Mastectomy

A: Seromas typically subside on their own after about a month, but it can take longer and in some cases, 1 – 2 years. For some individuals, it may be normal to expect a small to moderate amount of “chronic” seroma to be present at the surgical cavity in the long term. If it does not cause any discomfort, chronic seroma may be left alone.

If the seroma causes pain or discomfort, restricting your range of arm movements, your doctor may insert a fine needle to drain out the fluid. This procedure is usually painless and safe. Repeated drainage may be required in some cases.

Other treatments for seroma include:

• Sclerotherapy
• Temporary immobilisation
• Compression garments
• Steroids

A: The main disadvantage of a mastectomy is that it is a more radical procedure than a lumpectomy, and your recovery time will be longer. However, the chance of recurrence in the breast is less than that with a lumpectomy.

Consult your specialist to find out if your condition allows you to choose between a mastectomy and a lumpectomy. Weigh the risks and advantages of each procedure to determine the best treatment option for you.

A: Sometimes, the nearby lymph nodes in the underarm are removed during mastectomy. This is to check if any breast cancer cells have spread to the lymph nodes.

Removal of a large number of lymph nodes may disrupt the lymphatic flow and its ability to drain fluid in this area. The scarring that occurs following surgery as well as post-operative radiotherapy to the area can cause further obstruction. Thus, lymph fluid can build up in the surrounding tissues, leading to lymphedema (swelling) of the arm.

Fortunately, the incidence of lymphedema has reduced over the years due to:

• Improved surgical technique. Less extensive sentinel lymph node biopsy (1 – 3 lymph nodes) is done in place of axillary clearance (where more lymph nodes are removed) in most cases
• Early mobilisation with arm exercises
• Arm care and awareness to avoid untreated ascending arm infections
• Maintenance of a healthy weight and avoidance of weight gain

A: During a mastectomy, your surgeon will aim to remove the entire breast together with the cancerous areas it contains. Despite this, a tiny portion of breast tissue may still be left on the skin. Thus, the chances of local recurrence (in the same breast or chest wall) are possible after a mastectomy, although it is usually low.

Distant recurrence in other parts of the body (i.e. lung, liver bones and brain) may also occur following a mastectomy. Invasive cancer cells can spread beyond the confines of the breast by the blood stream to other parts of the body. This risk is reduced by the use of drugs like chemotherapy, targeted treatments or anti-hormone medications.

A: Mild to moderate pain and discomfort after a mastectomy is common. However, in most cases the surgical site feels numb and tight.

Some patients may experience chronic or long-term pain from nerve disturbances persisting beyond 6 months. This is uncommon and may be felt in the chest wall, armpit, or arm. If you are having prolonged post-mastectomy pain, consult your doctor for options to cope with your symptoms.

A: Some patients choose to have breast reconstruction surgery after mastectomy for reasons such as:

• Regaining a “lost” organ and restoring their physical appearance, which can help boost self-confidence
• Not needing to wear a breast prosthesis (an artificial breast form)

Breast reconstruction can be done at the same time as the mastectomy (immediate reconstruction) or after a period of time (delayed reconstruction). Immediate breast reconstruction has benefits such as:

• Fewer operations needed
• Better results as it is easier to preserve more of the native breast skin
• Not needing to wear a breast prosthesis at any time
• Less scarring

A: A mastectomy is necessary if there are:

• Two or more tumours in different parts of the breast
• Widespread or malignant-appearing calcium deposits in the breast that have been diagnosed as cancer during a breast biopsy
• Increased chances of recurrent breast cancer

A: You may feel pain and discomfort (e.g. pulling and stretching around your breast area for 2 – 3 weeks) after mastectomy.

A: The most suitable time to start wearing a prosthesis depends on your medical condition, the post-operative healing process, and the type of mastectomy performed.

Usually, it takes around 6 weeks to wear a permanent prosthesis after a mastectomy.

A: You can resume your usual diet as soon as you are able to swallow fluids. Make sure your diet includes:

• Protein-rich foods such as fish, eggs, poultry and low-fat dairy. Lean proteins can aid in cell repair and healing.
• Phytonutrient-rich fruits and vegetables as they contain carbohydrates, providing energy and preventing fatigue during recovery.
• Healthy fats such as omega-3 as they help to increase immune function, reduce inflammation in the body, and promote heart health.

A: Your doctor may recommend chemotherapy as adjuvant therapy with mastectomy. However, this completely depends on your overall health, age and medical history, as well as the type, stage and nature of your breast cancer.

• If the cancer is in situ type, it is unlikely to spread to other areas. Chemotherapy may not be recommended.
• If you are premenopausal, you may require chemotherapy due to an increased risk of aggressive types of breast cancer that readily spread at this age.
• If cancer is found in the lymph nodes, or has spread to locations other than the breast tissue, chemotherapy is usually required to eradicate the significant amount of cancer cells in the systemic circulation despite surgery.

Doctors typically recommend chemotherapy within 30 days of surgery. Early treatment minimises the risk of cancer spread, and improves the chances of survival.