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Mastectomy
Health Guide
A mastectomy means that all the breast tissue is removed. A new breast can be constructed at the time of surgery or at a later date (see breast reconstructive surgery). Lymph node dissection is usually performed at the same time but this is not always the situation. Your surgeon will discuss with you what is appropriate.

Lymph node dissection

This is usually a standard part of all breast cancer surgery. It is done to obtain information on whether the breast cancer has spread to the lymph nodes. As a rule if breast cancer spreads beyond the breast it generally is trapped in the axillary (armpit) lymph nodes first. There are 25 to 30 lymph nodes in each armpit. With lymph node dissection usually about one half to two thirds of the lymph nodes are removed. There are enough lymph nodes left to carry on their usual function which is to fight infection locally. The surgeon cannot tell how many are removed at the time of surgery as the lymph nodes are buried in fat. Unfortunately, in removing the lymph nodes the skin nerves giving sensation to the underneath of the upper arm and armpit are cut so that after the operation the patient may be aware of numbness in this area and sometimes 'nerve' pain after the operation. The numbness and nerve pain does improve and even if there is not 100% recovery the body adjusts to this so that it is not a long-term problem. If lymph nodes are removed following the operation there will be a plastic tube left in the armpit and this will drain under suction to a plastic bottle for usually five to seven days. The plastic bottle is easily portable and can be attached to clothing through means of a cloth bag. In a few cases some people will get a temporary build up of fluid in the armpit or under the wound once the bottle is removed. This can be easily drained with local anaesthetic.

Physiotherapy exercises

If the lymph nodes are dissected it means there will be discomfort in moving the arm but it is important to follow instructions regarding exercises (see section on Physiotherapy). This will ensure that you do not end up with a frozen shoulder.Recovery time

Everyone recovers from an operation at different rates. Minimum time off work would be seven to ten days. More realistically, two to three weeks should be taken off before returning to work. Stay in hospital is usually two to three nights.

Wound Care

If you leave hospital after only one night you will have a thick pressure bandage over the breast. This can be removed two days after the operation and a light dry dressing can be applied and changed as required. The surgeon uses layers of dissolving stitches under the surface. Consequently there is very little tension on the skin layer therefore steristrips (little paper sticky tapes) are used to close the skin incision. These steristrips should be left untouched and dry for a week Any sticking plaster remaining on the breast can be removed with a solvent such as methylated spirits or nail polish remover. It is important to keep the area dry for one week following the operation. If you inadvertently get it wet dry the area off with a hairdryer and re-apply a clean dry dressing. Once the wound has healed (one week after the operation) the steristrips are removed. Micropore tape (purchase from your local pharmacy) should be placed over the breast scar for four to six weeks and changed as required, perhaps twice a week. This ensures the skin edges 'knit' together and cosmetically achieves a beautiful result. You do not have to keep changing the tape after bathing as it can dry on the skin.

Complications

Only one or two women in every 100 will develop a post-operative complication such as a wound infection or haematoma (bleeding into the wound). If an infection develops the area will become painful, red and swollen. If there is bleeding into the wound the area will become swollen and painful. Generally you should expect comfort levels to improve each day and if for any reason the reverse happens notify St Marks Breast Centre. Both complications are easily treated.

Radiotherapy

This will be discussed in detail later. Occassionally radiotherapy is required for women who have a mastectomy. The 'Rule of Five' applies - radiotherapy begins usually about five weeks following the operation for five working days for five weeks for about five minutes a day. The radiotherapy 'sterilises' the chest wall tissue. Your surgeon will talk to you about this once the histology report has been received.Link to St Marks Breast Centre Online

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