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If you have been diagnosed with breast cancer, your specialist will be able to tell you about all of the treatment options that are available and appropriate in your case. The right treatment depends upon the size of the tumour, the number of tumours, whether the cancer has spread to other parts of the body, and also your personal preference. No operation will be done without your consent.

The best option for you may be a mastectomy. A mastectomy is an operation to remove a breast, and most of the skin covering it, usually because it has been affected by cancer.

There are three types of mastectomy:

A simple mastectomy - which involves the removal of the breast tissue.
A radical mastectomy - which means the removal of the breast tissue, plus the muscles from the chest wall (however this is very rare).
A modified radical mastectomy - which means the removal of the breast tissue, plus the lymph nodes (small glands) from under the arm.
If you are going to have a mastectomy, your surgeon will advise you about the type of mastectomy you need.

In the majority of cases, a mastectomy is a safe and effective operation. It is normal to experience certain side effects, such as short-term pain and swelling, and you will have a scar. However, in some cases there can be complications, and in order to be fully informed it can be useful to know what these complications are.

If your wound site becomes red, more painful and inflamed, with a discharge, you may have a wound infection. This can be treated with antibiotics. People who have had all their lymph nodes removed or treated with radiotherapy are more at risk of developing a condition called lymphoedema. This means that there is a build-up of fluid in your arm, and it causes swelling, pain and tenderness in your arm and hand. Your nurse will tell you how to prevent lymphoedema with appropriate skin care and exercise, but if it does occur, it can be controlled with early treatment. Sometimes, once the wound drain has been removed, fluid can collect around the wound (this may be referred to as seroma), and it may need draining.

Speak to your specialist or cancer care nurse straightaway if you think that you may be experiencing any of these complications.

Why is it necessary?
A mastectomy operation is designed to remove all cancerous cells from the breast. It is very important to remove all the cancerous tissue, because if any cancerous cells are left behind, there is a risk that the cancer will spread to other parts of the body. A mastectomy is not always the most suitable course of action, but in many cases it has proved to be very effective in curing breast cancer.

A mastectomy should be performed as soon as possible, once a firm diagnosis of breast cancer has been made. Early detection and treatment of breast cancer improves the chances of a successful outcome, and full recovery.

How is it performed?
You may be advised to have chemotherapy (anti-cancer drugs) or hormone therapy (drugs to stop the hormones in your body that encourage breast cancer) before your mastectomy. These treatments can be used in some cases to reduce the size of the tumour, which makes it easier to remove, and reduces the amount of breast tissue which needs to be removed. They can also be used after the surgery, to prevent the cancer coming back.

Not everyone can benefit from hormone therapy, as only some breast cancers will respond to this type of treatment . Your specialist will test your cancer cells to find out. This can be done with a fine needle aspiration (FNA), which is a quick and simple procedure using a fine needle and syringe to take a sample of cells from the lump in your breast. The cells can then be tested at a laboratory.

Radiotherapy (focused beams of radiation to kill cancer cells) is often also used after surgery as way of ensuring that there are no remaining cancer cells.

The mastectomy is performed under general anaesthetic, which means that you are completely unaware of the operation and feel no pain. (However you will feel sore when you wake up after the operation.) A diagonal or horizontal cut is made across the breast, and the breast tissue is removed. Some of the lymph nodes are usually removed, so that the surgeon can check them for breast cancer cells. If cancer is found in the lymph nodes, they will need to be removed, and you may need further treatment, such as radiotherapy, after surgery.

Some people have breast reconstruction at the same time as their mastectomy, some have this surgery later on, and some decide not to at all. It is your decision, and your specialist will be able to discuss the options with you. Breast reconstruction is a procedure that makes a new breast to replace the tissue removed during a mastectomy. A silicone implant, or tissue from another part of your body (for example your abdomen or back), can be used to create a new breast.

Once the procedure is complete the cut is then closed up with stitches.

When you wake up after the operation, you are likely to feel very sore, but this pain can be controlled with painkillers. It is very important to tell your doctor or nurse when you are in pain, as they can adapt your medication accordingly. This is essential to your recovery after the surgery.

You will also have some tubes in place and it can help to know in advance why they are there. You may have a drip in your arm so that you can be given essential fluids until you are able to eat and drink again. You may also have one or more drainage tubes coming from the wound site (the area of your body that was operated on). These tubes drain blood and tissue fluid from the wound, to prevent them collecting and causing swelling or infection.

Your stay in hospital will depend upon the extent of your surgery, but it is normally between three and five days. Before you leave the hospital your specialist or nurse will talk to you about what to do when you get home. You are likely to need a lot of rest, although gentle exercises are recommended to relieve pain and stiffness, and to encourage healthy circulation in the area that has been operated on.

Your specialist or nurse will also discuss with you suitable bras and prostheses (bra inserts) if you have not had breast reconstruction. If this is the case you will be provided with a lightweight artificial breast shape (a cumfie) that you can put inside your bra. They will also be able to tell you how to look after your scar. If you want to know what your scar is going to look like after your surgery your specialist may be able to show you some photographs.

Recovering from a mastectomy can be an emotional time. Some people find it helpful to talk to others who have been through the operation, both before and after the mastectomy. You can get information about how to get in touch with others who have had a mastectomy, from organisations such as CancerBACUP (see Selected links) and from specialist breast cancer care nurses.

Blood supplies oxygen to the body and removes carbon dioxide. It is pumped around the body by the heart.
Body tissue is made up of groups of cells that perform a specific job, such as protecting the body against infection, producing movement or storing fa
Lymph node
Lymph nodes are small oval tissues that remove unwanted bacteria and particles from the body. Part of the immune system.
Radiation therapy uses x-rays to treat disease, especially cancer.
A mastectomy is an operation to remove a breast, and most of the skin covering it. It is usually done to treat or prevent breast cancer.
Anaesthetic is a drug used to either numb a part of the body (local), or to put a patient to sleep (general) during surgery.
Pain is an unpleasant physical or emotional feeling that your body produces as a warning sign that it has been damaged.
Inflammation is the body's response to infection, irritation or injury, which causes redness, swelling, pain and sometimes a feeling of heat in the af
Discharge is when a liquid such as pus oozes from a part of your body.
A drip is used to pass fluid or blood into your bloodstream, through a plastic tube and needle that goes into one of your arteries or veins.
Analgesics are medicines that relieve pain. For example paracetamol, aspirin and ibuprofen.
Antibiotic s are medicines that can be used to treat infections caused by micro-organisms, usually bacteria or fungi. For example amoxicillin, streptomycin and erythromycin.

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Crown copyright material is reproduced with the permission of the controller of HMSO and the Queens Printer for Scotland.



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