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  • Ankita Mishra

Mastectomy: Before And After

let's understand briefly the cycle of care of a patient suggested with mastectomy as a treatment option. And then discuss possible complications following Mastectomy,


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Getting to know the correct diagnosis

You need to have the correct diagnosis of Breast cancer whether it is Invasive ductal carcinoma or invasive lobular cancer or any other form of the disease as it can change the treatment modalities. Some cancer can be easily treated with a Lumpectomy and some may need additional treatment along with Mastectomy.

Meeting your surgeon to discuss the treatment options

After coming to the correct diagnosis, you will meet the surgeon. The surgeon will take a thorough history of your symptoms, any present or past medical conditions, previous history of any trauma, surgery, or radiation therapy. The surgeon will then decide the procedure which is best suited for you. The decision of doing a reconstruction surgery is also taken at this point. If you opt for a reconstruction surgery then you will need to meet the plastic surgeon as well who will also assist with the surgery.

Preparation for the surgery

You will meet an anesthesiologist who will review your medical history and discuss your operation and lay down the plan for your anesthesia. You will then have to undergo preoperative evaluation and all routine examinations are done (Complete blood count, Urine analysis, ECG, X-ray, etc) to assess the current health status to prepare and prevent any complications that can delay the surgery or occur during the procedure.


Before the procedure

Stop taking blood-thinning medications like aspirin a week before the surgery -Tell your doctor about any medications that you are taking regularly like drugs for high BP or vitamin supplements

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Nil By Mouth (NBM): You are not allowed to eat or drink 8 to 12 hours before surgery. Your doctor will give you the specific information

Prepare for a hospital stay

Your doctor might prescribe your drugs( to reduce the anxiety of the surgery, decrease acid secretions, etc)

During the procedure

You will be anesthetized: A Mastectomy is usually done under general anesthesia (You will not be awake during the surgery)

You will be under continuous monitoring by the anesthesiologist who will make sure to inject fluids, blood, platelets, or any medication required to keep you stable.

The surgeon will make an elliptical incision around your breast.

The breast and underlying tissues are removed according to the type of Mastectomy that is being performed.

Tissues and lymph nodes that are removed will be sent for histopathological examination.

For Breast Reconstruction Surgery, the plastic surgeon will coordinate the surgeon.

Nil incisions are then closed with sutures after the placement of a drain at the site.

Anesthesia reversal is done: When the surgery is completed, the anesthesiologist stops the drugs that put you in Anesthesia and wait for you to wake up.

Post-surgery care

You will be taken to the recovery room where the doctor will monitor your Blood Pressure, Heart rate, and Breathing. The doctor will prescribe you medications to prevent any wound infections (Antibiotics) and pain relief medications.

Once your doctor is sure that you are out of any risk and don't have any complications following the surgery, you will be discharged.

Before discharging the doctor will instruct you regarding how to take proper care of the surgical wound, do regular wound and drain dressing and recognize the signs of early infection if any. Depending upon the biopsy report and the extent of the breast cancer, you will need to follow up for any additional treatment that might be needed like chemotherapy or radiation therapy.


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The Possible Complications That Can Occur Following A Mastectomy

Bleeding: A small amount of bleeding from the surgical site is often normal. But sometimes due to improper placement or displacement of drains or improper suture techniques, there might be significant bleeding.

In such cases, the drains are re-checked, and if required restoring is done with proper wound dressing.

Wound infection: Obesity, Diabetes Mellitus, Smoking, and old age can increase the risk of acquiring wound infections following breast surgery. The rate of wound infections in Mastectomy is around 1 to 20% and is most commonly caused by the bacteria Staphylococcus aureus which is normally present on the skin surfaces.

Wound infection can also occur because of improper dressing and not maintaining hygiene at the surgical site. The wound site becomes red, swollen, painful, and may leak discharge.

To prevent these doctors give preoperative and postoperative antibiotic coverage.


Seroma: This is the most common complication that occurs after a Modified Radical Mastectomy. Seroma means the accumulation of fluid around the surgical site, usually beneath the flap. It can impair the healing process.

To prevent this drain is placed and the drain is removed once there is diminished drain output. Seroma collections that develop after drain removal can be managed by percutaneous aspiration under aseptic conditions.

Injury to adjacent nerves: The breast and the armpit contains numerous nerves and vessels in close proximity. So it is not uncommon for an injury to occur. Usually, the nerves supplying the chest wall and back muscles are injured.

Hematoma: Hematoma means a collection of blood around the operative site. Blood-thinning medications like aspirin can increase the risk of developing Hematoma. It can cause pain and swelling at the wound site and prolongs the healing process. A Hematoma usually resolves on its own.

Chronic Pain and Shoulder stiffness: The incidence of chronic pain in patients with Mastectomy is around 20 to 30%. The pain is usually described as burning, constricting, or launching. The cause behind the pain is not known but it is believed to be nerve pain. Shoulder stiffness can be treated by physiotherapy and arm exercises.

Recurrence of breast cancer: This usually is a complication of breast conservative surgeries where recurrence of breast cancer occurs locally or at the site of the scar.


Blood clots or Venous Thromboembolism: After any surgery, there is an increased risk of formation of blood clots in your legs and lungs. This usually occurs after a prolonged period of immobility.


To prevent this you will be asked to ambulate as soon as possible and wear compression stockings.



Image from Blausen.com staff (2014). "

WikiJournal of Medicine


Lymphedema: It refers to swelling that occurs because of lymphatic blockage. Since Mastectomy involves the removal of lymph nodes from the arms and neck for Sentinel lymph node biopsy or axillary clearance there is an increased risk of developing lymphedema Post Mastectomy which presents as swollen arms.

To prevent and treat this the doctors prescribe using arm stocking and exercise.


Scar formation: Scar from at the suture site. A Scar in the armpit following Mastectomy is called cording which is harmless but can restrict the movement of the shoulders. It can be treated with anti-inflammatory medications.


It is important to identify the complications and treat them as soon as possible for quicker recovery and better outcomes.
 

References

1. Platt R, Zaleznik DF, Hopkins CC, et al. Perioperative antibiotic prophylaxis for herniorrhaphy and breast surgery. N Engl J Med 1990;322(3):153–60 2. Tran CL, Langer S, Broderick-Villa G, et al. Does reoperation predispose to postoperative wound infection in women undergoing an operation for breast cancer? Am Surg 2003;69(10): 852–6. 3. Tasmuth T, von Smitten K, Kalso E. Pain, and other symptoms during the first year after radical and conservative surgery for breast cancer. Br J Cancer 1996;74(12): 2024–31. 4. Angelique F. Vitug, Lisa A. Newman. Complications in Breast Surgery 2007


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