Mastectomy

What is a mastectomy?

A mastectomy is a type of breast cancer surgery that removes your breast tissue. Most of the time, it means removing all of your breast tissue from one or both breasts. Mastectomy is a treatment for most types and stages of breast cancer. It’s also a way to prevent breast cancer if you have a high risk of getting it.

There are several types of mastectomies. There are also several ways to reconstruct or replace your breasts after a mastectomy. These are some discussions that 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 can bring a variety of emotions with it. You may feel anxious and ready to do whatever it takes to remove the cancer. At the same time, you may feel regret about sacrificing your breast(s). These are normal, understandable reactions.

How does mastectomy treat breast cancer?

If you have breast cancer, removing the cancer cells is the best way to stop it from spreading. A mastectomy removes all the breast tissue where cancer cells might be hiding to ensure no cancer cells are left behind.

What types of breast cancer are treated with mastectomy?

Types of breast cancer that mastectomy treats include:

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

What stage of breast cancer is treated with mastectomy?

Any cancer stage before stage IV (4) may be treated with a partial or total mastectomy. Stage IV is metastatic breast cancer. That’s when breast cancer has spread beyond your breast tissue to other parts of your body. At this point, removing your breast tissue is no longer enough to stop the cancer from spreading.

What are the different types of mastectomies?

Mastectomies go by different names depending on how much tissue they remove. Types include:

• Partial mastectomy (lumpectomy): This breast-conserving surgery removes a tumor with a margin of healthy tissue around it. 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.
• Double mastectomy (bilateral mastectomy): A double or bilateral mastectomy is a total mastectomy of both breasts. You may have a double mastectomy if you have cancer in both breasts or have a high risk of cancer occurring in both breasts.
• Skin-sparing 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.
• Modified radical mastectomy: This operation removes all of your breast tissue and your axillary lymph nodes, the lymph nodes in your underarm 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 and your axillary (underarm) lymph nodes, as well as your pectoral muscles. This surgery is rare these days, but it may be necessary if the cancer has spread to your muscles.
• Prophylactic mastectomy: You might choose to have a prophylactic (preventive) mastectomy if you have a high lifetime risk of developing breast cancer. This is an option if you carry certain genetic mutations in your DNA, such as BRCA, p53 or PTEN.

You may have one or a combination of these types, depending on your needs and preferences.

How should I prepare for a mastectomy?

You and your healthcare provider will develop a treatment plan that includes the type of mastectomy you’ll have and any reconstructive surgery you might choose to have. You’ll also learn more about what to expect during your recovery. This will help you plan how to manage your daily activities after your surgery.

Your provider may tell you to restrict your activities during recovery. They’ll explain that you won’t be able to raise your arms over your head, so you may want to reorganize your shelves. They’ll tell you that you 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 a local breast cancer support group. Talking to others about their mastectomy experiences can help you feel less anxious about your upcoming mastectomy and recovery. You might learn helpful tips in advance, and you’ll make contacts that you can go back to during your recovery.

You may also need to:

• Quit smoking. Smoking affects your blood flow, which can make it harder to heal after surgery. You may not be eligible for reconstructive surgery if you currently smoke.
• Fast. Your surgeon may say you can’t eat anything for a certain number of hours before surgery. They’ll give you specific instructions about what to eat and drink, and when.
• Plan for your hospital stay. You’ll probably be in the hospital overnight. Make plans for others to help manage your work and home responsibilities while you’re away.
• Plan for help at home. You may want to have someone stay with you for the first few days at home. Also, consider asking family and friends to help prepare meals.

What happens during a mastectomy?

On the day of your mastectomy:

1. You’ll go under general anesthesia, which means you’ll be asleep through the procedure.
2. You’ll have a tube to help you breathe and a catheter in your vein to give you IV fluids. This keeps you hydrated during the procedure. You may also have a catheter to drain your pee.
3. Your surgeon will sterilize your skin and give you antibiotics through your IV to prevent infections.
4. Your surgeon may inject a mild radioactive tracer into your breast tissue, which helps to highlight your nearby lymph nodes. Your surgeon will use a handheld scanner to find them.
5. Alternatively, your surgeon might inject a blue dye into your breast tissue to highlight your lymph nodes. The dye will stay in your tissues for a few weeks.
6. Your surgeon will remove your breast tissue, including or sparing your skin and nipple. They may remove additional tissue if cancer has spread there.
7. Your surgeon may remove lymph nodes for biopsy. They’ll send them to the lab to check for cancer cells.
8. If you’ve chosen to have breast reconstruction surgery, your surgeon may now begin and complete this process. They may use an artificial implant, a temporary implant and/or tissue from somewhere else on your body.
9. 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.
10. 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 it take?

