What is a Mastectomy?
Men are at relatively low risk of breast cancer (1 in 1,000) compared with women (1 in 8). However, many people will be surprised to learn that over 6,300 men were diagnosed with breast cancer from 2004 to 2011–one percent of all reported cases. Unfortunately, men are often diagnosed at a later stage than women because they are less aware of the symptoms and less likely to seek medical attention when they arise.
Men are at an increased risk for breast cancer if they–
- Test positive for the BRCA gene mutation (see below).
- Have a female family member with a history of breast cancer.
- Previously had radiation to the breast or estrogen therapy.
- Have reduced testicular function (undescended testis or low testosterone production).
- Are over 60 years of age.
- Are obese.
Men with the BRCA mutation have only a 7 percent increased risk of having breast cancer, compared to 87% for women.” Although most surgeons believe prophylactic mastectomies for men aren’t necessary, this procedure is administered twice as often now as in the 00’s. Of course, all men diagnosed with breast cancer should have genetic testing to assess this risk factor
The earlier you’re treated, the better your chances of being cured. If you have a mastectomy, your doctor can perform another surgery afterward to help return your chest to its natural shape.
Types of male breast cancer
Most breast cancers in men begin in the milk ducts of the breast (yes men have milk ducts). Less than 2 percent of breast cancers in men begin in the lobules of the breast. In rare cases, men are diagnosed with non-invasive breast cancer or inflammatory breast cancer.
Treatment
Before the Mastectomy
During your initial consultation, come prepared with all your questions about the surgery and its possible risks. Dr. Roth will review your medical records and ask you about any medicines you are taking to ensure that you are not ingesting anything that could interfere with the surgery. For example, if you are taking aspirin or any blood-thinning medicine, you may be asked to stop taking them a week or two before the surgery.
You will also meet with the anesthesiologist or nurse anesthetist to discuss the type of anesthesia you’ll receive. This will depend on the kind of surgery scheduled and your medical history.
As with most all cosmetic procedures, you’ll need to quit smoking before surgery because tobacco constricts blood vessels, reducing the vital supply of nutrients and oxygen to tissues.
Surgical Options
Most men with breast cancer have a mastectomy, defined as “surgery to remove all the breast tissue, normally including one or more axillary (armpit) lymph nodes.” This includes glandular excision, liposuction and the complete removal of breast tissue. Surgeries may involve only partial removal of breast tissue if at the inception cancer, though complete removal is the safest option.
There are different kinds of mastectomy. Dr. Roth offers extensive experience and skill in performing all of them, including the following–
- A simple or total mastectomy removes the whole breast, including the nipple.
- A modified radical mastectomy removes the whole breast and nipple and many of the lymph nodes under the arm.
- A radical mastectomy removes the whole breast, lymph nodes, and the chest wall muscles under the breast.
- A partial mastectomy or lumpectomy removes just the tumor and some of the tissue around it. (This surgery is seldom performed because men have very little breast tissue).
To determine if your cancer has spread you may need–
- An Axillary Lymph Node Dissection (ALND)—in which your doctor removes 10 to 40 lymph nodes from under your arm. These are then checked under a microscope for signs of cancer.
- Or–A Sentinel Lymph Node Biopsy (SLNB)—in which your doctor takes only a few lymph nodes from the location cancer is most likely to have spread. A radioactive substance or blue dye is injected into the area around the tumor to locate the nodes. If there are signs of cancer, your surgeon may then perform an ALND.
During Surgery
A nurse will insert an IV line put in your arm to infuse medicines needed during the surgery. Your heart rhythm and blood pressure are carefully monitored throughout the procedure. You’ll get general anesthesia when the procedure is a mastectomy or an axillary node dissection. The length of the operation depends on the type of surgery. A mastectomy with axillary lymph node dissection and biopsy can take from 1 to 4 hours.
Recovery
After the surgery, you’ll wake up from the anesthesia in a recovery room. If all is well, you’ll go home later the same day or the next day.
Your chest will be bandaged and drainage tubes inserted into your breast area or underarm, which will need to stay in place for 1 to 2 weeks after your surgery. Our medical team will give you detailed post-op instructions, including specific guidelines for maintaining, emptying, and measuring the fluid that comes out. You’ll be directed to wait 4 weeks before returning to your normal exercise regimen (weight lifting, running, etc.). However, in most cases, you will want you to start moving the affected arm soon after surgery to prevent stiffness.
Men having a mastectomy and axillary lymph node dissection usually stay in the hospital overnight and return home the next day. However, this procedure is increasingly performed on an outpatient basis, with only a short-stay in an observation unit before going home.
Regardless, you doctor may arrange for a nurse to visit you at home to monitor your progress and provide care.
Men seldom get reconstructive surgery with implants. This is because they normally don’t enhance the shape of a man’s chest. However, your doctor can make the affected breast look more natural and symmetrical and even create a new (often tattooed) nipple.
What to expect after the operation
When you see Dr. Roth after the surgery, he will explain the results of your pathology report and discuss any need for further treatment. If you do require more treatment, he will refer you to a radiation or medical oncologist.
Post-surgery treatment options include–
- Radiation–High-energy beams that kill cancerous cells.
- Chemotherapy—Powerful drugs that kill cancerous cells.
- Hormone therapy—When your cancer was triggered by a testosterone deficiency or other hormonal imbalance.
Possible side effects of breast surgery
Mastectomy is safe, but any surgery has risks. Possible side effects include swelling (a greater risk if lymph nodes have been removed), bleeding and Infection. The buildup of blood in the wound (hematoma) and fluid in the wound (seroma) are also possible.
Long-term prognosis
Men with breast cancer are, on average, 84 percent as likely as men in the general population to live 5 years beyond their diagnosis. The 10-year relative survival rate for men with breast cancer is 72 percent.
