Mastectomy in Toledo, including skin- and nipple-sparing surgery

When mastectomy is recommended

For most early-stage breast cancers, long-term survival is the same with lumpectomy plus radiation as with mastectomy. Mastectomy is more likely to be recommended when:

• There are several separate areas of cancer in the breast
• The cancer is large compared with the size of the breast
• Radiation is not an option, for example after earlier radiation to the chest
• Cancer cells remain at the margins after one or more attempts at lumpectomy

When mastectomy is a choice

Some people who could have a lumpectomy choose mastectomy instead. Reasons include wanting to avoid radiation, wanting fewer follow-up images, or peace of mind. People with an inherited mutation such as BRCA1 or BRCA2, or a very strong family history, may consider removing both breasts to lower the risk of a new cancer. These are personal decisions. Dr. Mabry's role is to make sure you understand what each option offers, and what it does not, before you decide. High-risk assessment and prevention.

Types of mastectomy

Reconstruction, or not

Reconstruction can begin at the same operation as the mastectomy (immediate reconstruction) or months or years later (delayed reconstruction). It can use implants or your own tissue. Dr. Mabry works with plastic and reconstructive surgeons and coordinates with them before surgery, so the mastectomy and the reconstruction are planned as one operation.

Some people choose no reconstruction, and that is fully supported. A breast prosthesis worn in a mastectomy bra is another option at any time. If radiation is likely after surgery, it can affect the type and timing of reconstruction, which is one more reason to plan as a team.

Lymph nodes

For invasive cancer, a sentinel lymph node biopsy is usually done at the same operation to check whether cancer has spread to the lymph nodes under the arm. For DCIS treated with mastectomy, a sentinel node biopsy is often done at the same time, because it cannot be done afterward. Dr. Mabry has published on sentinel node mapping in DCIS, working with Dr. Armando Giuliano, a pioneer of the technique.

The day of surgery and recovery

Many people go home the same day or after one night in the hospital. Longer stays are more common when reconstruction with your own tissue is done at the same time. Small drains under the skin are often placed to collect fluid and are usually removed within one to two weeks. Most people return to light activity within a couple of weeks and to full activity in four to six weeks, longer with reconstruction. You will have clear instructions about arm movement, drains, and when to call the office.

1. Day of surgeryHomeThe same day or after one night in the hospital.
2. 1 to 2 weeksDrains outUsually removed within one to two weeks.
3. A couple of weeksLight activityMost people are back to light activity.
4. 4 to 6 weeksFull activityLonger with reconstruction.

After surgery

• Pathology review. At your follow-up visit, Dr. Mabry explains the final pathology and what it means for the next steps.
• Radiation is sometimes recommended after mastectomy, usually when the cancer was large or lymph nodes were involved.
• Medicines such as endocrine therapy, chemotherapy, or targeted therapy depend on the features of the cancer, and are planned with your medical oncologist.

Questions to ask about mastectomy

• Why is mastectomy recommended for me, and would lumpectomy be safe instead?
• Am I a candidate for skin-sparing or nipple-sparing mastectomy?
• Should I have genetic testing before I decide?
• What are my reconstruction options, and who would do it?
• Will I need radiation after mastectomy?
• How long will I be in the hospital, and how long until I can drive and work?

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