Mastectomy

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Preoperative Care

A few days before surgery, the patient's overall health is assessed. Preoperative tests depend on the patient's age and health and generally include a blood test, a chest x-ray, and possibly an electrocardiogram (EKG).

Medications that "thin" the blood, including aspirin, should be discontinued several days prior to a scheduled operation to avoid abnormal bleeding during the procedure. Patients must refrain from eating or drinking at least 8 hours prior to surgery to reduce the risk of vomiting during the procedure. This may include taking oral medications and this should be discussed with the physician.

On admission to the hospital, the patient must sign an informed consent form to make sure the surgeon has explained what a mastectomy is and the risks associated with the surgery.

Next, the anesthesiologist (physician who administers the anesthesia) performs a brief physical assessment and takes a medical history. The anesthesiologist is made aware of current medications, any history of allergies, and previous adverse reactions to anesthesia to assess conditions that may determine the choice of anesthesia and any precautions that must be taken.

An intravenous line (IV) is started to administer fluids and medication during the procedure. The patient is taken to the preoperative holding area and must stay in bed from this point on, except to use the bathroom. Sedation is sometimes given in the preoperative holding area, but the anesthesia is administered in the operating room.

Postoperative Care

Immediately following surgery, the patient is taken to the postanesthesia care unit (PACU) and is closely monitored by the nursing staff until the anesthesia wears off. When the patient awakens fully from the anesthesia and the vital signs stabilize, they are taken to their room.

After the anesthesia wears off, there is pain in and around the incision and pain medication is prescribed. Most mastectomy patients have a drainage tube placed in the breast or under the arm to drain blood and fluid that accumulates during healing. The tube is usually removed within a few days, depending on recovery; however, sometimes it must remain in place for a week or two.

The IV remains until the patient can tolerate fluids taken by mouth. Clear liquids are offered the day of the surgery or the morning after. Once liquids are tolerated, the diet progresses to solid food. If medication such as antibiotics has been prescribed, the intravenous remains in longer.

The length of hospitalization depends on the type of mastectomy performed, breast reconstruction, and complications. If a simple mastectomy has been performed, the patient may be discharged the same day. Most patients remain in the hospital for 1 or 2 days, but if reconstruction is done, the stay is longer.

If discharge is the same day as surgery, the patient must be accompanied home. Patients require assistance for several hours after the anesthesia wears off.

The drain may still be in place when a patient is discharged. Sponge baths instead of showers should be taken until the incision begins to heal and the stitches are removed. Redness or swelling at the site may indicate an infection and should be reported to the surgeon.

Muscle soreness and tightness on the side of the surgery may make it difficult to move the arm. After the drain is removed, simple exercises may be performed to relieve the tightness. A physical therapist can explain the best type of exercise to do. Keeping the arm elevated helps prevent edema (swelling).

After the stitches are removed and the incision is healing, stretching and increased range of motion exercises can be done to regain full movement in the affected arm. A physical therapist or other practitioner can recommend the most appropriate and effective types of exercise. If the patient's job requires lifting and strenuous physical activity, they may need to stay out of work, or temporarily transfer to another position. Complete healing generally takes about 6 weeks.

Postoperative Complications

Most patients recover from mastectomy without any problems, but complications such as infection, lymphedema, and seroma can occur.

Infection usually manifests as redness and swelling of the incision with pus or foul-smelling drainage. Fever may also indicate infection.

Lymphedema may occur when the lymph nodes are removed. The arm on the affected side sometimes becomes swollen when the lymph system is damaged by lymph node removal or radiation. Sometimes it resolves on its own, but the condition can become chronic.

Seroma occurs when blood or fluid accumulates in an area of the body that has just undergone surgery. Sometimes the body absorbs it, but if it becomes painful or infected, it must be removed.

Reconstruction

Postmastectomy breast reconstruction often can be done immediately following mastectomy. In reconstruction, a new breast is formed using an implant or tissue from the patient's body.

Breast reconstruction usually involves more than one operation and the first procedure is usually the most complex. The procedure is more complex for patients who have had a lot of skin removed and the skin-sparing mastectomy allows for the least difficult reconstructive surgery.

There are several different techniques available, and patients should discuss reconstruction options with their surgeon.

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