Mastectomy

Overview

• Triple-negative breast cancer, reconstruction timing: NICE NG101 says offer reconstruction after mastectomy, offer both immediate and delayed options whether or not they are available locally, and offer immediate reconstruction to women advised to have a mastectomy including those who may need radiotherapy; its table notes that implant reconstructions may be more affected by radiotherapy than flap reconstructions and that complications can delay chemotherapy or radiotherapy. The NHS says recovery takes several weeks, with wounds healing in about 6 weeks. Macmillan says you may choose no reconstruction and wear a prosthesis instead.
• When a mastectomy is recommended rather than chosen. Macmillan says surgeons try to do an operation that means you can keep your breast, and that a mastectomy may be recommended when the lump is large compared to the rest of the breast, when there is cancer in different parts of the breast (multicentric), when there is widespread DCIS, when the cancer is on the skin or in the underlying muscle, when you have had radiotherapy to the chest before to treat another cancer, or when you have a family history and have tested positive for a gene mutation.
• A mastectomy does not always avoid radiotherapy. NICE NG101 (1.13.10) says to offer adjuvant postmastectomy radiotherapy to people with node-positive (macrometastases) invasive breast cancer or involved resection margins, (1.13.11) to consider it for node-negative T3 or T4 disease, and (1.13.12) not to offer it to people at low risk of local recurrence, for example most people with lymph node-negative breast cancer.
• NICE NG101 (1.5.1) says to offer breast reconstruction to people after they have had a mastectomy for breast cancer, and (1.5.2) to be aware that some people may prefer not to have it. Cancer Research UK says a surgeon may be able to improve the appearance of the chest with further surgery after a mastectomy, and that a prosthesis is an alternative to reconstruction.