Mastectomy – breast removal surgery in Israel

Below you can find information about a mastectomy or complete breast removal surgery in Israel.

You will learn:

• Who are the experienced Israeli surgeons.
• In which hospitals the operation takes place.
• What questions should you ask the doctor and plastic surgeon before the operation in order to make a decision.
• How is a mastectomy in Israel going, step by step, from contacting us to leaving Israel.
• How long the operation and stay in Israel take.
• Mastectomy cost.
• What is after the operation.

Mastectomy is a part of breast cancer treatment, performed in cases where it is a multi-focal tumor (more than one tumor) or a large tumor in relation to the size of the breast (when the condition of the tumor does not allow you to reasonably save the mammary gland), or inflammatory breast cancer affecting the entire skin of the breast; or if you are a carrier of the BRCA1 and BRCA2 mutations that can cause cancer (in which case, complete mammary gland resection is a prevention).

Radical mastectomy is also required in cases of recurrent cancer that have been treated with radiation therapy in the past, or malignant tumors at an advanced stage.

The decision about surgery and the type of surgery is a common decision of both of the patient and the doctor, and is based on clinical medical findings and your personal preference. Typically, you can choose between removing only the tumor (lumpectomy) or removing the entire breast – unilateral, bilateral or double mastectomy.

Types of mastectomy

• Modified radical mastectomy (MRM): bilateral mastectomy – the entire breast is removed along with the lymph nodes in the armpit.
• Simple mastectomy: the entire mammary gland is removed without the lymph nodes in the armpit.
• Entire breast removal with only a sentinel lymph node sample.
• Tissue removal with maximum preservation of breast skin and nipple (gentle mastectomy).

In order to determine the type, volume of surgery, timing and cost, please consult an experienced Israeli doctor. Then it will be easy for you to make surgical and therapeutic decisions.

The surgeons with whom we cooperate are among the five leaders in performing lumpectomy or quadranthectomy and mastectomy in Israel, and for several years they have been included in the list of the best doctors in the world according to the international media Forbes. In addition, our doctors are empathetic persons who treat patients with delicacy.

Contact us to clarify the details of the consultation and cost. Submit all preliminary test results.

We will coordinate a consultation online. Doctor determines the hospital in which the mastectomy should be performed. Most of the surgeries are carried out in the Assuta hospital, which is equipped according to world standards, and also has a high level service in Israel.

We coordinate the operation even before your arrival in Israel. Date of the mastectomy is being agreed immediately after the consultation. As a rule, the operation is performed within the next few days after the consultation. We will help you prepare and settle all the bureaucratic issues in the hospital.

Upon your arrival in Israel, you meet with a doctor to conduct a personal examination and perform other diagnostics, including a mammary glands ultrasound to confirm or verify the diagnosis and the scope of the surgery and /or further treatment.

The day before the surgery you should undergo a preoperative examination, which takes about 2-3 hours and includes special blood tests, a cardiogram (sometimes a chest X-ray), and an anesthesiologist’s consultation.

Preoperative tests will be agreed with you prior to your arrival in Israel. The medical staff of the hospital will instruct you in details about the preparation for the operation, and we will accompany you in all procedures, providing all the necessary assistance.

How urgent should a mastectomy be done?

In most cases, this is not an emergency for the surgery or a treatment. Also taking into account the shock of the diagnosis, our doctors usually recommend waiting about two to three weeks to make an informed and rational decision.

Cancer cells grow slowly, and a few days do not affect the prognosis of the development of the disease and do not reduce the chances of recovery. On the other hand, this time allows for a better and more personalized decision, and not under pressure.

An Israeli surgeon gives you an advice on following questions:

• What kind of surgery should you do?
• What are the pros and cons of each type of surgery?
• How long bilateral mastectomy takes?
• What is a sentinel lymph node? Is it possible to do only by removing it or is it necessary to remove the axillary lymph nodes?
• What is the guarantee that the margins remain clean, which reduces the likelihood of a wide resection?
• What are the expected restrictions on daily activities after surgery?
• What are the possible complications and how to manage them?
• Will there be any fluid left after the surgery? If so, how long?
• What should be prepared for the operation? (special bra, etc.)
• Are there any physical changes expected?
• Will anything change in appearance?
• Are pain expected?
• What effects should you report to the therapy team?
• How is a surgical scar treated?
• When can exercise therapy begin?
• When, where and by whom is it recommended to do lymphatic massage?
• When can you return to full-time work?
• When should you seek the next consultation?

