Overview of Mastectomy
Mastectomy is an operation performed to remove all of the breast tissue in the affected breast. It is often used to treat breast cancer, but in some cases, the cancer can return even after the mastectomy. This article will provide an overview of mastectomy and discuss the risk of recurrence after the procedure.
Definition of Mastectomy
A mastectomy is a surgical procedure to remove one or both breasts, most commonly as a treatment for breast cancer. This surgical procedure can be done using an open technique, in which an incision is made in the skin of the chest, or it can be done using endoscopic (minimally invasive) techniques. The extent of tissue removal will depend on the type and stage of the cancer and can include partial or complete removal of the breast. Some additional tissue such as lymph nodes may also be removed. Although not routinely done, some women may opt for cosmetic breast reconstruction after mastectomy. Additionally, prophylactic (preventive) mastectomies are sometimes recommended for women who are at high risk for developing breast cancer but who have no history of the disease.
Mastectomies can significantly reduce a person’s chance of having a relapse of their cancer; however, it does not provide absolute assurance that it cannot return in other areas in the body or through local recurrence at the operative field site. The likelihood of this occurring depends largely on particular risk factors associated with each patient’s cancer and related treatments such as chemotherapy or radiation therapy.
Following mastectomy surgery, regular follow-up screenings should be conducted to ensure early detection should there be any signs that recurrence has occurred outside the area that has been treated by surgery.
Types of Mastectomy
Mastectomies are a type of surgery to remove all or part of the breast in an effort to treat or prevent breast cancer. Depending on the individual’s situation, different types of mastectomy may be recommended.
The most common type of mastectomy is known as a simple or total mastectomy, in which all of the breast tissue is removed while leaving muscle and other tissues behind. This is usually the recommended procedure for women with early-stage breast cancer who have not yet gone through menopause, as it can reduce the risk of any remaining cancer cells regrowing and recurring that might otherwise spread to other organs throughout their bodies.
Partial (or segmental) mastectomies are also performed, usually when Breast cancer has just been diagnosed. This procedure removes part of the affected breast tissue while preserving as much normal tissue (i.e., noncancerous cells) from each side as possible. This can help reduce post-surgery scarring and deformity associated with more substantial surgeries involving complete removal of the entire affected breast area during reconstruction procedures in women who have already gone through menopause.
For women who are at high risk for developing breast cancer, such as those with a family history or another genetic mutation that can contribute to changing cells in this area, preventive mastectomy (also known as a “prophylactic” or “risk-reducing” mastectomy) can be a good option, though it still carries risks like all other surgeries do. The main goal here is to remove one’s chances of developing future tumors by removing some or all of the tissue associated with this risk before it becomes evident through screenings such as mammograms and MRIs that something else was there before any symptoms manifested themselves clinically.
Risk of Recurrence
After a mastectomy, the risk of your cancer coming back is an important consideration. You may feel a sense of relief that the physical tumor has been removed, but it’s important to understand the potential for recurrence. While the risk is low, it’s still worth being aware of the factors that can contribute to the recurrence of cancer following a mastectomy.
Let’s explore the risk of recurrence in more detail:
Factors that Increase Risk of Recurrence
Though mastectomy surgery for breast cancer is often highly effective in controlling the growth and spread of the disease, it is possible for the cancer to recur. Certain factors can increase the risk of this happening.
Those with higher than average risk of a recurrence include women whose tumor was larger than five centimeters (two inches) at the time of their original diagnosis or who had cancer in more than one part of their breast or lymph nodes. Also, if hormone receptor status (i.e., estrogen or progesterone receptors) found on the original tumor were positive, then there is an increased chance of recurrence.
In some cases, radiation therapy after a mastectomy may be recommended to decrease the chance that the breast cancer will come back – either in the breast area or in other parts of the body. Women at high risk for developing cancer in other areas (such as lymph nodes) may also get additional treatments such as:
- Chemotherapy
- Hormone therapy
- Targeted therapies to lower their overall risk for a recurrence.
It is important to discuss treatment options thoroughly with your doctor prior to undergoing any treatments and make sure all your questions are answered thoroughly so that you can make an informed decision about your health care choices that best align with your goals.
Factors that Decrease Risk of Recurrence
Following a mastectomy, various measures can be taken to help minimize the risk of cancer recurrence. Surgery, chemotherapy, radiation and hormone therapy are the most common treatments for breast cancer. Studies have shown that treatment tailored to the individual patient may reduce the chances of recurrence or spread of the cancer.
Certain factors have been linked to a decreased risk of recurrence after a mastectomy. These include:
- The complete removal of tumors without any malignant cells left behind
- Radiation therapy aimed at specific areas and not generalized across the entire body
- Chemotherapy tailored to an individual’s unique medical profile and tailored with respect to their age and overall health
- Endocrine therapies that reduce levels of hormones linked with malignancies, such as estrogen
- The use of bisphosphonates that can prevent bone metastases making tumors more treatable
- Surgery in women who are under 45 years old
Understanding these factors is important in developing an effective plan for decreased risks. However, it’s also advised that any individual discuss their personal risk factors with their doctor before considering any course of action as different individuals will have different approaches to achieving optimal outcomes.
