Focus on Mastectomy | fathers and mothers

Mastectomy is a Removing the entire mammary gland. This surgery is done most often in the context of breast cancer. It is often performed with the goal of completely removing the cancerous tumor. In some cases, for women who are at high risk of developing breast cancer, it may be performed for preventive purposes. Then named Preventive mastectomy.

There is no difference between the two terms, both of them denote Breast removal surgery. The term mastectomy is the less commonly used of the two.

Total mastectomy is the complete removal of the breast. If it involves both breasts, it is called a bilateral mastectomy.

We sometimes speak of a partial mastectomy (or zonectomy or lumpectomy) which consists of removing (removing) part of the mammary gland.

The breast is removed Under general anesthesia in the operating room. Thus, this type of intervention consists in removing the entire mammary gland, with or without removal of the areola and nipple according to indications.
At the same time, axillary lymph node resection (resection) can be performed if it is indicated: sentinel lymph node resection (first lymph node staging of the breast tumor) or axillary dissection (resection of all axillary lymph nodes in the draining area of ​​the operated breast).

Treatment for breast cancer depends on local remedies (surgery, radiotherapy) on the one hand, and then Medical treatments (chemotherapy, anti-hormonal therapy, targeted therapies) on the other hand. The selection of different treatments, the choice of surgical approaches and the therapeutic sequence depend on the stage of disease, tumor size, histological type, etc.
With regard to surgery, the decision to perform A.J conservative treatment (lumpectomy, zonectomy, or partial mastectomy) or a Radical surgery (mastectomy) mainly depends on tumor size and patient history (recurrence after radiotherapy, mutation that predisposes to breast cancer, patient selection, etc.).

Some women are pregnant A genetic mutation that predisposes to breast cancerlike the boom BRCA 1 or 2. In these cases, the so-called preventive surgery can be suggested. It consists of a complete skin-sparing mastectomy, nipple and areola with immediate breast reconstruction.

These preventive bilateral mastectomy procedures are for women who have never had breast cancer. In these cases, surgery is often performed bilaterally simultaneously. This decision is often complicated for the women involved, most of whom have relatives (grandmothers, mothers, aunts, sisters) who died of breast cancer. Specific support and information is necessary to help them make their decision. Psychological support can be provided. These women are often seen in a reference center, within a hospital structure, that is also responsible for genetic mutation screening. More information on the BRCA France website.

Mastectomy is a common surgical procedure in the treatment of breast cancer. The postoperative period should be anticipated as best as possible, given the physical and psychological consequences it has for a woman’s health.

Like any surgical procedure, a mastectomy puts you at risk for postoperative complications or side effects; Women should be informed of these risks in advance by their surgeon and physician. The consequences of the operation can be:

• Unspecified risks: bleeding, hematoma, abscess that may require repeat operation
• Specific risks:

– In the lymph node procedure, especially in the case of axillary dissection: vascular or neurological lesions, loss of sensitivity of the inner side of the arm (which may persist for a long time after the intervention), decreased mobility of the shoulder, lymphedema (swelling of the arm)

– in mastectomy +/- removal of one or more lymph nodes: lymphocytosis (accumulation of lymph at the site of surgery) which may require puncture; Skin necrosis, which can cause delayed healing

• Pain that can sometimes become chronic:

Palpation pain
Pain around the scar
Pain in the armpit
Pain when moving the arm.

proper care and Physiotherapy and rehabilitation sessions It may be prescribed by your surgeon or oncologist to alleviate these side effects, and to allow for optimal recovery after a mastectomy. Resumption of modified sports activities is particularly recommended. Special care can be put in place to identify and relieve this pain.
If the healing process is proceeding normally, scar care can be offered from the first days after the intervention. the Scar massage May promote movement of underlying tissues and improve skin and tissue healing. The woman can ask the care team for advice on the best way to care for the scars.
Note: There are networks of specialist physiotherapists (RKS), Breast Physiotherapists Network (https://www.reseaudeskinesdusein.fr/).

A mastectomy scar is often associated with several negative aspects for women who have just had a mastectomy: Tightness, pain, healing problems, reminders of the absence of a breast, a significant change in body image …
“After a mastectomy, women go through a real physical revolution, they no longer have this or that breast that was part of their safety. They have to rebuild themselves physically and psychologically, and rebuilding takes time.”explains Angelique Lecomte, creator of the “Les Monocyclettes” line of underwear dedicated to women who have undergone mastectomy.

In the context of breast cancer, the issue of breast reconstruction is dealt with very early in the course of care. Two scenarios can arise: Breast reconstruction being performed at the same time as the mastectomy (that is immediate reconstruction), or exercise later (Secondary reconstruction), often at the end of treatment (radiotherapy and/or chemotherapy).

The timing decision is based on a range of clinical arguments, and will be discussed with the medical team. Many hospitals provide psychological support to help the patient live this journey better.

Even before a mastectomy, interested women can talk to their surgeon to talk about the progress and consequences of the reconstruction.

In the event that the breast is reconstructed immediately; The skin, and sometimes the areola and nipple are preserved. In the absence of immediate breast reconstruction, no preservation of the nipple and areola, a wider excision of the skin is performed.

In the case of a secondary restoration, it is necessary to wait a few months, especially after radiotherapy has finished (6 to 12 months), before surgery. In the absence of radiotherapy, faster reconstruction can be visualized. Sometimes women give up on that several years before making the decision to have breast reconstruction, and some patients never want it. “The breast reconstruction process is long, complex, and painful, often with multiple surgeries and results that are not always guaranteed. Many women are reluctant or even forgo this reconstruction.”Angelique Lecomte testifies.
Dialogue with the care team is essential to support women in this process.

Breast reconstruction surgeries With full support By health insurance, either in the context of breast cancer, or for preventive surgery in the presence of significant risk factors (women who carry a BRCA 1 or 2 gene mutation for example).

For women who have had a mastectomy, It is not easy to find suitable underwear. However, the ability to dress and take care of one’s physical appearance is essential to help the patient find as satisfying a daily, personal, social and professional life as possible. It is an essential component of maintaining self-esteem, especially after an illness.
Before breast reconstruction, or for those who do not want to undergo reconstruction, they wear External breast prostheses can be considered. It is not always easy to combine prostheses with underwear.

After the surgery, the patient is taken to the recovery room where the medical team takes care of this his supervision (vital parameters) for approximately 2 hours. Postoperative pain will be taken into consideration and managed throughout the postoperative phase.

On the other hand, bleeding A (small tube) may be held in place during the procedure in the operating area. It allows the evacuation of fluids that can build up during the healing process. The drain is not painful and the surgeon decides when to remove it depending on the progress of the healing.

the The length of the hospitalization period It may vary depending on the context and the patient’s health status, but it often lasts less than two days. Anticoagulant therapy may also be used to prevent the risk of phlebitis. After leaving the hospital, the patient can go home.

affiliate Scar care Home nurse for a few days. Resumption of daily activities will be discussed with the medical team. the duration of downtime It will suit each patient’s condition.