Simple Mastectomy (Total Mastectomy)

A simple mastectomy (total mastectomy) is a type of breast cancer surgery that removes your entire breast. This includes your breast tissue, skin, nipple and areola. It also includes the lining of your main chest muscle.

Your surgeon usually doesn’t remove all of your underarm lymph nodes. But sometimes, they take out a few for a sentinel node biopsy. This is a test to see whether the cancer has spread beyond the original tumor. By examining the lymph nodes, your provider can tell if the cancer has extended beyond your breast.

Simple mastectomy, or total mastectomy, is the most common type of mastectomy.

What does this procedure treat?

Healthcare providers use simple mastectomy (total mastectomy) to treat several different types of breast cancer. These include:

• Ductal carcinoma in situ (DCIS)
• Invasive ductal carcinoma (IDC)
• Invasive lobular carcinoma (ILC)
• Paget’s disease of the breast

Your provider may also suggest it if you have cancer that has returned. Or you may consider a simple mastectomy if you have a high risk of developing breast cancer.

How should I prepare for this procedure?

Your healthcare provider will let you know if you need to do anything special before the surgery.

They’ll likely perform an exam and ask you about your medical history. They’ll want to know about any medicines you’re taking, including:

• Prescriptions
• Over-the-counter (OTC) medications
• Supplements

They’ll also ask about any allergies and/or bleeding problems.

They may order a few tests, including lab tests, a mammogram or a biopsy. If you want breast reconstruction after total mastectomy, you’ll discuss your options with your provider.

Your provider will also let you know if you need to fast. That means you can’t eat or drink anything for a certain amount of time before the surgery. They’ll also talk to you about what to expect after the surgery. For instance, you’ll need a ride home. You may also want to arrange for some help while you recover.

What happens during this procedure?

On the day of the total mastectomy, a healthcare provider will insert a thin tube (IV) into one of your veins. This is so you can receive fluids and medicine. Your surgeon will likely perform the procedure under general anesthesia. That means you’ll be asleep and won’t feel any pain.

Then, your surgeon will:

1. Make a cut (incision) around your breast
2. Remove your breast tissue and the lining of your main chest muscle
3. Remove your breast skin, nipple and areola
4. Remove a few underarm lymph nodes for biopsy, if necessary
5. Perform immediate breast reconstruction or a procedure to prepare for delayed breast reconstruction (this depends on what you discussed with your provider)
6. Place a drain in the surgical site to collect fluid
7. Close the incision and cover it with bandages

How long does this procedure take?

A simple mastectomy takes one to three hours. If you’re having breast reconstruction, it will take longer. Your provider can let you know what to expect.

What are the potential risks or complications of this procedure?

Your healthcare provider will discuss any possible risks or complications that could occur. They’ll help you weigh these risks against the benefits of having the procedure. Possible risks of a simple mastectomy include:

• Fluid buildup under your skin (seroma)
• Surgical wound infection
• Pain in your chest wall
• Chest, arm or shoulder stiffness
• Nerve injury
• Cosmetic deformity
• Phantom breast syndrome
• Fluid buildup in your arm or hand (lymphedema)
• Depression
• Post-mastectomy pain syndrome (PMPS)

What happens after this procedure?

After surgery, you’ll spend some time in a recovery room. You’ll get pain medication if you need it. Your healthcare team will get you up and moving as soon as possible. They’ll check for any issues from surgery before they send you home. They’ll go over how to care for the wound and surgical drain. Ask questions if there’s anything you don’t understand.

Your provider may go over the next steps in your treatment plan. But they may have to wait for results from the lab. Depending on the results, you may need additional surgery, chemotherapy or another cancer treatment. Your provider will also discuss referrals for post-mastectomy prosthetics and clothing options.

What is the recovery time?

Most people go home the same day as the surgery. Some people stay a night in the hospital. Total mastectomy recovery time varies. But it typically takes a few weeks for the wound to heal.

You’ll want to increase your activity slowly. You can begin with short walks around your house. Then, gradually go further every day.

Make sure to avoid lifting anything heavier than a gallon of milk. You also don’t want to participate in strenuous activities for at least two weeks. Your provider will advise you on when it’s safe to start again. They may also recommend physical therapy. This can help you improve your range of motion and arm strength.

When should I call my healthcare provider?

You’ll have follow-up appointments with your provider. They’ll want to check on your recovery progress. They may also discuss the results of the procedure. They’ll talk to you about the next steps in the treatment plan.

Call your provider sooner if you develop any symptoms of infection or other complications. These include:

• Fever of 100.4 degrees Fahrenheit, or 38 degrees Celsius
• Chills
• Redness or skin discoloration around the incision site
• Bleeding, drainage or swelling coming from the incision site
• Nausea or vomiting
• Warmth, swelling or stiffness in your arm or hand
• Feelings of depression

Also, make sure to call your provider if there’s a clog in the surgical drain. They’ll also want to know if the stitches holding the drain are loose or missing.