Mastectomy in Thailand

Mastectomy refers to the partial or complete surgical removal of one or both the breasts. This surgery is most often indicated for breast cancer.

A lump in the breast or armpits is one of the earliest signs of breast cancer. It can cause a change in the shape, size, or color of the breast or nipple. Nipple tenderness, inward folding of the nipple, discharge from the nipple, and orange peel appearance of the skin of the breast are the other signs of breast cancer. Patients who observe any of the above-mentioned signs must see their physician immediately.

Who are advised to undergo breast cancer mastectomy?

Your physician may recommend you to undergo a partial or full mastectomy in the following conditions:

• If you have a massive malignant tumor in the breast or invasive ductal carcinoma
• If you have had a recurrent breast cancer after initial lumpectomy
• If you are pregnant and have been diagnosed with breast cancer and radiation therapy is contraindicated
• If you have a medical history of scleroderma and have been diagnosed with breast cancer
• If you are diagnosed with breast cancer and have a lump in the armpits

Additionally, if you have a family history of breast cancer or deleterious mutation of BRCA 1 and BRCA 2 genes, you are advised preventive mastectomy.

Pre-surgical steps

• Securing an intravenous line
• Oral administration of sedative drugs to facilitate placement of a breathing tube
• Placement of breathing tube
• Administration of general anesthesia
• Disinfecting the surgical site
  
  

Surgical Procedure

Three types of mastectomy surgeries can be performed in the patients, depending on the extent of the tumor as determined by the CT scan and mammography reports.

Simple mastectomy

This type of mastectomy is carried out when the tumor is small and the surrounding lymph nodes are not infiltrated by the tumor cells. When mastectomy is conducted on both the breast, it is known as double mastectomy. This is also used in cases of invasive ductal carcinoma.

 Step 1: Surgical incision at the site of tumor in the breast or breasts or invasive ductal carcinoma (in the case of double mastectomy)

Step 2: Retraction of the intervening tissue

Step 3: Resection of a tumor along with some normal tissue

Step 4: Establishment of drainage

Step 5: Surgical closure of the wound

Modified radical mastectomy:

This procedure is performed when the tumor is large and involves a few lymph nodes.

Step 1: Surgical incision across the nipple

Step 2: Retraction of the intervening tissue

Step 3: Resection of the tumor along with some normal tissue

Step 4: Resection of lymph nodes into which the tumor cells drain (sentinel biopsy)

Step 5: Establishment of drainage

Step 6: Surgical closure of the wound

Radical mastectomy:

This procedure is carried out when the tumor is extensive and involves all the lymph nodes and muscles of the breast.

Step 1: Surgical incision across the breast

Step 2: Retraction of the breast tissue

Step 3: Resection of a tumor, muscle and connective tissue of the breast

Step 4: Resection of all the lymph nodes of that side of the body

Step 5: Establishment of drainage

Step 6: Surgical closure of the wound

Apart from the above three procedures, there is lumpectomy (removal of just the lump along with some of the surrounding tissue) and subcutaneous mastectomy (nipple and skin tissue are not removed).

As the anesthetic effect starts to wear off, you may start experiencing pain. Analgesics are administered through an intravenous line for the first two days after the anesthetic effect wears-off. In the case of a simple breast cancer mastectomy, the drainage tubes are removed in the immediate post-operative period. They are retained for two days if you undergo a radical mastectomy. Any signs of inflammation or redness should be immediately reported, as it may indicate infection.

Initially, clear fluid diet is given during the recovery period and then this is slowly progressed to solid food. You should take sponge baths until the incision heals to prevent the occurrence of an infection.  You may keep the arms elevated to prevent the accumulation of fluid in the breast cavity. The hospital stay for radical mastectomy is one to two days. The complete recovery may take up to six weeks.