Breast health is a crucial aspect of a woman’s overall well – being. When faced with breast cancer or a high risk of developing it, some women may consider a double mastectomy. This major surgical procedure involves the removal of both breasts and can have a significant impact on a woman’s physical, emotional, and financial life. In this article, we will explore the details of double mastectomy, including the surgical process, the associated costs, and the postoperative recovery journey.
The Double Mastectomy Surgery
Types of Double Mastectomy
Total (Simple) Double Mastectomy
In a total double mastectomy, the entire breast tissue is removed. This includes the glandular tissue, fatty tissue, and the nipples and areolas. The goal is to eliminate all breast tissue that could potentially develop cancer. It is often recommended for women with early – stage breast cancer in both breasts or those at high risk of breast cancer, such as women with a strong family history of the disease or certain genetic mutations like BRCA1 and BRCA2.
The procedure is usually less invasive compared to some other types of mastectomies. The surgeon makes incisions around the areolas and may also have additional incisions along the breast crease to remove the breast tissue. After the tissue is removed, the skin is then closed, often with stitches or surgical staples.
Radical Double Mastectomy
A radical double mastectomy is a more extensive procedure. In addition to removing all the breast tissue, it also involves the removal of the underlying chest muscles (pectoralis major and minor) and the lymph nodes in the armpit (axillary lymph nodes).
This type of mastectomy is typically reserved for women with more advanced breast cancer, where the cancer has spread to the chest muscles or lymph nodes. The surgery aims to remove all cancerous tissue to improve the chances of long – term survival. The incisions made during a radical double mastectomy are larger than those in a total double mastectomy, and the recovery time is generally longer due to the more extensive nature of the surgery.
Modified Radical Double Mastectomy
This is a variation of the radical double mastectomy. In a modified radical double mastectomy, the breast tissue, nipple, areola, and axillary lymph nodes are removed, but the pectoralis major muscle is left intact.
It is a common choice for women with breast cancer that has spread to the lymph nodes but not to the chest muscles. By preserving the pectoralis major muscle, it can help maintain some upper body strength and function, which can be beneficial for the patient’s quality of life during and after recovery.
The Surgical Process
Pre – operative Preparation
Before the surgery, the patient will have a series of consultations with the surgical team, which may include a breast surgeon, an oncologist (if the mastectomy is for cancer treatment), and a plastic surgeon (if breast reconstruction is planned).
Diagnostic tests such as mammograms, MRIs, and biopsies are often repeated to confirm the diagnosis and determine the extent of the disease. The patient will also be required to undergo a physical examination, blood tests, and an electrocardiogram (ECG) to assess their overall health and fitness for surgery.
The surgical team will discuss the surgical procedure, potential risks, and benefits with the patient. Informed consent is obtained, where the patient understands all aspects of the surgery and agrees to proceed.
The patient may be asked to stop taking certain medications, such as blood thinners, before the surgery to reduce the risk of excessive bleeding. They will also be given instructions on how to prepare for the surgery, including fasting before the procedure.
During the Surgery
Double mastectomy is usually performed under general anesthesia, which means the patient is unconscious during the entire procedure.
The surgeon begins by making the appropriate incisions based on the type of mastectomy. The breast tissue is carefully dissected and removed. In cases where lymph nodes are being removed, they are carefully isolated and removed from the axillary area.
If breast reconstruction is being done simultaneously, the plastic surgeon will then take over. There are different methods of breast reconstruction, such as using implants or using the patient’s own tissue (flap reconstruction). For implant – based reconstruction, the implants are placed in the chest cavity, usually under the chest muscles. In flap reconstruction, tissue from other parts of the body, such as the abdomen (TRAM flap) or the back (latissimus dorsi flap), is used to create a new breast shape.
The surgical site is then closed, and drains are often inserted. These drains help to remove excess fluid from the surgical area, which can prevent the formation of hematomas (collections of blood) or seromas (collections of clear fluid) and aid in the healing process.
The Cost of Double Mastectomy
Components of the Cost
Surgical Fees
The surgical fees for a double mastectomy can vary widely depending on the surgeon’s experience, the location of the hospital or surgical center, and the type of mastectomy. On average, the surgical fees for a double mastectomy can range from 15,000. However, in some major cities or with highly specialized surgeons, the fees can be even higher.
If breast reconstruction is included in the surgery, the plastic surgeon’s fees will also be added. Breast reconstruction can add another 30,000 or more, depending on the method used and the complexity of the procedure.
Hospital or Surgical Center Fees
These fees cover the use of the operating room, recovery room, and hospital stay. The cost of the hospital stay can vary based on the length of stay, which is typically 2 – 5 days for a double mastectomy. Hospital fees can range from 30,000 or more, depending on the hospital’s location and the level of care provided.
Surgical centers may offer a more cost – effective option in some cases, but they also have their own set of fees, which can still be substantial.
Anesthesia Fees
The cost of anesthesia is another significant component. Anesthesiologists charge based on the length of the surgery and the type of anesthesia used. For a double mastectomy, anesthesia fees can range from 5,000.
Medical Tests and Pre – operative Care
The cost of pre – operative tests, such as mammograms, MRIs, biopsies, blood tests, and consultations with different doctors, can add up. These costs can range from a few hundred dollars to several thousand dollars, depending on the number and type of tests required.
