Total Mastectomy

Total mastectomy leaves the lymph nodes in the underarm region and the chest muscles intact. Although the surgeon may take a sample of the nearby lymph nodes to test for the spread of cancer. This procedure is known as sentinel lymph node biopsy.
This type of surgery is usually performed to treat the early forms of breast cancer, like ductal carcinoma in situ, as well as the invasive types of cancers.

Types:

Mastectomy or breast removal surgery can be of the following different types:

1. Total or simple mastectomy: The procedure involves the removal of the nipple, areola (area around the nipple that is darker in color), and the lining over the chest muscles, known as the pectoralis fascia. The doctor may perform a sentinel lymph node biopsy at the time of the procedure.
2. Radical mastectomy: The procedure involves the removal of the entire breast, including the nipple, the areola, the overlying skin, the lymph nodes under the arm, as well as the chest muscles, known as the pectoralis major and minor muscles present under the breast. This procedure is performed when the breast cancer has spread to the chest muscles.
3. Modified radical mastectomy: The procedure includes the removal of the entire breast, which includes the nipple, areola, lining over the chest muscles (pectoralis fascia), and the pectoralis minor muscle. The pectoralis major muscle is spared in this procedure. Some lymph nodes in the armpit region may also be removed. In some cases, the pectoralis minor muscle may be retracted instead of being cut. 
4. Skin-sparing mastectomy: This procedure involves sparing the skin over the breast. The breast tissue, nipple, and areola are however removed. 
5. Nipple-sparing mastectomy or total skin-sparing mastectomy: The procedure involves the preservation of the nipple skin and areola skin. The doctor cuts off some of the tissue around the nipple and areola and sends it to a pathologist to check for the presence of cancer cells. If no there are no breast cancer cells detected around and near the nipple and areola, these areas can be saved, or else this method is not recommended.
6. Laser Treatment for Breast Cancer: This procedure involves the use of a laser to heat and destroy the tumor cells. This procedure is called laser ablation therapy. It can be used to treat small tumors. The procedure takes lesser time, causes less damage to surrounding tissue, and has a quicker and better recovery rate. 

Symptoms

A total mastectomy may be recommended in the following cases:

• Two or more tumors present in different areas of the breast
• Widespread cancerous microcalcifications (calcium deposits) in the breast
• Recurrence of breast cancer after radiation therapy
• Having a gene mutation that increases the risk of developing second cancer in the breast
• Large-size breast tumor 
• Pregnant women having breast cancer, since radiation treatment may pose a risk to the unborn child
• Presence of a connective tissue disease, like lupus or scleroderma, since the patient will not be able to tolerate the side effects of radiation therapy to the skin
• History of lumpectomy (removal of the cancer tissue from the breast), but cancer is still present at the edges of the treated area
• Prophylactic procedure, for those who have an increased risk of developing breast cancer in the future due to a family history of breast cancer or the presence of some genetic mutations 

The different types of breast cancers that can be treated by total mastectomy include:

1. Ductal carcinoma in situ (DCIS) or a non-invasive type of breast cancer
2. Early-stage breast cancer
3. Locally advanced type of breast cancer after chemotherapy
4. Inflammatory breast cancer after chemotherapy
5. Recurrent breast cancer
6. Paget’s disease of the breast (breast cancer that starts on the nipple and extends to the areola)

Diagnosis

1. Physical examination: The doctor will examine the diseased breast in the sitting and lying down positions. The nipple and breast skin are examined for any discharge, prominent veins, ulcerative growth, etc. 
2. Medical history: The patient’s symptoms, family history, and medical history are noted.
3. Mammography: A mammogram helps in obtaining an x-ray image of the breast. 
4. Breast ultrasound: It is a type of imaging test that can be used in addition to mammograms, or when the results of mammography are inconclusive. It helps in checking if the breast lump is a fluid-filled cyst or a solid mass. 
5. CT scans, PET scans, and MRI scans: These are the different types of imaging tests that help in confirming the exact tumor size and its location, and if cancer has spread to other sites.
6. Breast biopsy: The doctor will excise a small portion of the suspected tissue growth and send it to the laboratory to check if there is a presence of cancer cells.

Treatment

Total mastectomy will be performed under general anesthesia, that is, the patient will be put to sleep during the procedure.
An elliptical incision or cut is made around the breast. 
The breast tissue is removed along with the nipple, areola, and pectoralis fascia.
The underarm lymph nodes are removed and sent to the laboratory to check for the presence of cancer cells and check if cancer has spread to the lymph nodes. This procedure is known as a biopsy.
Some patients may choose to undergo breast reconstruction surgery at the same time as a total mastectomy. The plastic surgeon will perform this procedure after the mastectomy.
One method of performing breast reconstruction surgery is by placing temporary tissue expanders in the chest region to form the new breast mound. This procedure is generally performed for women who need to undergo radiation therapy after mastectomy surgery. The temporary tissue expanders help in delaying the final breast reconstruction procedure until the completion of radiation therapy.
The incision is then closed using sutures (stitches), which may be dissolvable or can be removed later by the doctor.
One or two small plastic drainage tubes may be placed in the region of the removed breast. These tubes drain the fluids that have accumulated after the surgery. The tubes are sewn into their place and their ends are connected to a small drainage bag.

Risks

Total mastectomy may lead to the following complications:

• Pain
• Infection
• Bleeding
• Shoulder stiffness and pain
• Hard scar tissue formation
• Lymphedema (swelling) in the arm
• Hematoma (blood buildup in the surgical site)
• Seroma (fluid buildup inside the wound)
• Numbness in the arm 
• Flap necrosis (tissue death due to loss of blood supply)

After Procedure

• You may spend a day or more in the hospital after the surgery, depending on how extensive the surgery was.
• You will be taught how to take care of your wound and surgical drain at home.
• It is normal to feel soreness and stiffness in the chest and through the arm and shoulder initially after surgery. The doctor’s team will teach you specific exercises to help in quicker recovery.
• The stitches and drainage tubes will be removed by the doctor one or two weeks after the surgery.
• Some people may experience numbness in the chest region after surgery. The sensation in the chest may come back after approximately two years, but it may not be the same as before surgery.
• The wound healing may take about three weeks. Complete healing may take up to four to six weeks.
• Follow-up appointments with the doctor are recommended to check if cancer has been eliminated completely or if there are any chances of cancer recurrence.
• You can discuss with your doctor about breast reconstruction options after surgery.

Home remedies:

• Take plenty of rest for the first few weeks after the surgery.
• Take all your prescribed medications properly.
• Avoid showers or bathtubs until the drains and stitches are removed. Take sponge baths during this period.
• Do the exercises recommended by the doctor to prevent your arm from becoming stiff.

Cost of total mastectomy in India- 

The cost of a total mastectomy in Mumbai is between INR 1,00,000 to INR 2,50,000.
The cost of a total mastectomy in Delhi is between INR 85,000 to INR 2,25,000.
The cost of a total mastectomy in Bangalore is between INR 85,000 to INR 2,25,000.
The cost of a total mastectomy in Chennai is between INR 80,000 to INR 2,00,000.