How is a mastectomy performed in Israel?

After general anesthesia is administered, an incision is made in the breast through which all tissue, including the tumor, is removed. The site of the incision is chosen depending on the location of the tumor, the size and shape of the breast, and the mammary glands reconstruction method.

For women diagnosed with an invasive tumor, an additional incision is sometimes made near the armpit (if it is not accessible through the incision in the chest) to remove the sentinel node while preserving the blood vessels and nerves in the area.

Defining a sentinel lymph node – mapping in Israel

For successful cancer treatment, it is very important to know whether the cancer cells have spread to the lymph nodes, as this fact affects recovery, as well as the further treatment and follow-up after mastectomy.

The technique that allows you to clarify this is called the “lymphatic mapping”: the detection and removal of sentinel lymph nodes and their pathological examination during or after surgery. Mapping is done using radioactive material, blue paint, or both for maximum accuracy.

If cancer cells have managed to penetrate the lymphatic system, it is most likely that they first are localized in the lymph nodes, known as sentinel, as they are close to the tumor of the mammary gland, and therefore their careful detection and examination is more accurate than superficial inspection of all nodes.

A minimum amount of material (radioactive liquid and / or blue dye) is injected into the area around the tumor and, using appropriate medical equipment, the Institute of Nuclear Medicine doctor and surgeon map this area. The surgeon removes only stained (sentinel) lymph nodes and sends the sample for pathological examination.

In cases where cancer cells are not found in the sentinel nodes at the end of a complete thorough examination, it is highly likely that all other lymph nodes in the armpit are also not infected, so there is no need to remove them. This issue should be cleared up at the doctor’s consultation. Removal of the sentinel nodes has a very low complication rate.

If information that the lymph node is infected was obtained during the operation, the surgeon removes all the lymph nodes during the mastectomy.

If sentinel node metastases were found only during postoperative examination, further surgery to remove all lymph nodes may be required, although the incidence of such cases is decreasing.

There is a treatment trend in Israel today to reduce the number of major armpit surgeries because it does not improve the chances of recovery in many of them. The sentinel node method generally reduces the incidence of removal of all lymph nodes and thus also reduces the proportion of women who may suffer from lymphedema (swelling of the hand and arm that restricts movement and causes pain).

Breast reconstruction in Israel

If the decision was made about a radical mastectomy (complete resection), you should make another decision that completely depends on your choice: to perform breast reconstruction immediately during removal surgery or to perform it as a separate operation after a mastectomy.

Breast reconstruction is a surgical procedure aimed at restoring the volume of the breasts, nipple and areola. The new breast should resemble the original in shape and size.

Below are the questions you can ask your plastic surgeon:

• What breast reconstruction methods are available and what are the risks?
• What are the pros and cons of each method?
• What kind of recovery am I being offered and why?
• If I am offered reconstruction with an implant, how long the implant serves?
• Is the nipple removed during surgery? Can it be restored and by what methods?
• Can reconstruction complicate future diagnosis with mammography or other imaging aids?
• Can resection and reconstruction be performed in one operation?
• Will recovery affect my physical status and function? How many working days I have to skip?
• Will I be limited in my daily life at home and with the family?
• Can I see pictures of reconstructed breast?

Over the years, the techniques used for reconstruction after mammary glands cancer surgery have become more sophisticated. However, some women choose to avoid further surgery, live with a surgical scar, and use an artificial breast (prosthesis).

The decision to undergo reconstructive surgery is usually based on motives related to the personal feelings of the woman and / or her partner. The plastic surgeon will explain to you which reconstruction options are right for you and which surgical procedures are needed. As with any operation, the healing process requires general anesthesia and hospitalization.

