What is a Mastectomy?
A mastectomy is a surgery to remove all breast tissue from a breast to treat or prevent breast cancer. A mastectomy is used if you have breast cancer or are at a very high risk of developing it. You may have a mastectomy to remove one breast (unilateral mastectomy) or both breasts (bilateral mastectomy). Some lymph nodes from the underarm on the side of the tumor are usually removed as well to see if cancer has spread beyond the breast. However, lymph nodes are usually not removed when mastectomy is done to prevent breast cancer.
Dr. Schwartz can offer his patients the following types of mastectomies:
- Simple or Total Mastectomy – for women NOT interested in reconstruction
- Aesthetic flat closure – really a variant of the simple mastectomy, where Dr. Schwartz ensures that you are left as flat as possible without any excess skin or fat
- Nipple-sparing Mastectomy – for women planning on immediate reconstruction using implants or flaps, preserving their skin and nipples
- Wise-pattern Mastectomy – for women with large, droopy breasts, the mastectomy is done through an incision that is usually used for breast reduction. Often the nipple will need to be removed and reconstructed with this approach, but Dr. Schwartz has innovated a way to preserve it in most patients.
- Goldilocks Mastectomy – for women not interested in extensive breast reconstruction but not wanting a flat chest either
Who Needs Mastectomy?
Women with early-stage breast cancer may be offered mastectomy. This is one treatment option versus breast-conserving surgery (lumpectomy) when only the tumor is removed, and the remainder of the breast is preserved. Women may choose mastectomy over lumpectomy to avoid radiation (usually recommended after lumpectomy) or to avoid mammography in the future if they are often called back for biopsies or 6-month follow-up mammograms.
Deciding between these two surgeries can be difficult but Dr. Schwartz will be able to explain both options and recommend the best treatment for you. Both procedures are equally effective for treating and preventing breast cancer recurrence. There are benefits and drawbacks to both approaches which Dr. Schwartz will explain in detail which will allow you to make an informed decision about what works best for you.
Mastectomy and Reconstruction
Breast reconstruction is a surgery to restore shape to your breast and may be done at the same time as your mastectomy (immediate reconstruction) or many months later, after you have healed (delayed reconstruction).
If you’re faced with breast cancer, the last thing you want to worry about is your appearance. Dr. Schwartz understands that breasts are one of the most immediately recognized symbols of femininity, often irreversibly damaged from outdated surgical techniques. Dr. Schwartz has dedicated his career exclusively to breast cancer surgery and reconstruction to ensure his patients can look forward to preserving or even improving their breast appearance.
The latest mastectomy techniques, many of which Dr. Schwartz improved or invented, preserve breast skin (skin-sparing mastectomy) and nipples (nipple-sparing mastectomy), allowing for a more natural breast appearance after surgery.
When making decisions about having a mastectomy, you’ll want to think about whether you would also like to undergo breast reconstruction. Some people choose to have breast reconstruction surgery to restore the shape and appearance of one or both breasts. Others choose not to have reconstruction and may opt for a simple (or total) mastectomy (when all of the breast tissue, the skin of the breast, the nipple, and areola – the dark area around the nipple are removed) with an aesthetic flat closure (a surgical procedure that creates a smooth, flat chest wall). Prosthetic breast forms are an option for women who choose not to undergo breast reconstruction but want the appearance of having breasts under their clothes.
Most women who have a mastectomy are candidates for breast reconstruction surgery, although not all women are candidates for every type of reconstruction. Breast reconstruction can be done at the same time as the mastectomy (“immediate reconstruction”) or months or years later (“delayed reconstruction”). Dr. Schwartz will discuss which options are best for your individual situation.
Since Dr. Schwartz is the only oncoplastic surgeon in Gwinnet County (an expert in breast cancer removal and reconstruction), he can not only save you time and money but offer you the best possible results as well. By having Dr. Schwartz as the only surgeon for your cancer removal and reconstruction (versus multiple specialists requiring multiple surgeries), his surgeries are meticulously planned, taking into consideration the subsequent reconstruction providing you with the best aesthetic results requiring the least recovery and downtime. This is accomplished by providing all patients with immediate (done at the time of mastectomy) definitive reconstructions without planned additional surgeries.
Dr. Schwartz is an expert in breast cancer removal and immediate reconstruction, he can offer his patients the following types of immediate reconstructions after mastectomy:
- Implant Reconstruction
- Flap Reconstruction (your own tissue)
Breast reconstruction procedures are forever covered by your health insurance plan in most cases. The Women’s Health and Cancer Rights Act (WHCRA) of 1998 requires all group health plans and health insurance companies (including HMOs) that pay for mastectomy to also cover all stages of breast reconstruction.
Consultation and Procedure
During your consultation, Dr. Schwartz will discuss with you the various types of mastectomies, taking into consideration your goals and other considerations including your body type and shape and family history. He will also explain and set the right expectations for your surgical outcome. Thanks to Dr. Schwartz’s access to a private Outpatient Surgery Center, his patients can expect to have their total mastectomy and reconstruction scheduled immediately. Mastectomy, just like any other breast cancer diagnosis and treatment, is covered by health insurance companies.
When patients are NOT interested in reconstructive surgery and choose to undergo total mastectomy, the nipple and areola are removed along with all the excess skin to leave the patient as flat as possible. A drain is placed which is usually removed within ten days. This surgery is performed under general anesthesia and takes approximately 30 to 45 minutes for one side and 60 to 90 minutes for two sides depending on breast size. Surgery is usually performed at our Ambulatory Surgery Center and patients are discharged home the same day.
During your mastectomy surgery, Dr. Schwartz will sample the lymph nodes under your arm to stage your cancer and help other specialists decide whether you might need chemotherapy and/ or radiotherapy more accurately. Dr. Schwartz tries to minimize the number of lymph nodes removed, while still completely removing all cancer, to minimize your chances of developing lymphedema (swelling of the arm).
Recovery and Results
Recovery after total mastectomy takes approximately two weeks and any additional chemotherapy or radiation therapy required starts usually no sooner than four weeks after surgery depending on healing. Patients can be fitted for a prosthetic bra approximately three months after surgery if they choose to not undergo reconstruction.
Regardless of the type of mastectomy you have, the breast tissue and lymph nodes that are removed will be sent to a laboratory for analysis. The results of your pathology report should be available within a week or two after your mastectomy.