[libribook.com] Traumatic Scar Tissue Management 1st Edition

effectively prevent or reduce unnecessary pain and suffering for the many
women and men who are breast cancer survivors. What is needed is improved
access to care.
Mastectomy
As a result of early detection and the increase in breast cancer diagnosis, service
providers around the world have reported an increase in mastectomy surgery. As
an example, the English NHS had an increase in the number of operations
performed from 24 684 to 33 814 over the period 1997–2006, a 37% increase
(National Mastectomy Breast Reconstruction Audit 2008).
Surgical treatment for breast cancer is generally divided into two categories:
breast-conserving therapy (BCT) and mastectomy.
BCT involves removing the least possible amount of breast tissue when
removing the malignant tumor, and usually includes additional therapy after
surgery, most often radiotherapy (Johns Hopkins Medicine 2014).
Mastectomy is removal of all breast tissue and may be performed as
prevention/prophylactic or as treatment. There are various types of mastectomies
– see Table 6.2 (Johns Hopkins Medicine 2014). Certain risk groups (those with
gene mutations) may opt for a mastectomy to reduce the risk of developing
breast cancer whereas others will have a mastectomy upon diagnosis of
malignancy. Mastectomy can sometimes be combined with chemo, radio,
hormone and other targeted therapies.
Mastectomy type
Total simple
Modified radical
Skin sparing
Nipple sparing or
subcutaneous
Description
Removal of all the breast tissue, nipple and areola. No lymph nodes from the axillae are
taken. General recovery from this procedure, if no reconstruction is done at the same
time, is usually 1–2 weeks. Hospitalization varies; for some it may be an outpatient
procedure and other patients may require an overnight stay
Removal of the breast, nipple and areola as well as axillary node dissection. General
recovery, when surgery is done without reconstruction, is usually 2–3 weeks
Removal of the breast, nipple and areola, keeping the outer skin of the breast intact. A
tissue expander may also be placed as a space holder for later reconstruction. Tissue
expansion is a procedure that enables the body to ‘grow’ extra skin for use in
reconstruction. A silicone balloon expander is inserted under the skin near the area to be
repaired and then gradually filled with salt water over time, causing the skin to stretch
and grow. It is most commonly used for breast reconstruction following breast removal,
but also to repair skin damaged by birth defects, accidents or surgery, and in certain
cosmetic procedures (American Society of Plastic Surgeons)
A newer (controversial) technique reserved for a smaller number of women with tumors
that are not near the nipple areola area. An incision is made on the lateral side of the