Mastectomy (Breast Removal)

Overview

What is a mastectomy?

A mastectomy is surgery that removes one or both breasts to treat or prevent breast cancer. Surgeons can choose from several different types of mastectomy. Your options will vary depending on how much tissue your surgeon needs to remove.

What stage of breast cancer requires breast removal?

Surgery is the primary treatment for breast cancer at all stages. Generally, the larger the area of the disease and the more advanced the condition is, the more extensive the breast cancer surgery.

In earlier stages, when the tumor is small, you may have the option to remove only the tumor and a margin of tissue around it (called a partial mastectomy or lumpectomy). Your doctor will consider the size of the tumor in relation to your breast size to determine if you’re a good candidate for this treatment.

Larger tumors in later stages can spread to muscle, skin and lymph nodes around the breast. Surgery for stage three and stage four cancer generally requires removing the entire breast and nearby tissue affected by the cancer.

Will a prophylactic mastectomy prevent breast cancer?

A prophylactic (preventive) mastectomy removes the breast to prevent cancer. This is an option if breast cancer runs in your family. Through genetic testing, you can find out if you have inherited a higher risk of breast cancer. If so, you can discuss your options for high risk breast screening and may want to talk about prophylactic mastectomy with your healthcare provider. It reduces your risk of developing breast cancer by 85% to 100%.

Procedure Details

What are the different mastectomy procedure types?

There are many types of mastectomy. Your surgeon will recommend the type that is best for your specific diagnosis. The main difference between the types is how much tissue your surgeon removes.

Total mastectomy (simple mastectomy)

In this procedure, the surgeon removes your entire breast. But the chest muscle underneath your breast remains.

Skin- or nipple-sparing mastectomy

The skin- or nipple-sparing procedure is a variation of the total mastectomy and is normally performed to allow the surgeon to perform breast reconstruction. The surgery removes the same amount of breast tissue. The difference is that the surgeon leaves the breast skin (skin-sparing) and sometimes the nipple (nipple-sparing). Saving the skin and nipple makes breast reconstruction look more natural.

Modified radical mastectomy

A modified radical mastectomy removes the entire breast and the underarm lymph nodes. The chest muscles are left intact.

Radical mastectomy

A radical mastectomy is the most comprehensive surgery. It’s reserved for cases where breast cancer has spread to the underlying muscles. Your surgeon will remove the entire breast, underarm lymph nodes and chest wall muscles (pectoral muscles) during this operation. This type of surgery is rarely performed today.

Double mastectomy (bilateral mastectomy)

A double mastectomy removes both breasts at the same time. You may have this procedure to treat or prevent cancer. A double mastectomy is usually the same as a total mastectomy. The only difference is that it affects both of your breasts.

Can I get breast implants at the same time as a mastectomy?

It is possible to get breast reconstruction (breast implants) immediately following a mastectomy or at a later date. You can discuss with your surgeon if having two operations at once — mastectomy and breast reconstruction — is a good option for you.

Risks / Benefits

What are the possible complications after a mastectomy?

Like any surgery, there’s a chance that some problems could occur after a mastectomy. About one in 10 women experiences a complication. Having a double mastectomy or breast reconstruction at the same time slightly increases your risk. Diabetes, excess weight, smoking and other medical problems can also increase your risk for a complication. Possible complications include:

  • Buildup of blood (hematoma) or fluid (seroma) under the wound.
  • Burning or shooting pain in the chest, underarm or arm.
  • Decreased arm or shoulder movement.
  • Increased sensitivity in the scar area.
  • Infection.
  • Lumpy or painful scar tissue.
  • Numbness in the scar area, chest, nipple or upper arm.

Another complication of mastectomy and lymph node surgery is lymphedema, which causes swelling in your arm. Approximately 20% of people develop lymphedema after a mastectomy with lymph node removal.

Recovery and Outlook

How long does it take to recover from a mastectomy?

The bigger the operation, the longer the recovery time. It’s typical to stay in the hospital for one day after a total mastectomy. Within about four weeks, you’ll probably be comfortable doing all of your regular daily activities.

