Another term you may have heard of is a lumpectomy, which is where the tumour is removed and a small amount of surrounding tissue. Technically a lumpectomy is a type of mastectomy.
People with high genetic risk of breast cancer, such as those with strong family history of breast cancer, or are BRCA positive (a type of gene that increases the risk of ovarian and breast cancer) may opt to have a preventive mastectomy or double mastectomy. There have been a few famous women in the last decade who have had preventative double mastectomies due to their genetic risk, prompting an increase in this type of pre-emptive surgery.
For some people, they may have been recommended a lumpectomy, but due to the nature of the tumour, or their breasts, a mastectomy may be more beneficial. Women with small breasts, for example, may more be left with enough breast tissue after a lumpectomy; therefore a reconstructive mastectomy would be deemed more appropriate.
A single mastectomy is the removal of a single breast, typically the breast where the tumour resides in. Low-grade breast cancer or low genetic risk of breast cancer will usually lead to a single mastectomy or lumpectomy.
Double Mastectomy or Bilateral Mastectomy
A double mastectomy, on the other hand, is the removal of both breasts. A double mastectomy is usually requested if the tumour has spread to surrounding breast tissue or the other breast, if the patient has a high familial risk of breast cancer, if the patient is BRCA positive, or if the breast cancer high-grade or recurrent.
Angelina Jolie is BRCA positive. BRCA is a type of gene that is inherited from parent to child. It is predominantly seen in the Ashkenazi Jewish population, and in other demographics such as in Iceland and Norway.
Many women may feel that they would prefer a double mastectomy, but research has found that unless indicated, having a double mastectomy may be unnecessary and doesn’t reduce breast cancer recurring versus current medication and monitoring. Your doctor will be able to give you more information if you think you may be suitable for a double mastectomy.
It is important to get your arm and chest moving again, but slowly and gently. You will most likely be prescribed some exercises to begin after your operation; it is important to stick to these, within reason, to ensure you gain full mobility back to your arm and chest area following your mastectomy.
Your mastectomy aftercare will depend on what type of mastectomy you had. In general, you may find the area a bit sore and bruised post surgery, and movement slightly limited. Fluid can also collect in the area, especially if you have had surrounding lymph nodes removed, so you may find yourself with drain tubes attached.
Mastectomy aftercare will also depend on what country you live in and what type of health care system is available. In some countries, people may find themselves staying in the hospital for up to a week after their mastectomy, while in other countries a simple lumpectomy may be a day procedure.
Reconstructive mastectomies are a great alternative for people who are self-conscious about not having a breast, and are well enough to have the procedure. Reconstruction surgery can also occur at a later date (after the mastectomy).
Depending on your levels of swelling, scarring and your energy levels as you heal from breast surgery, you might find you can build up to doing normal activities again. However, there may be some activities, such as driving after a mastectomy or even just lifting your arms, which will be difficult for some time due to the position of the surgery wound. Wearing comfortable recovery clothing and using compression garments can help you to reduce swelling and stay comfortable during recovery from mastectomy.
What's important when healing from breast surgery is to take things at your own pace and communicate with your doctor and surgical team. With the right support and enough time to heal, when you do go back to normal life or return to work after mastectomy, you'll be feeling fully recovered and ready to hit the ground running.
Lumpectomy is usually accompanied by other treatments such as chemotherapy and radiation to eradicate any remaining cancer cells. If you have a lumpectomy, your medical team will usually monitor the remaining tissue surrounding the lump that was removed, to see if any cancer cells are found there.
Sometimes you will be able to choose whether you'd prefer to have a lumpectomy or a total mastectomy, and sometimes your medical team will advise one or the other based on the size and position of the lump, the likelihood of needing further treatment, and how difficult it will be for you to heal from the surgery.
If you're thinking about whether you should opt for a lumpectomy or a mastectomy, the following factors might be important to you:
- How anxious will you feel about the cancer recurring in your remaining breast tissue?
- Do you have any genetic risk factors that make mastectomy a less risky choice (.e.g BRCA1 gene)?
- Is it important to you to keep your breast? How do you feel about the appearance of your breast?
- Will you be able to have breast reconstruction surgery to help you cope with the loss of your breast, or changes to its appearance?
If you're facing breast surgery, try discussing some of these questions with your doctor and surgical team. They should be able to help you weigh up the advantages of lumpectomy vs mastectomy and come to a decision that's right for you.