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October 4, 2022

Understanding Mastectomy and Breast Reconstruction: Q&A with a Breast Surgeon

Understanding Mastectomy and Breast Reconstruction: Q&A with a Breast Surgeon

Breast cancer is the most common cancer in women nationwide. The disease affects about 1 in every 8 women.

If you — or a loved one — ever faces a breast cancer diagnosis or is at a significant risk for developing breast cancer, you may feel overwhelmed with choices and decisions. One of the most common treatment options is a proactive and potentially life-saving surgery known as a mastectomy.

Breast surgeon, Annie Oommen, MD, who practices at Westmed Medical Group, shares everything you need to know about procedures like mastectomy, lumpectomy, breast reconstruction, and more. She encourages women to be vigilant about early breast cancer detection by having regular mammogram screening tests and an annual breast exam with a provider, which could be your gynecologist or primary care physician. Your doctor may also recommend a breast ultrasound.

“Your treatment should be very individualized based on the specific type of cancer you have,” she explains. “Breast and plastic surgeons work closely with every patient to help them develop a plan that is best for them.”

What’s most important for patients to know? 

The most important decision women with breast cancer usually have to make is deciding between a lumpectomy and a mastectomy. Whichever option you choose, it is important to discuss if radiation or chemotherapy will be needed either before or after your surgery and what your options are for reconstruction.

What is a mastectomy?

A traditional mastectomy removes the entire breast and associated tissue, including the overlying skin and the nipple. This is commonly referred to as a total mastectomy. Women who receive a mastectomy generally do not need radiation after surgery because all of the breast tissue is removed.

Are there different types of mastectomies?

Yes, there are different options. Your surgeon will help you decide what type of mastectomy is best for you. This recommendation will be based on the type of cancer you have and any additional treatments you may need, such as chemotherapy or radiation.

    • A skin-sparing mastectomy removes the nipple and the breast tissue, but leaves as much of the overlying skin as possible.
    • A nipple-sparing mastectomy leaves the nipple as well as the overlying skin and simply removes the underlying breast tissue. A plastic surgeon is involved at the time of the operation and performs an immediate breast reconstruction.

What is a risk-reducing mastectomy?

A risk-reducing mastectomy involves proactively removing the breasts before you are diagnosed with cancer. Some women who test positive for gene mutations such as BRCA1 and BRCA2 or have other factors that put them at an increased risk of developing breast cancer, may choose this course of action. The procedure is not a 100% guarantee, but it is very close.

It is your decision as to what steps you want to take for peace of mind. Having a risk-reducing mastectomy is a personal choice. For women at risk, our breast surgeons also offer aggressive surveillance using advanced imaging tools like MRIs and mammograms.

What is a lumpectomy?

A lumpectomy is different from a mastectomy because it removes only the cancerous tissue while leaving the rest of the breast tissue in place. Lumpectomies are usually considered in very early-stage breast cancers.

The goal is to leave the patient with a similar breast to what they started out with before surgery. In most cases, lumpectomies are followed by radiation treatments, but every patient is unique.

What is breast reconstruction? Can mastectomy and reconstruction occur together?

Breast reconstruction is a cosmetic surgery that is used to rebuild the shape and look of the breast after a mastectomy. In many cases, mastectomy and reconstructive surgery can occur at the same time with both breast and plastic surgeons present.

There are different options for reconstruction, including:

    • Implant-based reconstruction is a two-part procedure. At the time of mastectomy, a tissue expander is put in position to stretch the muscle and skin. A few weeks later, when the stretching is complete, a permanent implant is placed during a quick, outpatient procedure.
    • Tissue-based reconstruction involves using tissue from another area of the patient’s body, such as the abdomen, to rebuild the breast.

It is important to know you do not need to have reconstruction. Some women prefer not to have any reconstruction while others may wear a prosthesis in their bra.

How long does it take to recover from a mastectomy?

Recovery time varies depending on the type of breast surgery you have, if lymph nodes were removed, and whether or not breast reconstruction was included. In general, recovery takes about two weeks for mastectomy patients not receiving reconstruction, and up to a month for individuals who have breast reconstruction. Most women generally find the pain tolerable with extra strength Tylenol.

What recent surgical developments have been made?

There have been significant improvements made in breast reconstruction. Ten years ago, the nipple was always removed as it was considered part of the breast. Now, breast surgeons can perform nipple-sparing mastectomies. From a cosmetic standpoint, skin-sparing mastectomies, nipple-sparing mastectomies, and immediate breast reconstructions are more beneficial to the patient both physically and psychologically. There have also been advancements in the type of implants that are available, as well as tissue transfer techniques.

Summit Health’s team of breast and plastic surgeons work closely with medical oncologists. Together, this team of experts help guide patients in choosing their best treatment options.