Double Mastectomy

What is a double mastectomy?

A double mastectomy (bilateral mastectomy) is a surgery to remove both of your breasts. Mastectomy means removing breast tissue. A double mastectomy removes all of your breast tissue on both sides.

You might need this surgery if you develop breast cancer in both breasts, or if you’re very likely to. Surgeons remove all the tissue where cancer can grow to stop it from growing and spreading.

Double mastectomy types

Different types of double mastectomy procedures have slightly different steps. Types include:

• Prophylactic bilateral mastectomy: A prophylactic mastectomy (risk-reducing mastectomy) is a preventive treatment. It’s for people with a high risk of developing cancer in both breasts.
• Contralateral prophylactic mastectomy: This means you have cancer in one breast, but have both of your breasts removed together. The removal of the opposite breast is preventive.
• Simple double mastectomy: Also called a total double mastectomy, this simply means removing both breasts entirely without plans for reconstruction.
• Modified radical double mastectomy: A modified radical double mastectomy removes both breasts and also several of the lymph nodes under your arms to test them for cancer.
• Skin-sparing double mastectomy: In this version, your surgeon removes all of your breast tissue, but spares as much of your breast skin as possible. They do this so they can use it to reconstruct your breasts.
• Nipple-sparing double mastectomy: This version removes both breasts, but keeps your skin, nipples and areolas intact. Your surgeon can use these to reconstruct your breasts.

Your surgeon will explain which versions of the procedure they recommend for you and why.

What happens before a double mastectomy?

Before scheduling a double mastectomy, you and your healthcare provider will discuss your condition and make a treatment plan. You’ll decide together if and how a double mastectomy fits into the plan.

Your provider will tell you what parts they need to remove and if they can save your skin or nipples. You’ll decide if you want to have breast reconstruction surgery at the same time or later, or at all.

Your plan may include other cancer treatments, either before or after your surgery. These plans may affect the timing of your breast reconstruction surgery or the methods your surgeon can use.

Your provider will also explain how to prepare for your surgery and your recovery at home. You may want to make some adjustments in your home or arrange for someone to help you with certain tasks.

What happens during a double mastectomy?

You’ll have general anesthesia for the procedure, so you’ll sleep through it. Once you’re asleep, your healthcare team will place a breathing tube in your throat to keep your airways open during surgery.

A provider will inject a substance into your breasts to locate your lymph nodes. Sometimes, they use a blue dye. Other times, they use a mild radioactive tracer. And sometimes, they use both.

Your surgeon will:

1. Remove a vast majority of your breast tissue from each breast. They’ll spare the skin and/or nipples if they can and if you want to reuse them. This part of the procedure takes one to three hours.
2. Remove at least one lymph node from each underarm to check for cancer spread. In some cases, they might remove all of your underarm lymph nodes and send them to the lab.
3. Begin your breast reconstruction if you’re having it now. This part can take anywhere from three to eight hours. They might use artificial parts or tissues from your own body, or a combination.
4. Finish by closing your incisions, leaving in a few surgical drains. These will stay in place for a few days to weeks to drain excess fluids from the site. Your surgical team will bandage your chest.

How long does a double mastectomy take?

You can expect to spend at least a few hours in surgery for a double mastectomy. If you have breast reconstruction at the same time, it can be six to 10 hours. Your surgeon will tell you what to expect.

What are the potential risks and benefits of a double mastectomy?

The benefits of a double mastectomy depend on your breast cancer risk or cancer stage. If your healthcare provider has recommended it for you, it’s because they believe it might be lifesaving.

All surgeries carry certain risks, including infection, bleeding and nerve damage. Having surgery on both of your breasts increases your risk of complications. But the risks of cancer are far greater than these.

Surgery isn’t the only way to treat or prevent cancer. Your provider will discuss all of your options with you. It’s not always the best option for everyone. But surgery is one of the most effective tools we have.

If you have cancer and it hasn’t spread yet, surgery is almost always your best bet. If you don’t have cancer, but your breast cancer risk assessment is high, your provider will discuss the pros and cons.

Long-term complications

Side effects or delayed complications of the procedure can include:

• Lymphedema: If surgery on your lymph nodes damages your lymphatic system, you might develop lymphedema. Excess lymph fluid builds up in your tissues, causing swelling and discomfort. This is a long-term condition. But it’s treatable, especially if it’s caught early.
• Post-mastectomy pain syndrome: Nerve damage related to breast surgery can lead to chronic neuropathic pain in the area. This causes ongoing, occasional symptoms, like tingling, prickling, burning, itching or shooting pain. Your provider can prescribe medications to treat it.

What happens after a double mastectomy?

Most can go home the same day. But in some cases, you may spend a night or a few nights in the hospital after your mastectomy. Your healthcare team will monitor you for complications.

They’ll also explain how to care for yourself at home, including:

• How to treat your pain.
• How to treat your wound.
• How to manage your surgical drains.
• How to recognize signs of infection.
• How to recognize signs of lymphedema.
• Exercises to prevent stiffness in your arms and shoulders.

You’ll have a follow-up appointment with your provider in a couple of weeks. At this time, you’ll discuss the pathology report from the lab that studied your tissues and what it means for your treatment plan.

What is the recovery time from a double mastectomy?

Recovery from a double mastectomy takes time, especially for more complex surgeries. It takes at least four weeks for your wounds to heal. It may take up to eight weeks if you had reconstruction at the same time.

During this time, you’ll need to avoid driving, reaching and heavy lifting. Your arms and chest will feel stiff and tight. Practicing your exercises every day will help relieve stiffness and promote healing.

You may have your surgical drains in for all or some of this time. They can be awkward under your clothes and when you’re trying to sleep. You can buy special mastectomy bras that hold them in place.

You may feel tired for weeks or even months afterward. You may also feel various sensations in your chest as your nerves slowly recover. Some people continue to feel numb in their chest for years.

When should I contact my healthcare provider during recovery?

Contact your provider if you have signs or symptoms of complications, like:

• Redness or swelling around your incisions
• Unusual swelling in your arms and legs
• Pain that doesn’t improve with time or gets worse
• Stiffness that doesn’t improve with movement