Post-mastectomy Breast

Question 1

What are the indications for mastectomy

Answer 1

Patient preference

Clinical evidence of multifocal/multicentric disease

Large lump in small breast tissue (depends on the breast size but often defined as a lump greater than 4cm)

Large area (over 4 cm) ductal carcinoma in situ

Involvement of the nipple

Question 2

What different types of mastectomy can be performed

Answer 2

Simple mastectomy - removal of the breast alone

The following are rarely performed as survival benefit has not been demonstrated:

• Modified radical mastectomy
• Radical mastectomy
• Extended radical mastectomy

Question 3

What is the disadvantage of simple mastectomy

Answer 3

The axilla still needs to be managed post-surgery - eg. with radiotherapy

Question 4

What is the use of drains in breast surgery

Answer 4

Two drains are placed

• One in axilla
• One at the site of surgery within the breast tissue
  
  • A suction drain to close the cavity and decrease the risk of scar and haematoma formation

Question 5

When are the drains removed post-breast surgery

Answer 5

Usually left for 3-5 days, or until drainage volume is less than 50mL in 1 day

Patients can be sent home with drains and followed up with district nurse support