Treatment Options
After a mastectomy, treatment options may vary depending on the type of cancer, its stage and if it has spread. Generally, most cancer patients will have additional treatments such as radiation therapy and/or chemotherapy following surgery. In some cases, hormonal therapy or targeted therapies may be required as part of the treatment plan.
In this section, we will discuss the various treatment options available and their associated risks:
Surgery
Surgery is generally the first line of treatment for breast cancer, and may be recommended at any stage. The most common procedure used to treat breast cancer is the mastectomy, in which all of the breast tissue is removed. Depending on the size and stage of your cancer, you may also have lymph nodes removed for further testing.
Other less-invasive procedures such as lumpectomy or partial mastectomy may be recommended to remove only a portion of the breast tissue. These procedures may be recommended if a woman prefers not to have a full mastectomy, or if her cancer does not require it. This depends on factors such as tumor size, location, and type/grade of cells present. Radiation therapy (such as with X-ray beams) may also follow other types of surgery in some cases to ensure that all cancerous cells are removed.
No matter what type of surgery is chosen, there is always a chance that some residual tumor cells remain in the body after surgery (known as “marginal disease“). Cancer can recur after any form of surgery depending on its severity before treatment began and whether any remaining cancer cells were completely eradicated with treatments such as chemotherapy or radiation therapy. As with all other forms of treatment for breast cancer, it is important to talk with your doctor about your individual case and prognosis before beginning treatment.
Radiation
Radiation therapy, also referred to as radiotherapy, involves using high-energy beams of radiation to target and destroy cancer cells. Radiation therapy may be used alone or in combination with other treatments, such as surgery and chemotherapy, depending on the type of cancer and its stage.
After a mastectomy, radiation therapy may be used if the cancer has spread to additional lymph nodes or there is evidence that it has recurred. Radiotherapy can be used either before or after chemotherapy. It is sometimes recommended after a lumpectomy if there are concerns that not all of the cancerous tissue was removed during surgery. Radiation works by damaging the DNA within the cancer cells, making them unable to divide and reproduce further.
The radiation is targeted at specific areas within the body where it will do the most good while limiting damage to healthy tissue. Localized radiation can have fewer side effects than more systemic treatments such as chemotherapy or immunotherapy but can still cause fatigue and skin irritation in some patients at the site of treatment. Long-term side effects from an excessive amount of radiation could include:
- Heart disease
- Secondary cancers
However, this is rare for individuals receiving a typical dosage for breast cancer treatment.
Chemotherapy
Chemotherapy refers to the use of medication to treat cancer by targeting rapidly dividing cells, either those in the tumor itself or in other areas. The form of chemotherapy recommended for a woman with breast cancer who has had a mastectomy is usually an adjunct to surgery. The goals of chemotherapy for breast cancer after a mastectomy are:
- To reduce the risk of early recurrence, especially in women classified as high risk due to specific factors.
- To slow down any distant metastases (metastatic disease).
- To decrease the likelihood of needing additional treatments such as an additional surgery or radiation.
The type and amount of chemotherapy administered will depend upon individual factors based on their disease stage, size and type. These medications can be delivered orally or through intravenous infusion and include various combinations such as:
- an anthracycline (Adriamycin®) plus cyclophosphamide (Cytoxan®),
- Taxotere® plus cyclophosphamide, or
- Femara® plus Aromasin®.
Chemotherapy is usually given over several months, with treatments becoming less frequent as time goes by. It can have side effects varying from mild to serious including fatigue, nausea/vomiting and hair loss. Patients should speak to their healthcare team about any concerns they may have about starting this treatment option so that potential side effects can be discussed beforehand and their individual chemo plan tailored accordingly.
Prevention
After a mastectomy, the risk of cancer coming back can greatly reduce. As such, there are several preventative measures one can take to reduce their chance of the cancer returning. This includes:
- Lifestyle changes
- Regular medical exams and screenings
- Post-operative follow-ups
Furthermore, there are certain medications one can take to help prevent the return of cancer. Let’s explore these preventative measures in more detail.
Regular Check-Ups
Even after a mastectomy, regular check-ups with a healthcare provider are important for early detection of cancer recurrence. Your doctor will conduct an exam and may order imaging tests such as a mammogram or MRI to get a better view of the area in the breast that saw treatment and changes. These images may also be used to detect any possible signs of recurrence, such as lumps or tumors. Depending on your history, your doctor may also take new tissue samples or biopsy areas around the surgical wound to rule out recurrence.
For some women, intensive follow-up care may also involve:
- Hormone therapy
- Medication, including radiation and chemotherapy
Usually, medications are administered with the goal of decreasing inflammation and encouraging healing instead of targeting any existing cancer cells in the body, even if they remain undetectable at the time. Your doctor can help you determine the best course for your individualized situation for lasting wellness results after treatment for breast cancer.