Nipple and areola reconstruction in Israel

It is also possible to repair the nipple and areola (the dark pigmented area around the nipple). This process is usually performed at a later stage, when the reconstructed breast takes its final shape. This way you can determine the most accurate nipple position and “fit” it to the nipple of a healthy side.

The doctor usually suggests waiting about three months before performing a nipple reconstruction. Nipples can be repaired in a variety of ways, such as by using reconstructed breast skin, a portion of the nipple from a healthy breast, or the skin behind the ear.

Areola reconstruction is performed by grafting skin taken from the groin area, or more often using a color tattoo, which avoids further surgery. Silicone nipples that are glued to the reconstructed breast also may be used in Israel. Each woman makes a choice according to her personal feelings and comfort.

Biological sheet

Special biological sheet (Acellular Dermal Matrix – ADM), which is based on human tissue that has been processed and cleaned by cells, therefore it contains all the components of biological skin without factors that can cause reflection in the body. Material types “Alodem” ® (Walloderm) are widely used in Israel and abroad. Its use allows immediate reconstruction of a fixed implant without the use of skin or temporary implants.

Maximum skin preservation mastectomy in Israel

During this procedure, all breast tissue and nipple are removed, but an attempt is made to preserve most of the breast skin. This method helps a team of plastic surgeons perform mammary glands reconstruction immediately after a mastectomy and preserve the natural lining of the breast.

Nipple-sparing mastectomy in Israel

During this procedure, all breast tissue is removed, but the nipple and areola are preserved (provided that the tumor is far enough away from them). The mammary gland tissue removed during the operation is sent for pathological examination for cancer cells. This method also helps the plastic surgeon team to perform reconstruction immediately after mastectomy and improve the cosmetic result.

How long does a mastectomy take?

A radical mastectomy takes up to two hours. If immediate breast reconstruction is added to it, the entire procedure can take several hours (depending on the type of reconstruction).

Hospitalization

After a complete mastectomy without reconstruction, hospitalization lasts about two days. After a complete mastectomy with reconstruction – about a week or more.

After a mastectomy

After a mastectomy, you may feel tired, weak, and painful, especially in the neck and back. It can be relieved with sedatives. The skin in the chest area can stretch and the muscles in the arm and shoulder can harden. Therefore, you may (not always) need physical therapy to increase the motor skills of the affected area. Removing the lymph nodes from the armpit can cause more pain or discomfort than the mastectomy itself.

The recovery process after surgery depends on the amount of tissue removed during the surgery and the location of the tumor. Recovery after breast-conserving surgery is faster than after complete breast removal surgery.

Removing lymph nodes from the armpit during surgery can also cause pain, most often the surgery itself, as well as fluid buildup in the arm, a condition called “lymphedema” that accompanies swelling in the arm.

How to care for a postoperative wound?

After mastectomy, the nurse will advise you on the care of the surgical wound. It, as well as the drainage entrance area, must be washed daily with soap and water. After rinsing, dry the area thoroughly and gently without rubbing. Do not apply ointments, creams, or deodorant to the surgical wound or drain entry area. The surgical wound can be left open or covered with a dry bandage.

Empty the drains at least once every 24 hours. The medical staff will also ask you to make a quantitative report of the discharge from the wound in one day.

Ensure that the drains are optimally sealed and that a vacuum is maintained in them. Secure the drains so that they do not move.

Physiotherapy after mastectomy

Physiotherapy is a part of the treatment which should be performed initially in a hospital under the guidance of a physical therapist to strengthen the muscles in the surgical site, prevent localized hardening, relieve tension from the surgical scar, allow free movement of the shoulder and arm, and maintain an upright posture. It is very important to activate the arm and hand on the operated side and gradually strengthen them.

Household activities that require raising and straightening the arm, such as ironing the clothes and making the bed, strengthen the muscles and the arm will likely return to normal function.

Rest and avoid physical activity for about three weeks after surgery.

Possible complications from mastectomy

Lymphatic edema is swelling of the hand and arm that restricts movement and causes pain. The swelling is usually mild and goes away with time, but rarely lasts long or remains permanently. Damage to a nerve in the area of ​​the surgery, which can cause a tingling or numbness sensation in the chest and arm that resolves over several weeks or months.

