Q. How is a mastectomy performed?

A mastectomy is a surgical procedure that involves the removal of one or both breasts, and the specific technique used can vary based on the type of mastectomy and individual patient factors. Here's a general overview of how a mastectomy is performed:

1. Anesthesia: Before the surgery begins, the patient is given anesthesia to ensure they are unconscious and pain-free during the procedure. The type of anesthesia (general or local) may vary depending on the specific case.

2. Incision: The surgeon makes an incision on the breast. The location and size of the incision can vary depending on the type of mastectomy and whether breast reconstruction is planned. Common incisions include a circular incision around the nipple-areola complex, a horizontal incision across the breast, or a diagonal incision from the nipple to the underarm.

3. Breast Tissue Removal: Once the incision is made, the surgeon carefully removes the breast tissue, which includes the glandular tissue, ducts, and fatty tissue. The extent of tissue removal depends on the type of mastectomy:
   - In a total or simple mastectomy, all the breast tissue is removed.
   - In a skin-sparing or nipple-sparing mastectomy, more of the breast skin and sometimes the nipple may be preserved for breast reconstruction.
   - In a radical or modified radical mastectomy, lymph nodes in the armpit may also be removed if the cancer has spread.

4. Lymph Node Dissection (if needed): In some cases, particularly if the cancer has spread or if lymph nodes need to be evaluated, the surgeon may remove lymph nodes from the armpit (axillary lymph nodes) during the same procedure.

5. Drain Placement: In many cases, drains are placed in the surgical site to remove excess fluids and reduce swelling. These drains may remain in place for a period after surgery.

6. Closure: The surgeon carefully closes the incision using sutures or staples. If breast reconstruction is planned, the surgeon may also prepare the chest area for the reconstruction during this phase.

The specific details of the procedure can vary based on the individual's medical condition, the type of mastectomy (e.g., total mastectomy, modified radical mastectomy, skin-sparing mastectomy), and whether breast reconstruction is part of the treatment plan. The surgery can be performed as an open procedure or minimally invasive surgery, such as robotic-assisted mastectomy, in some cases.

After the mastectomy, the patient will typically recover in a hospital for a few days, and they may receive additional treatments, such as radiation therapy or chemotherapy, based on their cancer diagnosis and stage. Additionally, if breast reconstruction is desired, it may be done either during the mastectomy procedure or at a later time. The patient's healthcare team will provide guidance on post-operative care, recovery, and follow-up treatments.