October 6, 2019
Clinical Contributors to this Story
Debra Camal, M.D. contributes to topics such as Breast Surgery.
A mastectomy is the surgical removal of the entire breast. There are several types of mastectomy:
- Total (simple) mastectomy: The surgeon removes the entire breast and the lining of the chest muscle.
- Modified radical mastectomy: The surgeon removes the entire breast, the lining of the chest muscles and some of the lymph nodes in the underarm area.
- Nipple-sparing mastectomy: The entire skin envelope is preserved (including the nipple), and the scar is located at the bottom part of the breast. Once the breast is reconstructed, it looks fairly close to normal because the nipple is present and the scar is not readily visible.
The specific diagnosis, of course, will guide the treatment plan.
Is Breast Reconstruction Included in the Mastectomy?
Breast reconstruction, should a woman choose it, can begin during a mastectomy (immediate) or later (delayed) after completing cancer treatment. Even reconstruction that is started immediately can involve a second procedure months later to complete the reconstruction, says Debra Camal, M.D., a breast surgeon at Riverview Medical Center.
Reconstruction can be grouped into three broad categories:
- Immediate: The breast is removed and the reconstruction is performed at the same time (with either immediate placement of an implant or immediate use of a tissue flap from the back or abdomen).
- Delayed Immediate: The breast is removed and a tissue expander is placed at the same time. A tissue expander works like a balloon and stretches the skin to make room for either an implant or a tissue flap, which would be inserted in a separate surgery at a later date. “You don’t always know who will need radiation later, so putting in an expander is a good option,” Dr. Camal says.
- Delayed: The breast is removed and the skin is closed without reconstruction. Then, if the patient chooses, she can have reconstruction as its own event months or years later.
The timing of the reconstruction depends on several factors, Dr. Camal says. Those include:
- A physical exam by the plastic surgeon
- Any surgical risk factors, such as smoking or being overweight
- Any further treatments necessary after surgery, such as radiation
For some, immediate reconstruction is the best choice. There is a decreased risk of social or emotional difficulties, possible fewer surgeries and often better cosmetic results.
For others, delaying their reconstruction makes more sense. Delayed reconstruction gives patients more time to consider options.
What Is Recovery Like?
Most mastectomy patients leave the hospital within 24 to 48 hours after surgery. Immediate reconstruction could add a couple extra days to a stay.
Whether reconstruction is delayed or immediate, you will have some soreness in your chest, underarm and shoulder. If the surgeon removes the lymph nodes, you could also have some numbness and a burning sensation around your arm.
Unfortunately, many women will feel numb across their chest—from their collarbones to the top of their rib cage—permanently after surgery. Some feeling may return to the area, but just a little.
Before you’re discharged, hospital staff will likely show you an exercise routine you can do to prevent arm and shoulder stiffness and to stave off the formation of significant scar tissue. But in general, patients are instructed to take it easy, to not lift anything heavy for at least a month and to avoid driving as long as you’re on pain medication.
“There are many different treatment paths depending on the patient, their wishes, their body type and their health,” Dr. Camal says. “But we see each patient as an individual. Cancer treatment comes first; cosmetics are important, but a secondary concern.”
Dr. Camal practices in Tinton Falls. To make an appointment, call 732-531-5200.
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The material provided through HealthU is intended to be used as general information only and should not replace the advice of your physician. Always consult your physician for individual care.