Breast reconstruction cosmetic surgery after total mastectomy or breast removal

Your doctor suggests that you remove your breast entirely, due to cancer. It is called a total mastectomy.

What is the proposed operation?

Principles and objectives

This procedure involves removing the part of your breast where the tumor is located.

Its purpose is to remove all of the lesions (cancer, micro-calcifications or benign lesion, etc.), while preserving as much tissue as possible to reshape the breast afterwards.

Place of intervention in general treatment

This surgical operation is integrated into a treatment program combining several disciplines. It has been, or will be, explained to you by your surgeon.

How do you prepare?

The mastectomie is performed under general anesthesia.

The anesthetist, responsible for this part of your intervention, will answer all questions relating to his specialty during the preoperative consultation.

Do not forget to tell your surgeon and anesthesiologist what treatments you take regularly and in particular aspirin, anti-coagulants etc.

If you have ever had allergic reactions, you should also report this to them.

Finally, during your hospitalization, bring all the medical documents in your possession: mammograms and recent breast ultrasounds, etc.

Your hospitalization

In general, your acceptance to the hospital will be scheduled on the morning of the operation. You must not eat from midnight the day before. As a rule, 6 hours of fasting before the scheduled operation.

How does the operation go?

On an empty stomach since the previous evening, you will be taken care of by the nursing and medical team. Shaving or axillary hair removal will have been done 3 to 5 days before, then you just have to take a shower with an antiseptic product. After a premedication based on tranquillizers, you will be taken to the operating room.

You will be given an infusion and the anesthesia will start.

The duration of the operation is usually from less than 1 hour to 1 hour 30 minutes.

The location of the scar varies according to the site of the lesion. The tumor is removed with the gland that surrounds it, then the breast is reshaped to leave it in a harmonious shape. If a lymph node removal is necessary, it is often carried out during the same intervention by an extension of the incision or by a second incision in the armpit (axillary dissection)

A drainage system, also called Redon, is sometimes put in place.

In some cases, the tumor to be removed is not palpable. The surgeon can then propose a preoperative location using a small metal wire placed under ultrasound or mammography at the level of the lesion. This is done the day before or the morning of the operation. The location of the tumor can afterwards be identified by simple marking with a felt pen on the skin. This identification makes it easier for the surgeon to find the lesion during the operation.

In the event that the diagnosis of cancer could not be made with certainty before the intervention, the surgeon may request a rapid examination of the tumor: this is a study in the pathology laboratory to confirm or rule out the cancerous nature of the lesion. With your prior agreement, the surgeon can perform a biopsy of the armpit nodes. However, this examination does not always make it possible to know the cancerous nature of the lesion and longer examinations are therefore essential.

Depending on the results, a second intervention could possibly be proposed.

During the operation, the surgeon may be faced with an unforeseen situation requiring additional acts that he would consider necessary. It also happens that the planned removal of the lesion is insufficient. Your surgeon will then offer you a different option.

After the intervention

You will stay in the recovery room before returning to your room and a postoperative treatment will be launched.

You can resume your normal diet the same day.

The discharge is often planned the evening of the operation, if you have not had an axillary cleaning and in the absence of drainage, depending on the healing and your general condition.

Prescriptions will be given to you before discharge and an appointment will be made for the post-operative consultation and the check of the results of the laboratory performed tests on the recovered tissues.

The sutures are usually absorbable and the scar does not require any particular care, except for daily cleaning with soap and water, followed by a thorough drying. You can take showers the day after the operation, if you have not had drainage but it is recommended to wait a month before immersing the scar in a bath. Wearing a soft bra is recommended.

In case of fever, scar disunity, significant discharge, notorious pain, especially in the calves or any other abnormality, it is essential to inform your doctor.

What are the possible risks?

Mastectomie is a common procedure, and is simple in the majority of cases. After the operation, the pain is very variable but often remains moderate. Treated preventively and adapted to your case, pain is the subject of all our attention and in particular the first 24 hours. After a few days, the spontaneous pain is minimal and only pain on palpation of the operated area persists. Sometimes a pocket of fluid called a lymphocele can form under the scar. It may then be necessary to drain the liquid by one or more punctures. When you leave, you will be given a telephone number to call if necessary. Skin healing can sometimes be difficult, especially after radiation therapy. Skin necrosis and scar disunity will require prolonged care and healing will take longer. Hematomas and infections are complications that can occur locally. Local care is often enough to treat them, however in rare cases, a new intervention must be scheduled to wash and drain the cavity. Your history and / or treatment taken before the operation may favor the occurrence of certain risks. It is therefore imperative to inform the doctor of your personal and family history and of all the treatments and medications that you take.

What are the serious and - or exceptional complications?

Any medical act, investigation, exploration, intervention on the human body, even carried out under conditions of competence and safety in accordance with current data from science and the regulations in force, conceals a risk of complication. In the exceptional case of a large hemorrhage, a blood transfusion or plasma transfusion may be necessary. Except in special cases, an anticoagulant treatment is prescribed after the operation to reduce the risk of phlebitis or embolism.

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