Mastectomy

What is a mastectomy?

A mastectomy is surgery to remove a breast. Sometimes other tissues near the breast, such as lymph nodes, are also removed. This surgery is most often used to treat breast cancer. In some cases, a mastectomy is done to help prevent breast cancer in women who have a high risk for it .

Why might I need a mastectomy?

A mastectomy may be done as part of treatment for breast cancer.

Your doctor will likely advise a mastectomy if:

  • The tumor is large
  • You have more than 1 breast tumor
  • You can't have radiation therapy
  • You prefer this surgery
  • You've had radiation therapy to your breast in the past
  • You have inflammatory breast cancer
  • The cancer has come back after other treatment
  • You have a gene change such as a BRCA mutation that puts you at high risk for another breast cancer

The size of your breast may also help decide what type of mastectomy is best.

In some cases, women with a high risk for breast cancer may want to have a mastectomy before cancer develops. This includes women with genes linked to breast cancer, such as the BRCA1 or BRCA2 gene. In these cases, a mastectomy is done to try to keep breast cancer from occurring.

There may be other reasons for your doctor to recommend a mastectomy.

What are the different types of mastectomies

There are many types of mastectomy procedures:

  • Total (simple) mastectomy. This surgery removes the whole breast, including the nipple, the colored ring around the nipple (called the areola), and most of the overlying skin. Sometimes lymph nodes under arms are removed, too.
  • Modified radical mastectomy.The entire breast is removed. This includes the nipple, the areola, the overlying skin, and the lining over the chest muscles. Some of the lymph nodes under the arm are also removed. Breast cancer often spreads to these lymph nodes. It can then spread to other parts of the body. 
  • Radical mastectomy. The entire breast is removed, including the nipple, the areola, the overlying skin, the lymph nodes under the arm, and the chest muscles under the breast. For many years, this was the standard surgery. But today it' s rarely done. It may be advised for large tumors that are growing into the chest muscles.
  • Skin-sparing mastectomy. The breast tissue, nipple, and areola are removed. But most of the skin over the breast is saved. This type of surgery is used only when breast reconstruction is done right after the mastectomy. It may not be a good treatment for tumors that are large or near the skin surface.

Some newer ways to do a mastectomy may be an option. But more studies are needed to see if these methods work as well to fully remove breast cancer or stop it from starting or coming back after treatment. An example of a newer method is:

  • Nipple-sparing mastectomy. This is a lot like a skin-sparing mastectomy. All of the breast tissue, including the ducts going all the way up to the nipple and areola, is removed. But the breast skin and the nipple and areola are kept. During surgery, the tissues under and around the nipple and areola are carefully cut away and checked by a doctor called a pathologist. If no breast cancer cells are found close to the nipple and areola, these areas can be saved. If cancer is found, the nipple must be removed. Reconstruction is done right after the mastectomy. Not all doctors agree on the best way to do this surgery or if it's a good surgery to treat breast cancer.

Breast reconstruction surgery after mastectomy

You may worry about how your breast will look after a mastectomy. In most cases, breast reconstruction surgery can be done. This surgery rebuilds the breast so it' s the size and shape of your other breast. Many women have breast reconstruction done at the same time as a mastectomy. Some wait and have it done as a second surgery later.

Talk with your doctor about your reconstructive surgery options. Other options after a mastectomy include wearing a breast form (breast prosthesis) or a special mastectomy bra.

What are the risks of a mastectomy?

All surgeries have some risk. Some possible complications of mastectomy include:

  • Short-term breast swelling
  • Breast pain, soreness, or both
  • Hardness or lumpiness because of scar tissue that can form at the site of the cut (incision)
  • Wound infection or bleeding
  • Swelling (lymphedema) of the arm, chest, and neck, if lymph nodes were removed
  • Pain in the breast that has been removed (phantom breast pain). This may be helped with medicines, exercise, or massage.
  • Numbness or trouble moving the arm if nerves were damaged during surgery

A clear fluid (seroma) is often found in the breast after a mastectomy. If this bothers you, it can be drained in the surgeon’s office. If needed, it can then be treated with compression. Or you may get an injection that helps to harden the space in the breast to help keep fluid from collecting there.

You will likely have a scar at the mastectomy site. Scar tissue may also cause a pulling feeling near or under your arm after surgery.

You may have depression and feelings of loss of sexual identity after a mastectomy.

It’s rare that breast reconstruction surgery causes complications. But problems may happen as you are healing. These problems may interfere with radiation or chemotherapy treatment.

There may be other risks depending on your specific medical condition. Be sure to discuss any concerns with your doctor before the surgery.

How do I get ready for a mastectomy?

  • Your doctor will explain the procedure to you and give you a chance to ask any questions that you might have.
  • You'll be asked to sign a consent form that gives permission to do the procedure. Read the form carefully and ask questions if any thing isn't clear.
  • Your doctor will take your medical history. He or she will also give you a physical exam. This is to be sure you are in good health before the surgery. You may also have blood tests or other tests.
  • You will be asked to not eat or drink anything for some time before the surgery. Your surgeon will give you instructions.
  • Tell your provider if you are pregnant or think you may be pregnant.
  • Tell your provider if you are sensitive to or allergic to any medicines, latex, tape, and anesthesia medicines (local and general).
  • Tell your provider about all the medicines you take. This includes both over-the-counter and prescription medicines. It also includes vitamins, herbs, and other supplements.
  • Tell your provider if you have a history of bleeding disorders. Let your provider know if you are taking any blood-thinning medicines, aspirin, ibuprofen, or other medicines that affect blood clotting. You may need to stop taking these medicines before surgery .
  • You may be given medicine to help your relax (a sedative) before surgery .
  • Your healthcare provider may have other instructions for you based on your medical condition.

