Mastectomy

A mastectomy is a type of breast cancer surgery that removes all of your breast tissue. Healthcare providers can use it to treat most types of breast cancer. Your provider may also recommend it if you have a high risk of developing 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 are located. After a mastectomy surgery, you may possibly need other cancer treatments to kill any remaining cancer cells in the surrounding tissue.

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

The decision to have mastectomy surgery may feel overwhelming. But you don’t have to make it alone. Your provider will help you understand your choices and what each type of mastectomy involves. Together, you can find the option that best supports your health, healing and peace of mind.

Types of mastectomy

The most common types of mastectomy surgery include:

• Total (simple) mastectomy: A total mastectomy (simple mastectomy) removes all of your breast tissue, breast skin, nipple and areola. Depending on your situation, your provider may also remove a few lymph nodes from your underarm area (axillary lymph nodes).
• Modified radical mastectomy: A modified radical mastectomy is similar to a total mastectomy. It removes all of your breast tissue, breast skin, nipple and areola. But it also removes most or all of your axillary lymph nodes.
• Skin-sparing mastectomy: A skin-sparing mastectomy removes all of your breast tissue, nipple and areola. But it preserves most of your breast skin. Your provider can use this skin pocket when performing reconstructive surgery.
• Nipple-sparing mastectomy: A nipple-sparing mastectomy is a type of skin-sparing mastectomy. It removes all of your breast tissue. But it spares your breast skin, nipple and areola. Your provider can use this skin pocket when performing breast reconstruction.

Other terms you may hear include:

• Double (bilateral) mastectomy): A double mastectomy (bilateral mastectomy) is a total mastectomy of both breasts. You may have a double mastectomy if you have cancer in both breasts. Or you might have it if you have a high risk of cancer occurring in both breasts.
• Prophylactic (preventive) mastectomy: You might choose to have a prophylactic mastectomy (preventive mastectomy) if you have a high lifetime risk of developing breast cancer. This is an option if you carry certain genetic changes in your DNA, like changes to the BRCA genes.
• Partial mastectomy (lumpectomy): This breast-conserving surgery removes a tumor and a small border of healthy tissue around it. Lumpectomy is an option for some people when treating breast cancer.

How should I prepare for a mastectomy surgical procedure?

Before surgery, you and your healthcare provider will develop a cancer treatment plan. It will include the type of mastectomy you’ll have. To restore your breast’s appearance, you may also choose to have breast reconstruction surgery after the mastectomy. Your breast surgeon usually partners with a plastic surgeon who’ll perform the reconstructive surgery.

You’ll also learn more about what to expect during your recovery. This will help you plan how to manage your daily activities after the surgery.

You may need to:

• Quit smoking: Smoking affects your blood flow. This can make it harder to heal after surgery and often limits your options for reconstruction.
• Fast: Your surgeon may say you can’t eat or drink for a certain number of hours before surgery because it can be unsafe for anesthesia.
• Plan for your hospital stay: 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.

What happens during this procedure?

On the day of the mastectomy, you’ll get general anesthesia. That means you’ll be asleep throughout the procedure. You’ll have a tube to help you breathe and a catheter in your vein to give you fluids intravenously (IV). This keeps you hydrated during the procedure. You may also have a catheter to drain your pee.

Your surgeon will:

1. Sanitize your skin and give you antibiotics through the IV to prevent infections
2. Make a cut (incision) around your breast or part of your breast
3. Remove your breast tissue (depending on the type of mastectomy, they may also remove the breast skin, nipple and areola)
4. Carefully dissect and remove axillary lymph nodes for biopsy, if necessary, and send them to the lab to check for cancer cells
5. Perform breast reconstruction surgery if you’ve chosen to have it immediately (they may use an artificial implant, a temporary implant and/or tissue from somewhere else on your body)
6. Place one or more mastectomy drains in the surgical site to prevent fluid buildup (these are tubes that draw excess fluid from the wound into collection bulbs on the outside of your body, and you may have them for a week or two after surgery)
7. Close your wound (you may have reconstructive surgery later, or you may choose not to have it at all)

How long does this procedure take?

The length of the procedure depends on which type of mastectomy you have. A partial mastectomy (lumpectomy) may take an hour. A total or double mastectomy may take several hours. If you have reconstructive surgery at the same time, that will make your procedure longer.

What are the potential risks or complications of this procedure?

Mastectomy complications can develop within days or weeks after 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 the 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 may need to remove the dead tissue and/or 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 removed from your underarm or on the side of your chest, where many nerves are located.
• 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.

What happens after a mastectomy?

You might spend a night in the hospital, or possibly longer if you have more extensive surgery. Your healthcare team will get you up and walking on the same day as the 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 figure out the next steps. Your surgeon will want to make sure 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 sometimes, your surgeon may need to remove more lymph nodes or tissue.

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

Mastectomy recovery

Healing from a mastectomy takes time. Surgery and other treatments may cure the breast cancer, but the loss of your breast can bring many emotions. Your body will also need time to heal.

Recovery time varies depending on the type of mastectomy. But in general, you can expect the surgical wound to heal in about three weeks. Your healthcare provider will explain how to care for the wound and surgical drains at home.

You’ll feel tired, sore and stiff for about six weeks. Pain, swelling and bruising are common in the first weeks of recovery. Mild pain relievers can help with soreness. Your provider will teach you gentle exercises to help relieve stiffness. They may also recommend physical therapy to improve your range of motion and strength.

Many people regain some of the sensation in their chest after about two years. But your sensation may never be quite the same as before. Long-term numbness is common.

Emotional support and counseling are important after a mastectomy. There are many support groups and resources available to help you process what you’ve been through.

How long after a mastectomy can you lift your arms?

You may be unable to use your sore arm for up to six weeks. You won’t be able to raise your arm over your head. So, you may want to reorganize your shelves ahead of time. You also won’t be able to lift anything heavier than a gallon of milk during the first few weeks.

When should I call my healthcare provider?

Follow-up appointments are important. Your healthcare team will monitor you for any complications or signs that the cancer has returned (recurred). Be sure to contact them if:

• You have pain that continues even after you take pain medication
• You notice signs of infection at the surgery site, like swelling or tenderness

What will my chest look like after the mastectomy?

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

What your chest looks like will depend on factors like:

• The types of cut(s) your surgeon made, and where they made them
• How your cuts heal (some scars may look red, discolored or raised)
• Whether you have breast reconstruction

Your surgeon will take steps to hide your scars as much as possible.