Mastectomy

What is a mastectomy?

A mastectomy is a type of breast cancer surgery that removes all of your breast tissue in one or both of your breasts. The procedure is treatment for several types of breast cancer and most breast cancer stages. It’s also a way to prevent breast cancer if you have an increased breast cancer risk.

There are many types of mastectomies, which remove part or all of your breast tissue. There are also many ways to reconstruct your breast(s) following removal. These are some of the discussions you’ll have with your healthcare provider. As you map out your breast cancer treatment plan together, you’ll have a series of choices to make.

The decision to have a mastectomy is a very personal one that often brings on a lot of different emotions. You may feel anxious and ready to take whatever steps are needed to remove the tumor. At the same time, you may feel sad about losing your breast to cancer. You may feel like you’re losing part of your identity. All of these are normal emotional reactions that your healthcare provider will understand.

How does a mastectomy treat breast cancer?

If you have breast cancer, removing cancer cells from your body is the best way to cure it and stop cancer from spreading to other parts of your body. In a mastectomy, your surgeon removes all the breast tissue, including where cancer cells exist.

How does a mastectomy prevent breast cancer?

People who carry certain genetic mutations in their DNA have a high chance of developing breast cancer in their lifetimes. Genetic testing can help determine if you carry any of these genes, some of which include BRCA1 and BRCA2, p53 and PTEN. If you do carry these genes, there are many methods for preventing cancer, including a preventive mastectomy, also called a prophylactic mastectomy. This can reduce your breast cancer risk by about 90%. A small risk remains because a few breast cancer cells may remain under your skin.

What types of breast cancer does a mastectomy treat?

A mastectomy is a treatment for the following breast cancer types:

• Infiltrating ductal carcinoma.
• Infiltrating lobular carcinoma.
• Triple-negative breast cancer.
• Inflammatory breast cancer.
• Paget’s disease of the breast.

What stage of breast cancer requires a mastectomy?

In general, a mastectomy may be a treatment option or choice if you have breast cancer that hasn’t spread to another part of your body. This is stage IV (4) or metastatic breast cancer. That’s because removing your breast won’t prevent cancer in other parts of your body.

What are the different types of mastectomies?

Mastectomies go by different names depending on how much tissue your surgeon removes:

• Partial mastectomy (lumpectomy): This procedure removes an individual tumor (“lump”) from your breast, with a margin of healthy tissue around it. A lumpectomy is an option when treating breast cancer in the early stages.
• Total mastectomy (simple mastectomy): A total or simple mastectomy removes all breast tissue but leaves your pectoral muscles beneath. A total mastectomy can be unilateral (one breast only) or bilateral (both breasts).
• Double mastectomy (bilateral mastectomy): A double mastectomy, also called a bilateral mastectomy, is a total mastectomy of both breasts. You may have a double mastectomy if you have cancer in both breasts or if you have a high risk of cancer occurring in both breasts.
• Skin-sparing mastectomy or nipple-sparing mastectomy: A skin-sparing or nipple-sparing mastectomy removes your breast tissue but spares the skin and/or nipple to use when reconstructing your breast.
• Mastectomy with breast reconstruction: Whether or not you're having a skin-sparing or nipple-sparing mastectomy, you may be able to have breast reconstruction surgery at the same time as your mastectomy. This will depend on your condition and treatment plan. You can also have breast reconstruction later in a separate surgery. Your breast reconstruction surgery may include nipple and areola reconstruction.
• Modified radical mastectomy: A modified radical mastectomy removes all of your breast tissue, as well as your underarm lymph nodes on the same side. This is often the first place that breast cancer spreads.
• Radical mastectomy: A radical mastectomy removes all of your breast tissue, underarm lymph nodes and your pectoral muscles underneath. This surgery is rare these days, but it may be necessary if the cancer has spread to your muscles.

How should I prepare for a mastectomy?