Post – operative Medications and Follow – up Care
After the surgery, patients will need pain medications, antibiotics, and other medications as prescribed. The cost of these medications can vary, but it can be several hundred dollars in the first few weeks. Follow – up appointments with the surgeon, oncologist, and other specialists are also necessary, and these visits may have associated costs.
Insurance Coverage
Health Insurance
Most health insurance plans in the United States are required to cover breast cancer treatment, including double mastectomy, under the Affordable Care Act. However, the extent of coverage can vary.
Insurance plans may have deductibles, co – pays, and out – of – pocket maximums. For example, a patient may have a deductible of 5,000, and they will need to pay this amount out of pocket before the insurance starts covering the costs. Co – pays for doctor visits and medications may also apply.
Some insurance plans may have restrictions on the type of hospital or surgeon a patient can choose. It is essential for patients to check with their insurance providers well in advance to understand what is covered and what their financial responsibilities will be.
Medicaid and Medicare
Medicaid, which provides health coverage for low – income individuals, also covers double mastectomy for eligible patients. The coverage may vary by state, but in general, it helps to reduce the financial burden significantly.
Medicare, which is for seniors and certain disabled individuals, also covers mastectomy as part of breast cancer treatment. However, like private insurance, there may be deductibles and co – pays associated with the treatment.
Postoperative Recovery
Immediate Post – operative Period (First Few Days)
Pain and Discomfort
After waking up from the anesthesia, the patient will experience pain and discomfort in the chest area. The pain can be managed with prescription pain medications, which are usually given intravenously in the hospital and then switched to oral medications as the patient recovers.
The area around the surgical site will be sore, and there may be a tight feeling due to the bandages and the swelling. The patient may also experience some numbness in the chest area, which is normal and may take time to resolve.
Drains and Wound Care
As mentioned earlier, drains are inserted during the surgery to remove excess fluid. These drains will need to be emptied regularly, usually several times a day. The patient or their caregiver will be taught how to do this before they are discharged from the hospital.
The surgical wounds need to be kept clean and dry. The hospital staff will change the dressings regularly, and the patient will be given instructions on how to care for the wounds at home. Signs of infection, such as redness, swelling, increased pain, or discharge from the wounds, should be reported immediately to the doctor.
First Few Weeks (1 – 4 Weeks)
Physical Limitations
In the first few weeks, the patient will have limited mobility. Raising the arms above the head, lifting heavy objects (usually anything more than 5 – 10 pounds), and strenuous activities should be avoided. This is to prevent straining the surgical site and to promote proper healing.
The patient may also experience fatigue, which is normal as the body is recovering from the surgery. Getting plenty of rest is essential during this time.
Emotional Adjustment
Losing both breasts can have a significant emotional impact on a woman. Many women experience feelings of sadness, anxiety, and body image issues. It is important for the patient to have a support system during this time, which can include family, friends, and support groups. Some women may also benefit from counseling or therapy to help them deal with these emotions.
First Few Months (1 – 3 Months)
Gradual Recovery of Mobility
As the weeks progress, the patient will gradually regain mobility. Physical therapy may be recommended to help improve range of motion in the shoulders and arms. Exercises such as gentle stretching and strengthening exercises can help to improve strength and flexibility.
Wound Healing and Scar Management
The surgical wounds will continue to heal, and the scars will start to fade over time. Some patients may choose to use scar – reducing creams or silicone sheets to help minimize the appearance of the scars. It is important to follow the doctor’s advice on scar management.
Continued Emotional Support
The emotional impact of the surgery may still be present in the first few months. It is normal for the patient to have ups and downs during this time. Support groups and counseling can provide ongoing support to help the patient adjust to their new body image and cope with the emotional aftermath of the surgery.
Long – Term Recovery (Beyond 3 Months)
Full Recovery of Physical Function
After three months or more, most patients will have fully recovered their physical function. They can gradually resume normal activities, including exercise and work. However, some women may still experience some limitations, especially if they had a more extensive type of mastectomy or if they had complications during the recovery process.
Reconstruction and Prosthesis Options
For women who had breast reconstruction, the final results may not be fully apparent until several months after the surgery. Some may need additional procedures to achieve the desired outcome.
Women who did not choose reconstruction may opt for breast prostheses. These are artificial breasts that can be worn inside a bra to restore a more natural appearance. There are different types of prostheses available, and the patient can choose the one that best suits their needs and preferences.
Ongoing Health Monitoring
Even after a full recovery, women who have had a double mastectomy will need to continue with regular health monitoring. This may include follow – up appointments with the surgeon, oncologist (if applicable), and regular check – ups to monitor for any signs of recurrence or other health issues.
Conclusion
Double mastectomy is a major surgical decision that has far – reaching implications for a woman’s life. Understanding the surgical process, the associated costs, and the postoperative recovery journey is essential for making informed decisions. While the physical and emotional recovery can be challenging, with proper medical care, a strong support system, and time, many women are able to move forward and lead fulfilling lives. It is important for women facing this decision to have open and honest discussions with their medical teams, explore all available options, and take the time to care for themselves both physically and emotionally throughout the process.
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