outcome.
What are the risks of a mastectomy?
A mastectomy, the surgical removal of breast tissue, is a significant procedure that carries various risks, as with any major surgery. Understanding these risks is crucial for patients considering a mastectomy as part of their breast cancer treatment or as a preventive measure. Here are some of the potential risks associated with mastectomy procedures:
Bleeding: As with any surgery, there is a risk of bleeding during or after the procedure. Surgeons take precautions to minimize blood loss, but in some cases, a blood transfusion may be necessary.
Infection: The surgical site is susceptible to infection, which can delay healing and require additional treatment, such as antibiotics. Patients with weakened immune systems may be at higher risk.
Delayed Healing: Some patients may experience slower healing at the surgical site, which can be influenced by factors such as diabetes, smoking, or obesity.
Pain: Postoperative pain is expected, but it can vary in intensity and duration. Pain management plans are tailored to individual needs to ensure comfort during recovery.
Lymphedema: If axillary lymph nodes are removed during the surgery, it can lead to lymphedema, a condition characterized by swelling in the arm due to fluid accumulation.
Scar Tissue Formation: Hard scar tissue may form at the surgical site, which can cause discomfort and affect the appearance of the breast area.
Shoulder Pain and Stiffness: The surgery can result in shoulder pain and stiffness, which may require physical therapy to improve mobility.
Numbness: Patients may experience numbness in the chest or under the arm, especially if lymph nodes are removed. This numbness may be temporary or permanent.
Psychological Impact: The emotional and psychological impact of a mastectomy should not be underestimated. The loss of a breast can affect self-image and sexuality, and support from healthcare professionals, counselors, and support groups is essential.
Anesthesia Risks: General anesthesia used during mastectomy carries its own set of risks, including allergic reactions and respiratory issues.
Blood Clots: There is a risk of developing blood clots, such as deep vein thrombosis (DVT), particularly if the patient remains immobile for an extended period after surgery.
Patients need to discuss these risks with their healthcare provider to make an informed decision about undergoing a mastectomy. While the procedure can be life-saving and is often necessary for treating or preventing breast cancer, weighing the potential risks against the benefits is a critical part of the decision-making process.
How do I get ready for a mastectomy?
Preparing for a mastectomy involves several steps to ensure you are ready for the surgery and the recovery period that follows. Here's a comprehensive guide to help you get ready:
Before the Surgery
Medical Consultation: Meet with your surgeon to discuss the details of the procedure, the type of mastectomy you will have, and any additional treatments required. This is also the time to discuss your options for breast reconstruction if you are considering it.
Preoperative Tests: You may need to undergo blood tests, a mammogram, and an EKG to ensure you are fit for surgery.
Medication Review: Inform your surgeon about all the medications and supplements you are taking, as some may need to be stopped before the surgery.
Home Preparation: Arrange your home for your return from the hospital. Place items you use frequently at arm level to avoid reaching or bending. Consider preparing meals in advance or arranging for meal delivery.
Personal Items: Pack a bag for the hospital with items you'll need, such as loose-fitting clothes, a toothbrush, deodorant, and any other personal items. Choose clothes that open in the front and are easy to put on and take off.
The Day Before Surgery
Fasting: Follow your surgeon's instructions regarding fasting before the surgery. This usually means no food or drink after midnight.
Hygiene: Take a shower using antibacterial soap to reduce the risk of infection. Do not apply lotions, perfumes, or deodorants after your shower.
Relaxation: Spend the evening relaxing and try to get a good night's sleep. Consider meditation or listening to calming music to ease any pre-surgery anxiety.
What happens during a mastectomy?
During a mastectomy, a surgical procedure to remove breast tissue, several steps are meticulously followed to ensure the operation's success and the patient's safety. The process typically unfolds as follows:
Preparation: Upon arrival at the hospital, the patient is prepared for surgery. This involves changing into a hospital gown and undergoing a final review of medical history and consent forms. The surgical site is then cleaned and marked for incision.
Anesthesia: General anesthesia is administered, which means the patient will be asleep throughout the procedure and not feel any pain. The anesthesiologist monitors the patient's vital signs and maintains their unconscious state during the surgery.
Incision: The surgeon makes a surgical incision across the breast. The location and length of the incision depend on the type of mastectomy being performed and whether reconstruction is planned.