Healthy Lifestyle
Leading a healthy lifestyle is one of the most important things you can do to help prevent cancer from returning after a mastectomy. Eating nutritious, balanced meals and exercising regularly will not only strengthen your immune system, but also help boost your overall health and wellbeing. Incorporating some of the following tips into your routine can be beneficial as part of reducing your risk for recurrence:
- Incorporate an abundance of fruits and vegetables into your diet. Choose organic whenever possible to reduce exposure to pesticides and toxins.
- Cut back on sugary drinks, processed food and red meats – these are all carcinogenic foods which are linked to increasing your risk for cancer cells.
- Make sure you are getting enough essential vitamins and minerals. A balanced diet along with exercising each day should provide you with clear guidance on what nutrients you may be missing in order handle stress while also promoting cell growth and regeneration.
- Drink plenty of water throughout the day to hydrate cells and flush out toxins, aiding general wellbeing and keeping bodily processes running smoothly.
- Stay active daily; this could involve yoga classes, jogging or simply taking short walks each day in nature – all these activities contribute to strengthening immune systems, reducing tension levels as well as triggering greater creativity flows.
Genetic Testing
Genetic testing is available to determine your risk of developing breast cancer and can help confirm an earlier diagnosis if the cancer returns after a mastectomy. Genetic testing may provide insight into your overall risk of developing breast cancer as well as any other types of mutation-related health issues you may be at risk of having.
Genetic testing involves providing a sample of your DNA to a laboratory, which will then analyze the cells and look for possible genetic mutations that could be associated with an increased risk of developing cancer. Depending on the tests used, results vary from very low to very high risk, so it is important to speak with your doctor or healthcare team before deciding what course of action to take.
Support
Dealing with a cancer diagnosis, and the treatments that may ensue, can be a very stressful and emotional experience. Knowing that you have support can make a tremendous difference in this journey. It is important to find help and companionship along the way.
This section will cover all the different sources of support available to those going through a mastectomy:
Support Groups
A cancer diagnosis can bring a wide range of emotions. If you’re dealing with the issue of a recurrence after a mastectomy, you might find it helpful to join a support group with others who understand your experience.
Support groups can offer many benefits, including:
- A safe place to share experiences and emotions
- Answers to questions from people who have had similar experiences
- Information about treatment options and other resources
- Comfort from being with people who are facing similar challenges
- A chance for family members and friends to ask questions about their loved one’s cancer journey
These groups may be conducted in person or online. Ask your doctor or nurse if there are any such groups in your area, or look for them through local hospital and community organizations. Also, many national organizations such as the American Cancer Society provide support opportunities specifically for breast cancer patients, as do some online communities. You don’t have to go through this process alone; there is help available to assist you during this difficult time.
Online Resources
Fortunately, there are many online resources available to help those with a history of breast cancer. A variety of organizations offer support in the form of workshops and seminars, support groups, and discussion boards for sharing experiences. Additionally, there are numerous websites dedicated to raising awareness about cancer and providing helpful information about living with the disease.
Many oncology specialists suggest joining a local support group or participating in an online forum devoted to breast cancer survivors or to a specific type of cancer. Such discussions can provide emotional support and allow individuals to learn from the experiences of others facing similar issues. Additionally, some agencies provide one-on-one counseling for individuals coping with a diagnosis or dealing with recurrence after a mastectomy.
The American Cancer Society has several programs dedicated to breast cancer survivors. Their Reach To Recovery program offers volunteer visitors who can provide emotional support and answer questions, while their Look Good…Feel Better program teaches beauty techniques customized for people undergoing treatment for the disease. The Cancer Hope Network links patients with trained volunteers who have had personal experience with cancer, allowing them to offer emotional help as well as insights into available resources like clinical trials or additional treatments options. The American College of Surgeons’ Commission on Cancer also offers resources specifically designed for people coping with breast cancer recurrence following mastectomy surgery such as survivor-to-survivor pairing programs that link experienced survivors who understand what you are going through together by telephone or email interaction.
Mental Health Support
Cancer affects all aspects of a person’s life and may cause feelings of sadness, anxiety, fear, and anger. It’s important to seek help from mental health professionals if symptoms extend beyond a few weeks. Clinical psychologists and psychiatrists can assess your needs and work with you to develop personalized coping strategies.
Support groups are also beneficial in providing emotional support during this difficult time. Look for local support groups online, which are run by health care professionals who can offer expert advice about managing emotions after cancer treatment and provide access to resources for further assistance. One-on-one counseling sessions with a skilled psychotherapist can also be beneficial; he or she can work with you to develop unique strategies for managing stress, anxiety or depression associated with the risk of recurrence.
Social workers are available in many hospitals and other settings who can provide additional information about resources in the community that may assist in recovery from the emotional toll of cancer recurrence and offer referrals to additional types of therapy such as art therapy or yoga. Seek out these comforting sources of support regularly so that you have access to these much needed outlets if needed during times of distress.