You may need a longer hospital stay if the surgery you had was more involved, like a mastectomy with breast reconstruction using your own body tissue It can take a few months to feel fully recovered.

What can I expect during recovery?

Following a mastectomy, it’s common to have pain or tenderness in the surgical area. You’ll also have limited movement in your arms and chest. You may need someone to help you at home. You’ll leave the hospital with pain medication and instructions for aftercare, including:

  • How to care for the bandage (if you have one).
  • How to care for the drain (if you have one). This temporary tube leads out of the surgical site and collects fluid.
  • How to wash and bathe around the surgical site.
  • When you can wear a bra or prosthesis.
  • What activities to avoid and for how long.
  • What exercises to do to increase arm mobility and reduce scar tissue formation.

You don’t have to worry about your stitches or staples. Usually, surgeons use stitches that dissolve on their own. If you have stitches, your surgeon will remove those at your follow-up appointment.

Does mastectomy cure breast cancer?

A mastectomy is usually one part of a breast cancer treatment plan. Your plan may also include chemotherapy, radiation therapy and/or hormone therapy.

Once you’ve beaten breast cancer, it usually doesn’t return. But occasionally it does come back, even if you’ve had your breasts removed. There are many factors that can increase your risk of cancer returning, including whether the cancer has spread to your underarm lymph nodes. Talk to your healthcare provider about your risks.

When to Call the Doctor

When should I see my healthcare provider?

Call your provider if you have any concerns about your surgical site or symptoms. If you have an infection, you should seek medical care. Signs at the surgical site include:

  • Redness.
  • Swelling.
  • Warmth.
  • Fever.
  • Pus.

A note from Cleveland Clinic

A mastectomy is an important part of your breast cancer treatment or prevention plan. You’ll likely have several options to consider. Whether, and sometimes when, you want breast reconstruction is entirely up to you. Deciding to remove one or both breasts may be another decision to discuss with your doctor. Now is the time to consider what will best protect your health and give you peace of mind.

Last reviewed by a Cleveland Clinic medical professional on 10/15/2020.

References

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  • American Cancer Society. Mastectomy. (https://www.cancer.org/cancer/breast-cancer/treatment/surgery-for-breast-cancer/mastectomy.html) Accessed 12/7/2020.
  • American Cancer Society. Treatment of Breast Cancer Stages I-III. (https://www.cancer.org/cancer/breast-cancer/treatment/treatment-of-breast-cancer-by-stage/treatment-of-breast-cancer-stages-i-iii.html) Accessed 12/7/2020.
  • American College of Surgeons. Breast Cancer Patients’ Fear Exceeds Risk. (https://www.facs.org/media/press-releases/jacs/lymphedema0313) Accessed 12/7/2020.
  • Breastcancer.org. Researchers Identify 110 Genes Associated With Breast Cancer. (https://www.breastcancer.org/research-news/110-genes-associated-with-breast-cancer) Accessed 12/7/2020.
  • Breastcancer.org. Mastectomy. (https://www.breastcancer.org/treatment/surgery/mastectomy) Accessed 12/7/2020.
  • Kwok AC, Goodwin IA, Ying J, Agarwal JP. National trends and complication rates after bilateral mastectomy and immediate breast reconstruction from 2005 to 2012. (https://www.ncbi.nlm.nih.gov/pubmed/26054659) Am J Surg. 2015; 210: 512-6. Accessed 12/7/2020.
  • National Breast Cancer Foundation. Mastectomy. (https://www.nationalbreastcancer.org/mastectomy) Accessed 12/7/2020.
  • Susan G. Komen. Mastectomy. (https://ww5.komen.org/BreastCancer/Mastectomy.html) Accessed 12/7/2020.
  • Susan G. Komen. Survival and Risk of Recurrence After Treatment. (https://ww5.komen.org/BreastCancer/SurvivalandRiskofHavingCancerReturnAfterTreatment.htm) Accessed 12/7/2020.

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