What is a mastectomy?
A mastectomy is the surgical removal of part or the entire breast. Doctors most commonly perform a mastectomy to treat or prevent breast cancer in women. A mastectomy may also involve removing lymph nodes in the underarm and other tissues near the breast, such as chest muscle. Your surgeon may perform breast reconstruction surgery at the same time of your mastectomy or in a second surgery.
Other treatments that may be recommended with a mastectomy include radiation therapy, hormone therapy, and chemotherapy.
Mastectomy is a common but major surgery with serious risks and potential complications. You may have less invasive treatment options. Consider getting a second opinion about all of your treatment choices before having a mastectomy.
Types of mastectomy
The type of mastectomy you receive depends on the stage and type of your breast cancer. The greater the spread of cancer cells, the more breast and nearby tissue your surgeon will remove. The types of mastectomy procedures include:
Partial mastectomy, also called a lumpectomy or segmental mastectomy, is a procedure to remove the cancerous breast tissue. Your surgeon will also remove a small area of normal breast tissue around the cancer. This conserves as much breast tissue as possible.
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Nipple-sparing mastectomy, also called subcutaneous mastectomy, is surgery to remove all or most of the breast tissue under the skin. This surgery leaves the nipple, areola, underarm lymph nodes, and chest muscle intact.
Simple mastectomy, also called total mastectomy, is the removal of the entire breast. This includes the breast tissue, nipple, areola, and skin. This surgery leaves the underarm lymph nodes and chest muscle intact. Your surgeon may also take a sample (tissue biopsy) of the nearby lymph nodes to test them for the spread of cancer.
Modified radical mastectomy is surgery to remove the entire breast. This includes the breast tissue, nipple, areola, skin and the underarm lymph nodes.
Radical mastectomy is the most extensive mastectomy procedure. Radical mastectomy removes the entire breast, including breast tissue, nipple, areola, and skin. Your surgeon will also remove your underarm lymph nodes and all of the chest wall muscles under the breast.
Why is a mastectomy performed?
Your doctor may recommend a mastectomy to treat breast cancer in women and men. Your doctor may only consider mastectomy if other breast cancer treatment options that involve less risk of complications have been unsuccessful. Ask your doctor about all of your treatment options and consider getting a second opinion before deciding on a mastectomy.
Some people opt to have a prophylactic mastectomy to help prevent breast cancer. Your doctor may discuss a prophylactic mastectomy with you if you have a high risk of breast cancer. People who have a high risk of breast cancer include people who have a certain gene mutation, such as a mutation in the BRCA1 or BRCA2 gene. Men and women with a mutation in either one of these genes have a much greater chance of developing breast cancer compared to men and women with normal copies of these genes.
Who performs a mastectomy?
A general surgeon performs a mastectomy. A general surgeon specializes in the surgical treatment of a wide variety of diseases, disorders and conditions. Some general surgeons specialize in the treatment of patients with breast disease; they may use the term breast surgeon. Surgical oncologists may also perform mastectomy.
How is a mastectomy performed?
Your mastectomy will be performed in a hospital. The surgery involves making an incision in your chest. Your surgeon will then remove part or all of the breast and possibly the lymph nodes and chest wall muscles.
Your surgeon will advise you on which procedure is best for you and how long you need to stay in the hospital based on your diagnosis, age, medical history, general health, and possibly your personal preference. Learn about the different mastectomy procedures and ask why your surgeon will use a particular type for you.
Types of anesthesia that may be used
Your surgeon will perform mastectomy using general anesthesia. General anesthesia is a combination of intravenous (IV) medications and gases that put you in a deep sleep. You are unaware of the procedure and will not feel any pain.
You may also have a peripheral nerve block infusion in addition to general anesthesia. A peripheral nerve block infusion is an injection or continuous drip of liquid anesthetic. The anesthetic flows through a tiny tube inserted near your surgical site to control pain during and after surgery.
What to expect the day of your mastectomy
The day of your surgery, you can expect to:
Talk with a preoperative nurse. The nurse will perform an exam and ensure that all needed tests are in order. The nurse can also answer questions and will make sure you understand and sign the surgical consent form.
Remove all clothing and jewelry and dress in a hospital gown. It is a good idea to leave all jewelry and valuables at home or with a family member. Your care team will give you blankets for modesty and warmth.
Talk with the anesthesiologist or nurse anesthetist about your medical history and the type of anesthesia you will receive.
A surgical team member will start an IV.
The anesthesiologist or nurse anesthetist will start your anesthesia.
A tube may be placed in your windpipe to protect and control breathing during general anesthesia. You will not feel or remember this or the surgery as they happen.
The surgical team will monitor your vital signs and other critical body functions. This occurs throughout the procedure and your recovery until you are alert, breathing effectively, and your vital signs are stable.
What are the risks and potential complications of mastectomy?
As with all surgeries, a mastectomy involves risks and possible complications. Complications may become serious and life threatening in some cases. Complications can develop during surgery or recovery.
