Breast Removal (Modified Radical Mastectomy): A winning approach to fight breast cancer

Breast removal or breast surgery is the main process in treating breast cancer.

After I finished my 6 cycle chemotherapy session, the big lumps are no longer visible nor feel. It is necessary to do the next step as soon as possible. To do it, I needed to choose between breast removal (mastectomy) or breast conservation ( lumpectomy) My oncologist referred me to a surgeon to discuss what kind of breast surgery is best for me. 

Lumpectomy or mastectomy? Which procedure should I choose?

Breast removal (Mastectomy) or breast conservation (lumpectomy) Which is way better?

The size of the lumps before chemotherapy matters in deciding what you will take on your surgery. The doctor advised me to take a mastectomy. Meaning my whole left breast will remove. It is not possible to preserve my breast or lumpectomy because of the following condition:

• The lump before chemotherapy is large enough and not suited for conservation. It is 6×2.5x3cm with tiny internal calcification.
• The margin of tissue that needs to consider. It has to remove after the size of the lump.
• The size of the breast. It is not advisable for those with smaller breasts size with big lumps.
• The outcome after lumpectomy or breast conservation. – After assessing the lumps, breast conservation is not applicable because it will leave a little muscle in the breast resulting in a displeasing look. 

After explaining the process of breast removal, I decided to choose “Modified radical Mastectomy”.

You may want to read about a common lab test to distinguish what kind of breast cancer you have before proceeding chemotherapy. Read this.

What is modified radical mastectomy 

It is a process of removing the entire breast including breast tissue and lymph nodes of the underarm. This is necessary for those with invasive breast cancer so that the lymph nodes can be examined. It helps to identify if the cancer cells may have spread beyond the breast. 

In my case, twenty-one (21) lymph nodes are removed and dissected. 

What are the procedures before breast removal or surgery?

I was confined in the hospital for four days to prepare for surgery. On the first day, I was given a gown and instructed to take a bath. The nurse inserted an intravenous infusion (IV) at my right hand since the tumor is at the left breast. They conducted a blood test, ECG, and mammogram. It is important that all blood tests and ECG are in the normal range to continue the process. 

Inside the Operating Room

I’m very nervous at that time. This is my first time entering an operating room. Everything should be sanitized. Even your underwear should be removed. This is a protocol to prevent bacteria that can cause infection. I was introduced to the staff. They are nurses, anesthesiologists, doctors, and interns. I was asked if I’m ready to undergo an operation. They checked my vital signs and immediately sedated. It was given through IV. And suddenly I was dozed off.

When I opened my eyes, I was in a recovery room. I never felt anything hurt from my chest after breast removal. After they found out that I’m awake, they transferred me to my room immediately. It was a 2-hour operation and I slept for 3 hours.

Understanding the Breast Removal Process ( Mastectomy)

After my operation, the doctor explained what they did when I was asleep.

The incision is about 13cm long. From the middle of the chest to the half of the underarm. All breast mass was removed. Nipple and skin were not spared. So, totally it was a modified radical mastectomy. The doctor explained that they “clean” all the cells in the breast, and removed 21 lymph nodes at underarm. Dissecting and examination of the removed parts are included in the package. The examination of the tissue includes:

-HER2 Neu

-ER/PR

– Dissecting and examining the lymph nodes.

It was found out that out of 21 lymph nodes one (1) got positive. So, I need to undergo radiation therapy.

In their examination, it was discovered that the cancer cells are Her2 Positive. It was previously known as HER2 negative but it turns out from the large specimen that it was positive. We need to add an additional plan to approach this turnaround.

Discharged at the Hospital with the drain

A drain is a thin PVC tube with holes at the end. During surgery, the cavity is created after the tissue was removed. The tube is placed around the incision to collect the fluid after an operation. The end of the tube is attached to a collecting bag which allows the fluid to comes out from the wound. The fluids are measured to recognized the healing progress of the wound.

The drain is important because of cut tissues during operation leak fluid after surgery. If this fluid is not collected it may be built under the skin and potentially cause problems like infection. The drain also helps to minimize any bruising in the area. It helps to heal the wound and reduce discomfort in a closed cavity.

All the collected fluid should be recorded and will be the basis of the surgeon to decide if the drain is safe to remove.

At first, the collected fluids are 100 cc per day. You need to empty the drain 2 to 4 times a day. The color of the fluid may be bright red in the early days but gradually change to a straw color after a few days.

If you notice that there’s an increase of fluid in the drain, it is a sign that you’ve been too active and need to take it easy for a few days.

At Home after breast removal ( Mastectomy)

It’s important to take a rest after mastectomy. It may take a few weeks to recover and heal.

Here are some guidelines you can do at your home.

1. Rest. Your body is shocked by the procedure. It is better to rest for weeks to gain your strength and allow the wounds to heal. Reduce your workload and let the family members do the chores.

2. Take your medicine. For some instances, there is numbness and pain around the chest wall and incision. Medicine that is advised by a doctor can help you relieve this pain.

3. Don’t take a bath until the drain has been removed. A sponge bath is safer while your drain is still attached to your body.

4. Little by little exercise. It is necessary to have your exercise after surgery to prevent stiffness and to keep your arm flexible. Limit your move if you’re doing exercise unless advised by your doctor.

5. Recognize some signs of infection. Your surgeon would explain how to recognize the signs of infections like redness or swelling at the side of the affected area.

Be aware of possible problems after breast removal or mastectomy

Breast cancer surgery is safe but there are some risks for a possible problem.

• Infection. If there is redness and swelling around the incision with puss and a foul smell around the drainage.
• Lymphedema. The swelling of arms and hand caused by the removed lymph nodes under the arm. Generally, it may go away on its own but you can do some treatments like draining the liquid, putting some compression bandages to swell it down, arm exercise and skincare
• Hematoma or building up of blood under the skin
• Seroma or building up fluid under the skin. It may cause swelling and need a doctor to drain the area.

How do you feel after a Month of having a Mastectomy?

• They call it “phantom sensations” or “phantom pain”. It is a weird crawly sensation as the nerves grow. There are itchiness and pressure that may discomfort you. The doctor 

may give analgesics to address the pain. NSAIDs and Opioids may also help to treat the nerve injury.

• Continue the regular exercise routine to keep your arms limber.