Ask The Experts: When do breast cancer patients need a total mastectomy?

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Key considerations for mastectomy

Breast cancer patients considering mastectomy may have further treatment after the surgery and must be aware that the cancer may return.

“Surgery is only one part of cancer treatment. Chemotherapy and radiation therapy
(when necessary) are equally important and play key roles to help control the cancer and minimise a chance of relapse. While the mastectomy aims to remove as much breast tissue as possible, there are usually small pockets that will remain. Therefore, it is possible that breast cancer could return. Fortunately, this is rare with good treatment and control,” says Dr Chan.

Removing both breasts is not necessary unless the patient carries a genetic mutation. It is advisable that patients below 45 years old should consider having genetic testing done to find out more before making a decision.

Dr Chan highlights three main things to bear in mind before opting for a mastectomy:

1. Quality of life post-surgery
The main issues are usually psychological, especially when patients choose to forgo
reconstruction, and hence end up with a flat chest on the operated side. This can lead to loss of self-confidence, depression and patients withdrawing socially from close family members and friends.

2. Recovery concerns
Physical recovery is usually smooth, even in patients with other problems such as
diabetes. Mental recovery is more challenging unless patients know what to expect and have had some mental preparation about how they will look.

3. Breast reconstruction
Immediate reconstruction is the recommended procedure today, unless the patient’s cancer is aggressive and carries a high risk of early relapse. Patients can choose to use their bodies’ natural tissues or artificial implants in breast reconstruction, depending on their lifestyle or expectations. Another option is to treat excess skin on the breast as an implant, depending on suitability, however patients who ‘qualify’ for this are few in number.

A mastectomy does not offer a cancer-free guarantee and Dr Chan recommends that breast cancer patients seek medical advice on the next course of action. Additionally, every woman should run self-checks for all lumps in the breasts and go for regular screening.

After all, early breast cancer detection can save breasts, and lives.

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