General risks of surgery
The general risks of surgery include:
Anesthesia reaction, such as an allergic reaction and problems with breathing
Bleeding, which can lead to shock
- Infection
Potential complications of mastectomy
Complications of a mastectomy include:
Damage to nearby organs, such as the lymph nodes and lungs
Fluid buildup under the incision scar, which could be a hematoma (blood) or a seroma (clear fluid)
Hardening of the incision scar
Lymphedema, swelling of the arm on the side of the removed lymph nodes
Numbness, tenderness, or sensitivity of the surgery site due to cut nerves
Weakness of the arm muscles due to nerve damage
Opening of the external incision
Shoulder pain or soreness on the side of the removed breast (occurring mostly with radical mastectomy)
Reducing your risk of complications
You can reduce the risk of certain complications by following your treatment plan and:
Following activity, dietary and lifestyle restrictions and recommendations before surgery and during recovery. This includes physical therapy, occupational therapy and other rehabilitation treatments.
Informing your doctor if you are nursing or there is any possibility of pregnancy
Notifying your doctor immediately of any concerns, such as bleeding, fever, increase in pain, or wound redness, swelling or drainage
Taking your medications exactly as directed
Telling all members of your care team if you have any allergies
How do I prepare for my mastectomy?
You are an important member of your own healthcare team. The steps you take before surgery can improve your comfort and outcome.
You can prepare for a mastectomy by:
Answering all questions about your medical history and medications. This includes prescriptions, over-the-counter drugs, herbal treatments, and vitamins. It is a good idea to carry a current list of your medical conditions, medications, and allergies at all times.
Getting preoperative testing as directed. Testing will vary depending on your age, health, and specific procedure. Preoperative testing may include a mammogram, breast biopsy, chest X-ray, EKG (electrocardiogram), blood tests, and other tests as needed.
Losing excess weight before the surgery through a healthy diet and exercise plan
Not eating or drinking before surgery as directed. Your surgery may be cancelled if you eat or drink too close to the start of surgery because you can choke on stomach contents during anesthesia.
Stopping smoking as soon as possible. Even quitting for just a few days can be beneficial and help the healing process.
Taking or stopping medications exactly as directed. This may include not taking aspirin, ibuprofen (Advil, Motrin), and blood thinners.
Questions to ask your doctor
Facing surgery can be stressful. It is common for patients to forget some of their questions during a doctor’s office visit. You may also think of other questions after your appointment. Contact your doctor with concerns and questions before surgery and between appointments.
It is also a good idea to bring a list of questions to your appointments. Questions can include:
Why do I need a mastectomy? Are there any other options for treating my condition?
What type of mastectomy procedure will I need?
What are my options for breast reconstruction?
How long will the procedure take? When can I go home?
What restrictions will I have after the surgery? When can I return to work and other activities?
What assistance will I need at home?
Will I need physical therapy or rehabilitation?
What medications will I need before and after the surgery? How do I take my regular medications?
How will you treat my pain?
When and how will I receive the results of my lymph node biopsy test?
What other treatment will I need?
When should I follow up with you?
How should I contact you? Ask for numbers to call during and after regular hours.
What can I expect after my mastectomy?
Knowing what to expect can help make your road to recovery after mastectomy as smooth as possible.
How long will it take to recover?
You will stay in the recovery room after surgery until you are alert, breathing effectively, and your vital signs are stable. You may have a sore throat if a tube was placed in your windpipe during surgery. This is usually temporary, but tell your care team if you are uncomfortable.
You may have a few small tubes in your chest at your surgery site. These are attached to small bags into which fluid can drain. Your doctor will remove them within a week or so. During this time, you will need to empty the drain several times a day. Your care team will show you how to do this before you go home.
You may stay in the hospital for a few days, or you may go home the same day of your surgery, depending on the type of mastectomy you had. If you had breast reconstruction with your mastectomy, you may stay in the hospital a little longer. For a partial or simple mastectomy, you may go home the same day.
Recovery after surgery is a gradual process. Recovery time varies depending on the procedure, type of anesthesia, your general health, age, and other factors. Full recovery time varies depending on the type of mastectomy and generally takes weeks to months.
Will I feel pain?
Pain control is important for healing and a smooth recovery. There will be discomfort after your surgery/procedure. Your doctor will treat your pain so you are comfortable and can get the rest you need. Tell your doctor or care team if your pain gets worse or changes because it may be a sign of a complication.
When should I call my doctor?
It is important to keep your follow-up appointments after a mastectomy Contact your doctor for questions and concerns between appointments. Call your doctor right away or seek immediate medical care if you have:
Bleeding
Breathing problems, such as shortness of breath, difficulty breathing, labored breathing, or wheezing
Change in alertness, such as passing out, unresponsiveness, or confusion
Chest pain, chest tightness, chest pressure, or palpitations
Fever. A low-grade fever (lower than 101 degrees Fahrenheit) is common for a couple of days after surgery. It is not necessarily a sign of a surgical infection. However, you should follow your doctor's specific instructions about when to call for a fever.
Inability to urinate, pass gas, or have a bowel movement
Leg pain, redness or swelling, especially in the calf, which may indicate a blood clot
Numbness, pins and needles sensation or unusual sensations of your chest or arm on the side of the mastectomy
Pain that is not controlled by your pain medication, worsening pain, or pain that changes
Swelling of your arm on the side of the mastectomy
Unexpected drainage, pus, redness or swelling of your incision
How might mastectomy affect my everyday life?
A mastectomy can help cure or prevent breast cancer. However, it will take some time to adjust to a reconstructed breast or the absence of a breast.
You may experience depression and other emotions due to the loss of your breast or both breasts. There are many options for breast reconstruction and breast prosthetics to help you feel more positive about your new appearance. Many women find comfort in talking with therapists, support groups, and friends and family about life after a mastectomy.
