Saiba mais sobre a mastectomia

A mastectomia é uma forma de tratar o câncer de mama que consiste na retirada cirúrgica de toda a mama. Muitas vezes, é realizada quando uma mulher não pode ser tratada com a cirurgia conservadora da mama (lumpectomia), que poupa a maior parte da mama. Também pode ser feita se uma mulher preferir a mastectomia sobre a cirurgia conservadora da mama por motivos pessoais.

Tipos de Mastectomia

Existem vários tipos de mastectomia, com base na forma como a cirurgia é realizada e em quanto de tecido é removido:

  • Mastectomia Simples. A mastectomia simples é o tipo mais comum de mastectomia usada no tratamento do câncer de mama. Neste procedimento, o cirurgião remove toda a mama, incluindo o mamilo, mas não remove os linfonodos axilares e o tecido muscular sob a mama. Às vezes, os linfonodos são removidos em um procedimento diferente durante a mesma cirurgia. A maioria das mulheres, recebem alta hospitalar no dia seguinte ao procedimento.
  • Mastectomia Poupadora do Mamilo. Este procedimento é uma variação da mastectomia poupadora de pele. É uma opção para mulheres que têm um tumor pequeno em estágio inicial próximo à parte externa da mama, sem sinais de doença na pele ou perto do mamilo. Neste procedimento, o tecido mamário é removido, mas a pele da mama e o mamilo são preservados. Este procedimento é seguido pela reconstrução mamária. Muitas vezes, o cirurgião remove o tecido mamário sob o mamilo e a aréola durante a cirurgia, para verificar se existem células cancerígenas. Se for diagnosticado câncer neste tecido, o mamilo deve ser removido. Ainda existem alguns problemas com este tipo de cirurgia poupadora de mamilo. Por exemplo, o mamilo não tem um bom suprimento de sangue, por isso às vezes pode murchar ou ficar deformado. Como os nervos também são cortados, há pouca ou nenhuma sensação na mama. Para as mulheres com mamas maiores, o mamilo pode parecer fora do lugar após a reconstrução. Como resultado estético, esta cirurgia parece ser melhor em mulheres com mamas de pequeno a médio porte.
  • Mastectomia Dupla. Se a mastectomia é feita em ambas as mamas é denominada mastectomia dupla ou bilateral. Esse procedimento é muitas vezes considerado como uma cirurgia preventiva para mulheres com alto risco de desenvolver câncer na outra mama, como àquelas que têm uma mutação no gene BRCA.
  • Mastectomia Poupadora da Pele. Para algumas mulheres que consideram a reconstrução mamária imediata, pode-se fazer uma mastectomia poupadora de pele. Neste procedimento, a maior parte da pele da mama é preservada. A quantidade de tecido mamário removido geralmente é a mesma que numa mastectomia simples. Nestes casos, implantes ou tecido de outras partes do corpo são usados ​​para reconstruir a mama. Este tipo de mastectomia pode não ser adequado para tumores maiores ou aqueles que estão próximos da superfície da pele.
  • Mastectomia Radical Modificada. A mastectomia radical modificada combina a mastectomia simples com a remoção dos linfonodos axilares, denominada dissecção do linfonodo axilar.
  • Mastectomia Radical. Neste procedimento, o cirurgião remove toda a mama, os linfonodos axilares e os músculos peitorais (parede torácica) sob a mama. Atualmente, essa cirurgia é raramente realizada. Esta cirurgia ainda pode ser feita para tumores grandes que estão crescendo nos músculos peitorais.

Muitas mulheres com câncer de mama em estágio inicial podem escolher entre cirurgia conservadora da mama e mastectomia. Em princípio, a preferência inicial é pela mastectomia como uma maneira de “tirar tudo o mais rápido possível”. Mas o fato é que, na maioria dos casos, a mastectomia não oferece melhores possibilidades de sobrevida a longo prazo ou um melhor resultado do tratamento. Estudos que seguem milhares de mulheres por mais de 20 anos mostram que, quando a cirurgia conservadora da mama pode ser realizada, fazer a mastectomia não aumenta a sobrevida.