Tissue Removal: The surgeon retracts the breast tissue to expose the area that needs to be removed. In a total mastectomy, all of the breast tissue, including the nipple and areola, is removed. If a skin-sparing or nipple-sparing mastectomy is being performed, the underlying breast tissue is removed while preserving the skin, nipple, or both.
Lymph Node Removal: In some cases, particularly in a modified radical mastectomy, lymph nodes under the arm are also removed for examination. This helps determine if cancer has spread beyond the breast.
Drainage: To prevent fluid accumulation, the surgeon may establish drainage at the surgical site. Small tubes are often placed to drain excess fluid, which is collected in a small bulb that can be emptied as needed.
Closure: Once the breast tissue (and possibly lymph nodes) has been removed, the surgeon closes the incision with sutures, staples, or surgical glue. The closure method depends on the extent of the surgery and the patient's skin.
Recovery: After the surgery, the patient is taken to a recovery room where they are closely monitored as they wake up from anesthesia. Pain management begins immediately, and the medical team ensures the patient is stable before moving them to a hospital room or discharging them home.
The entire procedure typically takes about one to three hours, depending on the complexity of the surgery and whether immediate reconstruction is performed. Recovery time in the hospital may vary, with some patients going home the same day, while others may stay overnight.
What happens after a mastectomy?
After a mastectomy, a surgical procedure to remove breast tissue, patients embark on a recovery journey that typically spans four to six weeks. The initial phase of recovery begins in the postoperative unit, where healthcare providers monitor vital signs and administer medications for pain and any other symptoms, such as nausea.
Patients will have drains placed at the surgical site to collect excess fluid, which are connected to soft plastic bulbs that need to be emptied periodically. The care team will instruct patients on how to manage these drains at home, and they are usually removed during the first follow-up appointment.
Once stable, patients are either brought to their hospital room to continue recovery or sent home, depending on the extent of the surgery and their overall health. The average hospital stay after a mastectomy is about three days, but some may go home the same day.
At home, medication remains an integral part of recovery. The treatment plan may include opioids for surgical pain, medications like gabapentin for nerve pain, and acetaminophen for soreness. Many hospitals employ an enhanced recovery after surgery (ERAS) model, which aims to reduce the need for opioids, involves less fasting before and after surgery, encourages early mobilization, and utilizes various pain management strategies.
Patients are advised not to remove their bandage until the first follow-up appointment. Most sutures used today dissolve over time, eliminating the need for removal. As patients care for their dressing, they must be vigilant for any signs of infection around the surgical site.
Recovery also involves managing pain, refining diet to include nutritious food, and starting gentle physical activity as soon as it's comfortable. Patients must rest and allow their bodies to heal, but also to maintain some movement to aid circulation and prevent complications.
Patients should call their healthcare provider immediately if they develop any signs of infection, such as fever, increased redness, or discharge from the surgical site. Regular follow-up appointments are essential to monitor healing and address any concerns that may arise during recovery.
Mastectomy in Iran
Equipped hospitals, advanced specialized centers with experienced doctors and specialists are available in all medical treatment areas in Iran. Also, good hotels and entertainment centers have made Iran an appropriate choice for patients who are dealing with breast cancer and need a Mastectomy.
Mastectomy cost in Iran
The cost of a mastectomy in Iran can vary widely depending on several factors, including the type of mastectomy performed, the hospital or clinic chosen, and whether additional treatments such as chemotherapy or radiation are required. Iran is known for offering medical procedures at more affordable prices compared to many Western countries, which has contributed to its growing reputation as a destination for medical tourism.
The types of mastectomies available in Iran include complete (or simple) mastectomy, modified radical mastectomy, radical mastectomy, skin-sparing mastectomy, and nipple-sparing mastectomy. Each of these procedures has different complexities and may require different levels of postoperative care, which can affect the overall cost.
In terms of pricing, while specific costs are not readily available, the affordability of breast cancer treatment in Iran, including mastectomy procedures, is emphasized by various medical service providers. Mastectomy procedure in Iran costs around 1500-2000 USD. Patients are encouraged to seek quality medical services in Iran, where they can receive comprehensive care that includes surgical procedures like mastectomy or lumpectomy, as well as adjunct therapies if needed.
Before undergoing a mastectomy, patients should have a detailed consultation with a specialist to discuss their treatment options and get a clear understanding of the costs involved. It's also advisable for patients to inquire about package deals that may include pre-surgery consultations, the surgery itself, and post-operative care, as these can offer a more cost-effective solution.