A partial mastectomy (lumpectomy) may take an hour. A total or double mastectomy may take several hours. If you have reconstruction surgery at the same time, that will make your procedure longer.

What are the potential risks or complications of mastectomy?

Mastectomy complications can develop within days or weeks after your surgery, and sometimes later.

Early complications from the procedure can include:

• Surgical wound infection: Surgeons are careful to prevent this. The risk is less than 1%.
• Hematoma: This rare complication involves a buildup of blood under the surgical wound.
• Seroma: This happens when fluid builds up inside your wound, causing swelling and tenderness.
• Flap necrosis: This complication involves a loss of blood supply to the cut tissue, leading to tissue death (necrosis). Your surgeon will remove the dead tissue and replace it with a skin graft.

Delayed complications can include:

• Post-mastectomy pain syndrome (PMPS): PMPS is when you have nerve damage that causes symptoms like tingling, prickling, burning, itching or shooting pain. This can happen when you’ve had tissue close to your underarm removed. Your surgeon can prescribe medications to treat it.
• Lymphedema: Lymphedema is when lymph fluid in your body doesn’t drain properly and builds up in your tissues, causing swelling (edema). This can happen if surgery to remove lymph nodes damages your lymphatic system. Physical therapy and massage can help manage the symptoms.

What happens after a mastectomy?

Typically, you’ll spend a night in the hospital, or possibly longer if you have more extensive surgery. Your healthcare team will have you up and walking on the same day as your surgery. This reduces the risk of blood clots and pneumonia from lying in bed for a long time. You’ll have pain relief as needed.

You’ll wait for lab results to determine the next steps. Your surgeon will want to ensure they got all the cancer. They should have these results within a couple of weeks. Most of the time, there’s no need for more surgery. But occasionally, your surgeon may need to remove additional lymph nodes or tissue.

You might also need additional cancer treatment after surgery, like radiation therapy or chemotherapy. Some people wait to finish these treatments before starting breast reconstruction surgery. If you have started it, you might need additional follow-up surgeries to achieve the final cosmetic result you want.

What is the recovery from mastectomy like?

A mastectomy is a life-changing event. While surgery and other treatments may cure your breast cancer, the loss of your breast can bring many emotions to process. Your body will also need time to heal.

In general, you can expect:

• Your surgical wound will heal in about three weeks. Your healthcare provider will explain how to care for your wound and your surgical drain at home. They’ll tell you when it’s safe to bathe.
• You’ll feel tired, sore and stiff in your chest, shoulder and arm for about six weeks. You may be unable to use your sore arm to reach or lift anything heavy during this time. Take it easy.
• Mild pain relievers will help with soreness. Your healthcare provider will give you gentle exercises to practice to relieve stiffness. These are important to prevent permanent stiffness.
• Your nerves are the slowest part of your body to heal. As they do, you may feel a variety of sensations in your chest over the next several months, such as numbness, twinges or pain.
• Many people regain some of the sensation in their chest after about two years. However, your sensation may never be quite the same as before, and long-term numbness is common.
• Your provider might recommend talking to a counselor or support group to process what you’ve been through. Complementary medicine, like meditation or acupuncture, may also help.

What will my chest look like after my mastectomy?

Any type of breast surgery will leave a scar and change the appearance of your chest. Those changes differ from person to person. If you’re like most people, your scars will become less apparent over time.

What your chest looks like will depend on factors like:

• The types of cuts (incisions) your surgeon made, and where they made them.
• How your incisions heal (some scars may look red and raised).
• Whether you have breast reconstruction surgery.
  • During reconstruction, your surgeon will take steps to hide your scars as much as possible.

When should I call my healthcare provider?

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

• You have pain that persists even after you take pain medication.
• You notice signs of infection at the surgery site, like if it’s red, swollen and tender.