Types of risk-reducing breast surgery
To help you understand what is involved in this type of surgery you should be able to discuss it with a breast surgeon and a clinical nurse specialist.
You may have been referred to the surgeon by your GP or by the genetics clinic. The surgeon and nurses usually work as part of a team of health professionals who will look after and support you throughout the whole process of deciding whether or not to have the surgery. As well as the breast surgeon and the clinical nurse specialist you may also see:
a clinical geneticist/genetic counsellor
To help you understand what’s involved it can sometimes be useful to talk to other women who’ve had risk-reducing breast surgery. Your surgeon or specialist nurse may be able to put you in contact with other women.
The breasts are made up of fat, connective tissue and glandular tissue, which contains lobes. A network of ducts connects the lobes to the nipple.
Under the skin, a ‘tail’ of breast tissue extends to the armpit (axilla). The armpits contain a collection of lymph nodes (also called lymph glands), which are part of the lymphatic system. There are also lymph nodes just beside the breastbone and behind the collarbones.
Risk-reducing mastectomy is major surgery involving a general anaesthetic. During the operation the surgeon removes the entire breast with or without the skin and/or nipple. The lymph nodes and underlying muscles of the breast are not removed.
However, it isn’t always clear where the breast tissue ends and other tissue begins; particularly at the lower part of the breast and the part that extends into the armpit (the axillary tail).
This is why it can’t always be guaranteed that all the breast tissue has been removed. The amount of breast tissue that is left behind after risk-reducing mastectomy can vary.
Bilateral risk-reducing mastectomy without reconstruction takes about two hours. The operation takes longer if it includes breast reconstruction.
Different types of surgery can be used. Each woman will be assessed individually so that the most appropriate surgical option is recommended by the breast surgeon. Your surgeon should be happy to fully discuss your operation with you.
Some of the different types of surgery currently used are listed here. It’s important to discuss these in detail with your surgeon. Your surgeon might use slightly different terms to those used here and new techniques might become available that are not mentioned.
Total mastectomy is also sometimes called a simple mastectomy. This involves removing as much of the breast tissue as possible. The nipple (which contains breast ducts), the areola (the coloured skin around the nipple) and most of the skin covering the breast are removed. It can’t be guaranteed that all the breast tissue has been removed; but only a very small amount will be left after this operation.
This involves removing as much of the breast tissue as possible including the nipple and the areola. The skin covering the breast is not removed, which helps to form the shape of the breast when reconstruction is done.
This involves removing as much of the breast tissue as possible usually through a cut (incision) in the fold under the breast, leaving in place the skin, the nipple and the areola.
It may be possible to keep the nipple and your surgeon will discuss this with you before the operation. However, keeping the nipple and areola means that a small amount of breast tissue is left behind. There is a very small risk of cancer developing in that tissue, so you should discuss with your surgeon the risks and benefits of keeping the nipple and areola in your situation.
Tests on the removed breast tissue
After your surgery, samples of the breast tissue that has been removed are sent to a laboratory and examined under a microscope. This is to see if there are any changes in the cells that might be the early stages of cancer. If any cancerous changes are found your doctors will talk to you about any treatment you might need.
Recovery after risk-reducing breast surgery
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During the operation you will have a drip (infusion) into a vein in the back of your hand or in your arm. The drip is to keep you hydrated and will continue for a short time after the operation until you’re drinking enough, when it will be removed.
After your operation you may have some pain and discomfort around the wound. This may continue for several weeks. You’ll be given painkillers and it’s important to take them regularly as prescribed. Let your nurses and the doctor know if you still have pain so that more effective painkillers can be given.
Wounds and drainage tubes
The mastectomy wound(s) will be covered by dressings.
There may be a drainage tube coming out of the wound(s) attached to a small container to collect any excess blood/body fluid. This will be removed once the drainage has slowed. This is usually within a few days of the operation. After a risk-reducing mastectomy (with/without breast reconstruction) the wounds should heal completely within six weeks of surgery.
Time in hospital
How long you stay in hospital, and your recovery time, depends on the type of surgery you have. The length of stay in hospital after mastectomy without reconstruction is quite short; usually a few days. If you have reconstruction your stay will be longer and determined by the type of reconstruction you have (this is explained in much greater detail later in this booklet).
Getting back to normal
Getting back to normal can take a while and will depend on the type of surgery you’ve had. Some women will have numbness or pins and needles across their chest for some time, but this is usually temporary.
Many women want to know when they can get back to doing everyday things like driving, carrying the shopping or gardening. This will vary depending on the type of surgery you’ve had and how you feel. It’s a good idea to discuss this further with your surgeon or breast care nurse.
It’s usually fine to start driving again when you feel that you could safely do an emergency stop or move the steering wheel around suddenly, if necessary. Some women find that this is possible within a few weeks of the surgery and others find that it takes longer. Some insurance companies have specific guidelines about when you can drive again after an operation, so you should check this with your car insurance company.
If you decide not to have breast reconstruction and want to know more about breast prostheses, bras and clothes after surgery, there is information available from Breast Cancer Care.