You and your healthcare provider will develop a treatment plan that includes the kind of mastectomy and any reconstructive surgery that you’ll have. This discussion is a good time to learn what you should expect during your recovery. Understanding what goes into recovering from a mastectomy will help you plan how to manage your daily activities after your surgery.

For example, your provider may tell you to restrict your activities as you recover. They may explain that you won’t be able to lift your arms over your head, so you may want to reorganize your shelves and place essential items on lower shelves. They may tell you that won’t be able to lift anything heavier than a gallon of milk, so you should plan to have help at hand.

You may want to contact local breast cancer support groups. Talking to someone about their mastectomy experience may help you feel less anxious about your mastectomy and recovery.

There are some other things you should do to get ready for your surgery, including:

• Quit smoking: Smoking affects your blood flow, which can make it harder for you to heal after surgery. You may not be considered for reconstruction if you’re actively smoking or using nicotine (vaping).
• Fast: For example, your surgeon may say you can’t eat anything for at least six hours before surgery. You may be able to drink clear liquids for a certain amount of time before surgery. But be sure to double-check with your surgeon.
• Plan for your hospital stay: A mastectomy is a major surgery. You’ll probably be in the hospital overnight. Making plans for others to manage your work and home responsibilities means you can focus on healing.
• Plan for help at home: You may want to have someone stay with you for the first few days at home. Consider asking family and friends to help with meals.

What happens during a mastectomy?

1. First, a healthcare provider will give you general anesthesia, which means you’ll be asleep throughout the procedure.
2. You’ll have a tube to help you breathe and a catheter in your vein to give you IV fluids. You may have a catheter to drain your urine if it’s a longer procedure.
3. Your surgeon will clean and sterilize the surgical site and give you antibiotics through your IV to prevent infections.
4. You may have a mildly radioactive substance called a tracer injected into your breast to help highlight your nearby lymph nodes. Your surgeon will use a handheld scanner to find them.
5. Alternatively, your surgeon may inject a blue dye into your breast tissue to highlight your lymph nodes. The dye will stay in your tissues for a few weeks. It will turn your pee a different color for the first few days after your surgery.
6. Your surgeon will remove your breast tissue, including or sparing your skin and/or nipple. They may remove additional tissue if cancer has spread there.
7. Your surgeon may remove one or several lymph nodes from your underarm. They’ll send them to the lab to check for cancer cells.
8. In some cases, your surgeon may do an axillary lymph node dissection to remove all the lymph nodes from your underarm.
9. Your surgeon may begin and complete the process of reconstructing your breast at this time. They may use an artificial implant, temporary implant and/or tissue from somewhere else on your body.
10. If you’re not having breast reconstruction at this time, they’ll close the opening. You may have reconstruction surgery later, or you may choose not to have it.
11. Your surgeon will most likely leave a temporary drain inside the surgical site. This is a tube that draws excess fluids from the wound into a collection bulb on the outside. You may have it for a week or two afterward.

How long does a mastectomy take?

That depends on the type of mastectomy and whether you’ll have breast reconstruction surgery during the procedure. In general, a partial mastectomy (lumpectomy) may take an hour. A total mastectomy may take more time.

What happens after a mastectomy?

Typically, you’ll spend a night in the hospital, possibly longer if you have more extensive surgery. Your healthcare team will have you up and walking on the same day of your surgery. Walking reduces the risk you’ll have blood clots or develop pneumonia after surgery.

Your healthcare team will teach you how to care for your wound and your surgical drain at home.

You’ll wait for lab results to determine next steps. Your healthcare team will check the breast tissue and lymph nodes they removed to ensure they got all the cancer. They’ll usually have your results within a couple of weeks. Most of the time, there’s no need for additional surgery. But occasionally, they may need to remove additional lymph nodes or a wider margin of tissue in the area.

You may also need additional cancer treatment after surgery like radiation or chemotherapy. Some people prefer to complete these treatments before beginning the process of breast reconstruction. Even if you’ve begun your breast reconstruction, you might need additional follow-up surgeries (revision surgery) to achieve the final cosmetic result you want.

