Mastectomy

Whilst lumpectomy and mastectomy have the same outcomes long term, there are some occasions when Dr Cheung may recommend a mastectomy instead and these include: 

• When there are two or more tumours in separate areas of the breast 
• There are widespread or malignant-appearing deposits of calcium (microcalcifications) in the breast that have been confirmed through biopsy 
• You’ve previously had radiation and the breast cancer is a recurrence  
• You’ve had a lumpectomy but cancer is still present at the edges (margin) of the area operated on 
• You carry a high-risk gene mutation, that gives you a personally high risk of developing breast cancer in the future, or developing a second cancer if you’ve already had breast cancer before
• Your tumour is large compared to the rest of the breast 
• You have a disease such as lupus where your skin may not be able to tolerate the side effects of radiation 
• You are pregnant and radiation creates risks to the unborn child 
• Patients typically stay 1-2 nights in hospital after a mastectomy.  Patients recover and can do most activities of daily living from a few days.
• Generally after a mastectomy, patients may be given chemotherapy, hormone therapy or targeted therapy to lower the risk of the cancer recurring.
• Radiation therapy and/or hormone therapy is usually delayed until chemotherapy is completed, if chemo is required. Speak to Dr Cheung about what to expect with your treatment options. 

What is a simple or total mastectomy? 

• Dr Cheung acknowledges that not all patients desire or are suitable to have breast reconstruction and hence some patients may elect to have a simple mastectomy where the entire breast including the skin and nipple are removed.
• Most patients stay in hospital for 1 night and most patients are on mild pain killers only.
• Patients may wear an external prosthesis after a simple mastectomy. 

What is a nipple sparing mastectomy? 

• Unlike conventional mastectomy, this surgery removes the breast tissue leaving the breast skin, areola and nipple intact.
• The surgeon is often able to hide the scar on the underside of the breast, so scarring is minimal which preserves the natural appearance and feel of the breast. A better cosmetic outcome has a profound effect on a woman’s body image and how she copes with her breast cancer surgery.
• A recent US study published in the journal BMC Cancer found the majority of women said scars from their breast cancer surgeries had negatively impacted their lives – yet one third were reportedly not told of surgical options that would minimise scarring.
• In addition to the benefits of a better cosmetic outcome, nipple sparing mastectomy is gaining acceptance as a safe option in breast cancer patients, with no significant increase risk of cancer returning.
• The prestigious Mayo Clinic reports that in 2009, 8 percent of mastectomies performed were nipple sparing but five years later that figure had tripled to 30%, and continues to rise.
• Dr Cheung is considered one of the nation’s most experienced surgeons in this technique, having presented the first personal series of nipple sparing mastectomies in Australia confirming its safety and positive patient satisfaction.
• Dr Cheung is also a strong advocate for nipple sparing surgery in the context of immediate breast reconstruction because she understands that minimising the physical impact of surgery can immensely improve how a woman copes with her cancer treatment.
• During this surgery, the cancer is treated on the same day as reconstruction, (instead of two separate operations), and is conducted under general anaesthetic in hospital.
• Additionally, during the operation some lymph nodes in the axilla (armpit) will be removed and tested (sentinel lymph node biopsy) to check if cancer cells have metastasised (spread to lymph nodes) or will be removed if cancer cells are detected. 
• Immediate reconstruction is performed either with a tissue expander, silicone implant or using your own tissue using lipofilling or autologous flap from the tummy or back.

What is a skin-sparing mastectomy? 

• Unlike conventional mastectomy, this surgery removes the areola and nipple, but a skin envelope is left behind for a better coverage of reconstruction with your tissue or implants. This procedure can be performed either as a simple mastectomy or as a modified radical mastectomy to provide the skin needed for immediate breast reconstruction. 
• There are a few exceptions to this procedure which include:

• Having inflammatory breast cancer, where there may be a likelihood tumour cells are close to the skin

What happens during a skin-sparing mastectomy?

• During this procedure Dr Cheung will remove the nipple, areola and the biopsy scar, moving the tissue through a small opening she creates. 
• The remaining “pouch” of skin is then used to accommodate a reconstruction with your own tissue or implants.  Many women choose the option for immediate breast reconstruction when having this procedure.