Why Have A Mastectomy For Dcis
Mastectomy involves removal of the whole breast and is usually recommended if the DCIS affects a large area of the breast, if it has not been possible to get a clear area of normal tissue around the DCIS by wide local excision, or if there is more than one area of DCIS. The mastectomy can be either partial (simple) or total (radical). Radical mastectomy involves removal of all visible breast tissues including skin, nipple, areola and fatty tissue down to chest muscle. In contrast, simple mastectomy removes only the outer layer of skin and some fat from the breast. This leaves behind a small pocket below the remaining skin which may contain scar tissue left over from previous surgery. After the operation women have to wear a supportive bra for 6 weeks, then a compression garment for another 6 weeks after that.
Women with ductal carcinoma in situ who undergo mastectomy are at increased risk of developing invasive cancer on the other side of the breast within 5 years, but this does not happen very often. It is important to note that women diagnosed with DCIS should always consult their doctor about further treatment options. Most doctors will recommend close monitoring and follow-up visits every 3 months for 2 years. If no changes occur during these visits, or if the DCIS turns into an invasive cancer, additional tests such as mammography and MRI scans may be recommended. Thereafter regular checkups are not necessary. Women who choose to continue surveillance may need to consider genetic testing and/or BRCA gene screening.
The most common reason for undergoing a mastectomy is to remove a lump or thickening in the breast, known as mass or phyllodes tumor respectively. These lumps tend to appear suddenly and grow rapidly. They may cause pain and discomfort when touched. Lumps associated with fibrocystic disease, or cysts, also require surgical intervention because they can become infected. Other reasons include trauma to the breasts due to injury, radiation therapy, infection, obesity and hormonal imbalance. Some medical conditions such as scleroderma can affect the size and shape of the breasts and sometimes make them difficult to measure accurately.
Breastfeeding mothers should know that mastectomies do not interfere with breastfeeding. However, the mother’s milk supply may decrease slightly following the procedure. Also, antibiotics must be used before and after the surgery to prevent any potential infections from spreading throughout the body.
Loss of sensation in the nipples and/or breast occurs occasionally following a radical mastectomy. Nipple sensitivity returns naturally in several days to a few weeks. Nipple numbness can be relieved somewhat with topical medications such as benzocaine.
Radical mastectomies leave scars under the arm where the lymph nodes were located. Scars left over after a simple mastectomy are smaller and hidden under the skin. Both types of scars fade away completely within several months.
Risks Associated With Breast Cancer Surgery
Patients considering breast cancer surgery should discuss all available treatments with their health care provider prior to making any decisions regarding surgery. Following is a list of risks commonly associated with breast cancer surgeries:
Blood clots – blood clotting disorders increase the likelihood of forming blood clots after surgery. Blood thinners must be taken preoperatively and postoperatively to reduce the chance of clot formation.
Surgical complications – infection, bleeding, nerve damage, poor wound healing, seromas (fluid collections), asymmetry/unexpected findings, delayed recovery
Cosmetic concerns – loss of nipple, altered appearance, unevenly distributed nipple pinches, asymmetrical breasts, deformities such as inverted nipples, rippling, dimpling, wrinkling, loss of feeling, unsightly scarring, painful scars, drooping breasts, asymmetrical breasts
Infection – bacteria, viruses, fungal spores, yeast, mollusks, parasites, and others
Pregnancy related problems – pregnancy induced hypertension, hemorrhage, premature labor, placenta previa (low lying placenta), preeclampsia, eclampsia, placental abruption, gestational diabetes, miscarriage, stillbirth
Unplanned pregnancy – ectopic pregnancy, abortion, birth defects, prematurity, low birth weight babies, neonatal death, fetal abnormalities
Tumors – fibroadenoma, adenoma, liposarcoma, leiomyosarcoma
Neuropathy – peripheral neuropathies, central nervous system tumors, brain metastases
Dry eye syndrome – chemical burns, dry socket, eyelid necrosis, Stevens-Johnson syndrome, toxic epidermal necrolysis, corneal ulcers, conjunctivitis, glaucoma
Allergic reactions – swelling of lips and tongue, breathing difficulties, severe nausea, vomiting, rash, hives, difficulty swallowing, mouth sores, burning eyes, blurred vision, blurry vision
Anesthesia risks – allergic reaction to anesthesia, respiratory depression, oxygen deprivation, desaturation, pulmonary edema, cardiac arrest, stroke, arrhythmia, heart attack, sudden death
Other risks – blood transfusion, fluid buildup, pneumonia, urinary retention, dehydration, constipation, electrolyte imbalance, deep vein thrombosis, leg cramps, ileus (bowel obstruction), hypothermia, shock, sepsis, fever, chills, pressure wounds, cellulitus (swelling caused by trapped air), amputation, lymphedema (legs), hernia, paralysis, organ failure, internal injuries.