What are the benefits of a mastectomy?

If you have breast cancer, a mastectomy that removes the tumor may help you worry less that breast cancer will come back to the area where it started. But cancer may come back somewhere else in your body even after a mastectomy.

If you have a high risk of developing breast cancer, a prophylactic mastectomy may reduce the risk you’ll develop the condition.

What are the risks or complications of a mastectomy?

All surgery comes with certain risks or complications. Mastectomy complications may develop within days or weeks after your surgery. But some complications develop later.

Early complications from the procedure can include:

• Surgical wound infection: Surgeons are careful to prevent this and give you antibiotics at surgery. The risk is less than 1%.
• Hematoma: This rare complication involves a buildup of blood under the surgical wound. This occasionally means removing this buildup of blood in the operating room.
• Seroma: This happens when fluid builds up inside your surgical wound. It can cause swelling and tenderness at the surgery site. This may need to be drained in the office.
• Flap necrosis: This complication involves loss of blood supply to the cut tissue, leading to tissue death. It would require cutting off the dead tissue and possibly replacing it with a skin graft. The risk of flap necrosis is low.

Delayed complications can include:

• Post-mastectomy pain syndrome (PMPS): PMPS is when you have nerve damage that may happen if your surgeon needs to take tissue close to your underarm. This condition causes symptoms like tingling, prickling, burning, itching or shooting pain. Talk to your surgeon if you have these symptoms. They can prescribe nerve pain medication.
• Lymphedema: This happens if your surgery involves removing many lymph nodes and damages your lymphatic system.

What is the recovery time?

Recovery time is different for everyone. Here’s what you may experience:

• Your surgical wound may heal in about three weeks.
• You may feel sore and stiff for up to six weeks after your surgery, particularly in your arm, chest and shoulder. Mild pain relievers will help with soreness. Stiffness improves with gentle activity. Your healthcare team will give you specific exercises to do to help your recovery.
• During that time, you may feel tired. Your arm, chest and shoulder may feel sore and stiff.
• Over the next several months, you may feel a variety of sensations in your chest as your nerves begin to heal. Your chest may feel numb, but you may also feel momentary twinges, tenderness or phantom sensations.

What programs can help me recover from a mastectomy?

A mastectomy is a life-changing event. In some cases, surgery and follow-up treatment may cure your breast cancer. But while you may feel relieved after surgery, losing one or both of your breasts can bring on lots of emotions. Your body will need time to heal. Here are some programs that may help you on your road to recovery:

• Physical therapy.
• Talk therapy with a psychologist.
• Wellness programs like complementary medicine.
• Support groups.

When should I call my healthcare provider?

You’ll have follow-up appointments with your care team. But you should contact your team when:

• You’re having pain that persists even after you take pain medication.
• You notice signs of infection in the surgery site, like the site feels tender to your touch, is red or swollen or you develop a fever.

What will my chest look like after my mastectomy?

Any type of surgery will leave a scar and change the appearance of your chest. But those changes are different from person to person. If you’re like most people, your scars will become less apparent over time. Changes to your chest depend on factors like:

• The surgery type, including the type of cuts (incisions) your surgeon made.
• How your incisions healed. Your surgery scars may look red and raised.
• Whether you have breast reconstruction surgery. In breast cancer reconstruction, your surgeon will take steps to hide your scars as much as possible.

A note from Cleveland Clinic

If tests show you have breast cancer, you might consider a mastectomy to eliminate cancer. If you’re at risk of developing breast cancer, you may want this surgery to reduce your cancer risk. Either way, you’re making a life-changing choice when you’re contemplating this procedure. You may feel overwhelmed by all the things you need to manage, from your emotions and planning for surgery to aftercare and recovery.

If that’s your situation, remember that your healthcare team is ready to help. They understand your concerns and answer your questions. They’ll also recommend resources, like breast cancer support groups, which can connect you with people who’ve experienced what you’re going through.