Breast Cancer

Simple (Total) Mastectomy

In this procedure, the entire breast including the nipple and the areola, the darker-colored area of skin around the nipple, is removed. This procedure is sometimes called a total mastectomy.

Simple mastectomy is advised when there is a need or desire to remove the entire breast and the lymph nodes are free from cancer cells. A simple mastectomy without reconstruction may be done in 1 to 2 hours and usually involves a one- or two-night hospital stay. The length of the surgery depends on whether a procedure is done to evaluate the lymph nodes. A single incision across half the chest usually allows the surgeon to remove the breast and any lymph nodes necessary.

After the surgeon completes the mastectomy, a plastic tube about the width of a pen is gently sewn into place to draw off fluids. The end of this drain is attached to a pocket-sized suction device. The patient is instructed in the care and monitoring of the drain and drainage until the drain is removed several days after surgery. Although some women find this bothersome, it's usually not painful.

Most women do not experience excessive pain following simple mastectomy. It is common to use some pain medication for the first 3 to 7 days after surgery and then an over-the-counter pain reliever as needed. A sensation of numbness can occur under the arm, which usually happens only if an axillary dissection is performed. Some of this numbness slowly fades as nerve cells regenerate, but some numbness may be permanent.

Fatigue is to be expected following the surgery. In addition to the emotionally draining experience of facing cancer surgery, it is physically taxing as well. It's a good idea to plan a lighter schedule, with the possibility of daily naps, for the weeks following surgery.

In most cases of early-stage breast cancer, radiation treatment is not recommended after mastectomy. However, radiation may be recommended if any of the following is true:

• The tumor is larger than 2 inches (4 centimeters).
• Cancer cells are found in lymph nodes.
• The cancer cells are close to the chest wall, which increases the likelihood that the cancer may recur on the chest wall.