What is it?
Mastectomy means removal of a breast. At the same time some or all the glands in the arm pit may well be be taken out. The end result is smooth skin across half the chest with a scar across it.
You will be given a general anaesthetic and be completely asleep during the operation. The operation takes about 60 minutes.
Leaving things as they are would mean that the problem in the breast will get worse. Simply taking out the diseased part and using x-ray treatment for the rest of the breast is not for you.
This is because a safe margin of healthy breast tissue can not be achieved, or the background tissue is not stable, or you are not happy with the idea. X-ray treatment on its own would not be as good in your case. Neither would drug treatment on its own. Coring out the breast tissue would not give a safe margin. Re-building the breast with an implant at the time of mastectomy is often risky from the point of view of healing.
Before the operation
Stop smoking and get your weight down. (See Healthy Living). If you know that you have problems with your blood pressure, your heart, or your lungs, ask your family doctor to check that these are under control. Check you have a relative or friend who can come with you to hospital, take you home, and look after you for the first week after the operation. Bring all your tablets and medicines with you to hospital. On the ward, you may be checked for past illnesses and may have special tests, ready for the operation. Many hospitals now run special preadmission clinics, where you visit for an hour or two, a few weeks or so before the operation for these checks. You should already have met the Breast Specialist Nurse. She will continue to help you during and after your hospital stay.
After - In Hospital
You will be able to drink within an hour or two of the operation provided you are not feeling sick. The wound has a dressing which may show some staining with old blood in the first 24 hours. The dressing will be exchanged for a clean one which stays until the drain tubes are removed after 4 to 5 days. You will probably have a drip tube in an arm vein and also one or two fine plastic drainage tubes in the skin near the wound. There is some discomfort on moving rather than severe pain. You will be given injections or tablets to control this as required. Ask for more if the pain is still unpleasant.
You will be expected to get out of bed the day after the operation, despite the discomfort. You will not do the wound any harm, and the exercise is very helpful for you. The second day after the operation you should be able to spend most of your time out of bed and in reasonable comfort. You should be able to walk slowly along the corridor. By the end of one week the wound should be virtually pain free. There will probably be stitches or clips in the skin. They will be taken out in 7 days or so. Sometimes the wound is held together underneath the skin with stitches that just melt away and do not need further attention. The drain tubes are removed in 4 to 5 days depending on the amount of drainage. Do not be disappointed if the drainage actually increases after 3 days or so. You can wash the wound area as soon as the dressing has been removed. Soap and tap water are entirely adequate. Salted water is not necessary.
The wound gradually improves for one to two months after the operation. You may be fitted with a soft sponge filling for your bra to give you some shape until a more permanent filling can be fitted when the wound has settled down. A check up will be arranged for a week or so after you leave hospital. The results from the examination of the breast tissue will be available then. You will be informed about deciding on any further treatment. The nurses will advise about sick notes, certificates etc.
After - At Home
You are likely to feel very tired and need rests 2 to 3 times a day for a week or more. You will need to continue arm and shoulder exercises to prevent getting a stiff shoulder. You will gradually improve so that by the time a month or so has passed you should be able to return to your usual level of activity. You can drive as soon as you can make an emergency stop without discomfort in the wound, i.e. after about 10 days. You can safely wear a seat belt. You can restart sexual relations within a month or so, when the wound is comfortable. You should be able to return to a light job after about 4 weeks and a heavier job within 8 weeks.
Complications are seldom serious. If you think that all is not well, please ask the nurses or doctors. Bruising may be troublesome. Occasionally some old blood collects under the wound, but this can easily be removed with a needle in the two or three weeks after you leave hospital. Occasionally the wound edge does not heal well in places. This settles down, but may take 3 or more weeks to do so. Infection is a rare problem and settles down with antibiotics in a week or two. Aches and twinges may be quite troublesome in the wound, shoulder and arm for up to 6 months. Occasionally there is a numb patch in the skin of the armpit and down the inside of the upper arm. This patch slowly lessens in size but may always be present. There may be some swelling of the arm.
The mastectomy operation is much less of an undertaking than was the rule 10 or more years ago. Patients are usually surprised how little discomfort there is. However it may take a year or two before they feel comfortable about having had a mastectomy. Details of further treatment, including possible rebuilding of the breast, will be discussed with you and your surgeon. These notes should help you through your operation. They are a general guide. They do not cover everything. Also, all hospitals and surgeons vary a little. If you have any queries or problems, please ask the doctors or nurses.
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