What is the success rate of a mastectomy?

Mastectomy is considered the safest operation, with a low rate of complications, and its goal of removing a malignant tumor is always fully achieved.

After you are discharged from the hospital, you should see the surgeon. After receiving the pathology results done by one of the leading Israeli pathologists (usually after 3-4 days), a decision will be made on further treatment. The doctor will discuss with you all the options – whether a wide resection is necessary or you can fly home and recover in your own conditions as well as possible chemotherapy, immunotherapy, target therapy, hormonal or other.

Molecular tests of the tumor in Israel

After removal of the tumor, the tissue is sent to the pathological institute for further examination. An experienced pathologist examines the tumor under a microscope, determines its size and the number of lymph nodes affected by the disease.

In addition, he performs a special staining of tumor cells, by which the oncologist can determine the course of treatment. Each tumor in the breast stains with estrogen and progesterone receptors, which determines whether hormone therapy is right for you. In addition, staining is done for a protein called “Mount Tu” (HER2) to determine if a targeted treatment (such as Herceptin) is right for you.

There are other tests that can be performed on a mammary glands tumor to help the oncologist choose the right treatment. Tests have recently been developed for more accurate molecular diagnostics of tumors, called Oncotype DX, MammPrint and Prosigna.

These tests check the activity of a large number of genes simultaneously in cancer tumor cells and determine their “molecular profile”. In some cases, they help decide whether chemotherapy should be added to the protocol or can be avoided, depending on the tumor profile.

Currently, new additional methods are being tested all over the world, allowing to develop an individual approach to the treatment of each woman, depending on her genetic profile. It is a personalized treatment for breast cancer.

⇒ List of specific oncotests for breast cancer in Israel

At home

To complete the treatment, to strengthen the muscles in the surgery area and prevent localized hardening, you will be asked to perform specific physiotherapy exercises depending on your condition. Damage to the nerves in the operated area can cause tingling or numbness in the chest and arms in some patients. These symptoms are expected to gradually disappear over time and as you recover.

You can gradually return to exercise. At first, exercise caution when performing hand activities that require effort, such as driving a car, swimming, tennis, aerobics, and lifting weights over 2.5 kg.

Take care of your hand and armpit hygiene and protect them from injury (even from animal bites and scratches). Avoid shaving your underarms, wearing jewelry that puts pressure on your arm or palm, and taking blood pressure measurements, infusion / injection / blood tests on the operated side.

Avoid carrying heavy objects and other strenuous activities such as pushing with your hand. Avoid exposure to extreme heat (for example, in a sauna) – this increases blood circulation and thus can cause congestion in the arm or arm, which does not drain effectively. It is sometimes recommended to raise the arm as high as possible to facilitate the flow of blood.

It is recommended that you do balanced exercises, such as walking and cycling, to contract the muscles and thus facilitate the drainage of lymphatic fluid. It is recommended that you support your hand or wear an elastic sleeve during the flight. Maintain a healthy weight as much as possible.

The return home and routine can be accompanied by fear and uncertainty. It is important to remember that in the first few days you may feel tired and weak, possibly even painful. These are natural feelings that shouldn’t bother you.

Get back to your routine at your own pace. Breast surgery does not require a new wardrobe. You can use your clothes, including bras, in the future. The feeling of discomfort will pass over time, you will return to strength and full functioning.

References: cancer.org.il

Additional information on the breast cancer treatment in Israel:

⇒ Recommendations for genetic testing for all women diagnosed with breast cancer, regardless of the risk of genetic mutations and heredity. American Society of Breast Surgeons (ASBrS)

⇒ Non-invasive ductal carcinoma in situ (DCIS)

⇒ Invasive ductal carcinoma (IDC)

⇒ Triple Negative Breast Cancer (TNBC)

⇒ Immunotherapy for breast cancer

⇒ New treatment options for breast cancer with brain metastases in Israel

⇒ Breast Cancer Intensifier and New Linear Accelerator Makes Cancer Treatment Easier