Prevention Of Postoperative Complications
To help patients better understand how to prepare themselves for breast cancer surgery, the American Society of Plastic Surgeons developed a handout called “Your Guide To Surgical Care.” This informational guide provides information about what to expect during hospitalization, medications you’ll take, and helpful hints to assist you in preparing for your operation. The document covers both simple and complex mastectomies. Patients should be aware of the possibility of surgical complications such as blood clots, infections, and even death.
Simple tips to lower the chances of experiencing a complication include:
Take time off work. Tell your employer why you’re going to have surgery and give him advance notice. Ask him to keep your job open until you return to work. You may be eligible for short term disability insurance benefits while recovering from surgery.
Wear loose fitting clothing made out of breathable fabric rather than cotton. Wearing tight clothes restricts circulation, leading to a higher incidence of blood clots. Loose, comfortable garments allow easy movement of the arms and legs, helping to promote good circulation.
Avoid smoking and drinking caffeinated beverages 12 hours before surgery. Smoking increases the risk of blood clots whereas caffeine can lead to irregular heartbeat, dilating veins, and dizziness.
Consume adequate amounts of protein and calories the day before your surgery. Protein helps maintain healthy red blood cells and prevents bruising. Calorie intake boosts metabolism and keeps you energized.
Eat foods high in fiber, antioxidants, and omega-3 fats. Eating a balanced diet rich in fruits, vegetables, and lean proteins lowers cholesterol levels, reduces stress, and promotes overall well being. Omega-3 fatty acids found in fish oil are essential for maintaining optimum cardiovascular and immune function.
Drink plenty of water. Drinking fluids helps flush toxins through the kidneys and improves urine flow. Dehydration leads to headaches, fatigue, and confusion. Avoid alcohol 48 hours before surgery. Alcohol dehydrates the patient and makes the patient sleepy, increasing the risk of falling.
Bring someone along who knows you really well. Someone who will act like your personal support person, keeping track of things like appointments, medication schedules, etc., especially if you are elderly or disabled.
Have someone drive you home immediately after surgery. Your surgeon may want you to stay overnight in the hospital following your operation. Having someone drive you home right after surgery and set up your home so that you don’t have far to walk helps speed up your recovery process.
Ask questions. Ask your physician anything you might think of. Don’t be shy; ask lots of questions. Be sure to find out everything you’d like to know about your operation, its expected outcome, and recovery period.
Get enough rest. Sleeping less than 4 hours per night puts your body into a state of catabolism, slowing the healing process. Sleep peacefully without worrying about waking up to go to bathroom.
Exercise regularly. Exercise stimulates production of endorphins, hormones produced in the pituitary gland that produce feelings of well-being. Regular exercise also relieves anxiety and stresses, allowing faster recovery times.
Don’t smoke. Smoking has many serious effects on the lungs, heart, and general health. Cigarette smoking causes lung inflammation, impairs wound healing, delays bone growth, weakens bones, raises the risk of infection, and aggravates asthma symptoms.
Receive nutrition through intravenous feeding tubes. Enterally feeding yourself through a tube inserted directly into your stomach greatly decreases your ability to heal properly. Nurses can teach you how to feed yourself enterally.
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