A mastectomia da mama pode ser uma boa opção se você:

  • Não consegue fazer radioterapia ou prefere uma cirurgia mais extensa para não fazer radioterapia.
  • Já fez radioterapia na mama.
  • Já fez cirurgia conservadora da mama e a doença não foi completamente removida.
  • Tem duas ou mais áreas de câncer na mesma mama que não estão próximas o suficiente para serem removidas sem alterar a aparência da mama.
  • Tem um tumor maior que 5 cm ou um tumor grande em relação ao tamanho de sua mama.
  • Está grávida e precisa fazer radioterapia durante a gravidez, com risco para o feto.
  • Tem um fator genético, como uma mutação BRCA, que pode aumentar sua chance de um segundo câncer
  • Tem uma doença importante do tecido conjuntivo, como esclerodermia ou lúpus, que pode torná-la sensível aos efeitos colaterais da radioterapia
  • Tem câncer de mama inflamatório.

Para as mulheres que estão preocupadas com a recidiva da doença, é importante entender que fazer uma mastectomia em vez da cirurgia conservadora da mama mais radioterapia reduz o risco de desenvolver um segundo câncer de mama no mesma mama. Mas, não diminui a chance de metástases para outros órgãos.

Reconstrução Mamária após a Mastectomia

Após a mastectomia, a mulher pode querer considerar a reconstrução para restaurar a aparência da sua mama. Isso se denomina reconstrução mamária. Embora cada caso seja diferente, a maioria das pacientes que fazem mastectomia pode fazer a reconstrução, ao mesmo tempo que a mastectomia (reconstrução imediata) ou num momento posterior (reconstrução tardia).

Se você está pensando em fazer a reconstrução mamária, converse com o cirurgião e, com o cirurgião plástico antes da mastectomia. Isso permitirá que a equipe cirúrgica planeje o tratamento mais adequado para você, mesmo que você espere e faça a cirurgia de reconstrução posteriormente. 

Algumas mulheres optam por não fazer a cirurgia de reconstrução. Usar uma prótese de mama é uma opção para algumas mulheres que querem usar apenas um contorno de uma mama sob suas roupas sem fazer uma cirurgia. Muitas mulheres se sentem confortáveis ​usando apenas próteses mamárias.

Recuperação da Mastectomia

A maioria das mulheres pode retornar às suas atividades rotineiras dentro de 4 semanas. Mas, se também for realizada a reconstrução da mama pode demorar alguns meses para a mulher retornar completamente a todas as suas atividades. Normalmente, você seus familiares e cuidadores receberão instruções escritas sobre os cuidados após a cirurgia. Essas instruções devem abranger:

  • Como cuidar do local da cirurgia e cuidados ao se vestir.
  • Como cuidar do dreno, caso esteja com dreno.
  • Como reconhecer sinais de infecção.
  • Orientações sobre como tomar banho após a cirurgia.
  • Quando ligar para o médico.
  • Quando começar a usar o braço novamente e como fazer os exercícios com o braço para evitar rigidez.
  • Quando começar a usar um sutiã novamente.
  • O que pode (ou não) comer.
  • Uso de medicamentos, incluindo medicamentos para dor e, possivelmente, antibióticos.
  • Qualquer restrição de atividades.
  • O que esperar sobre sensações ou dormência na mama e no braço.
  • O que esperar dos sentimentos sobre a sua imagem corporal.
  • Quando agendar uma consulta de acompanhamento.
  • Programas de apoio.

Tratamentos após a Mastectomia

Algumas mulheres podem fazer outros tratamentos após a mastectomia, como radioterapia, terapia hormonal, quimioterapia ou terapia alvo. Converse com seu médico sobre os tratamentos indicados para o seu caso.

Efeitos Colaterais

Os efeitos colaterais da mastectomia podem incluir:

  • Dor.
  • Inchaço na parte superior do braço.
  • Hematoma.
  • Seroma.
  • Limitação nos movimentos do braços ou do ombro.
  • Dor neuropática na parede torácica, axila e/ou braço.

Assim como em todas cirurgias, pode ocorrer hemorragia e infecção. Se os linfonodos axilares forem removidos, também pode ocorrer outros efeitos colaterais, como o linfedema.

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