What happens during a mastectomy?

A mastectomy often requires a hospital stay. The process may vary depending on your condition and your doctor's practices.

For the most part , a mastectomy follows this process:

  1. You 'll be asked to remove your clothing and given a gown to wear.
  2. An IV (intravenous) line may be started in your arm or hand. You 'll be given medicine through the IV. This will help you relax or put you into a deep sleep during the surgery so you don't feel pain.
  3. You will lie on your back on the operating table.
  4. Your heart rate, blood pressure, breathing, and blood oxygen level will be checked during the surgery.
  5. The healthcare team will clean the skin over the surgical site with a sterile solution.
  6. The healthcare provider will make a cut (incision) in your breast. The type of cut made depends on the type of mastectomy you have. .
  7. The provider will gently cut free and remove underlying tissue.
  8. The provider may remove lymph nodes after the breast or breast tissue has been removed.
  9. If you 're having breast reconstruction along with the mastectomy, a plastic surgeon will do the reconstruction after the mastectomy.
  10. Breast tissue and any other tissues that are removed will be sent to the lab for testing.
  11. One or more drainage tubes may be put in the breast to drain fluid as the area heals.
  12. The skin will be closed with stitches, glue, or adhesive strips.
  13. A sterile bandage or dressing will be placed over the site.

What happens after a mastectomy?

In the hospital

After surgery , you 'll be taken to the recovery room and watched closely. Your recovery process will depend on the type of mastectomy and the type of anesthesia used. Once your blood pressure, pulse, and breathing are stable and you are alert, you 'll be taken to your hospital room.

You 'll likely stay in the hospital for a  day or so after your mastectomy. This will depend on the extent of your surgery and if you had breast reconstruction done.

Radiation therapy or chemotherapy may be needed after a mastectomy. Your doctor will talk with you about this before surgery .

At home

Once you' re home, keep the surgical area clean and dry. Your doctor will give you specific bathing instructions.

You'll also be taught how to take care of the drainage tubes. They should be taken out after about 2 weeks at the first follow-up exam.

The amount of pain you have will vary. It depends on the amount and location of tissue removed during surgery. Most soreness lasts a few days. Take pain medicine as advised by your doctor. Aspirin and some other pain medicines may increase your chance of bleeding. Be sure to take only recommended medicines.

If lymph nodes were removed with your mastectomy, your doctor may have you see a physical therapist and will want you to do certain exercises. These can help limber up your shoulder and arm and help prevent swelling. Soreness after surgery may cause you to keep your arm and shoulder very still. This can make your arm and shoulder stiff. But overdoing the exercises can also hurt you. Start the exercises slowly. Do them regularly, and progress a little each day. You may be asked to do these exercises even if you didn’t have lymph nodes removed.

You can often go back to your normal activities in a few weeks, based on your doctor’s recommendation. In the meantime, avoid doing anything strenuous. Don’t do things that involve using your arm too much, such as cleaning windows or vacuuming for a long time. Your doctor will tell you when you can start driving again and when you can go back to work.

If you have problems dealing with your recovery, your doctor may refer you to a volunteer agency or group for support.

Your doctor will talk with you about when call. You may be told to call if you have any of the following:

  • Fever or chills
  • Redness, swelling, or bleeding or other drainage from the incision site
  • Increased pain around the incision site
  • Swelling, numbness, or tingling in the affected arm

Your doctor may give you other instructions, too . Ask about signs you should watch for and when call. Know how to get help after office hours and on weekends and holidays.

Arm care after lymph node removal

Removing lymph nodes can affect how lymphatic fluid drains from your arm, neck, and chest on the affected side. Problems with lymphatic drainage can cause swelling in your arm. You may also be at greater risk for infection from injury to your arm. Still, it's important to use your arm like you normally would.

You will have to follow certain safety steps for the rest of your life after lymph node removal. Once lymphedema starts, it cannot be cured. But there are things you can do to help prevent problems in the affected arm. Some of these safety steps include:

  • No needle sticks or IVs in the affected arm
  • Have your blood pressure taken in your unaffected arm
  • Follow instructions about arm exercises carefully.
  • Don't overtire your arm or do repetitive motions. Don't do any heavy pulling or lifting.
  • Don't expose your arm to extreme temperatures like ice packs or heating pads. Don't use saunas or hot tubs.
  • Use lotion to keep your skin soft. 
  • Try not to get scratches or splinters in the affected arm. Clean any injuries right away and watch for signs of infection.
  • If your arm aches or swells, raise (elevate) it , with your hand above your elbow, to help drain lymphatic fluid.
  • Wear gloves when gardening or doing any activity where there' s a risk for getting a cut in your fingers or hands. Also wear gloves when using strong or harsh chemicals, like detergents or household cleaners.
  • Don't get a sunburn.
  • Use a clean razor to shave under your arm.
  • Wear loose fitting bras with straps that don't dig into your shoulders
  • Don't wear any tight items on the affected arm. This includes elastic cuffs, tight watches, or other jewelry.
  • Use your unaffected arm or both arms to carry heavy packages, bags, or purses
  • Don't get insect bites or stings. Using insect repellents or wear long sleeves

Talk with your doctor about seeing a lymphedema specialist to learn more about what you can do to help protect yourself from this problem.

Next steps

Before you agree to a test or procedure, make sure you know:

  • The name of the test or procedure
  • The reason you' re having the test or procedure
  • What results to expect and what they mean
  • The risks and benefits of the test or procedure
  • What the possible side effects or complications are
  • When and where you are to have the test or procedure
  • Who will do the test or procedure and what that person’s qualifications are
  • What would happen if you did not have the test or procedure
  • Any alternative tests or procedures to think about
  • When and how will you get the results
  • Who to call after the test or procedure if you have questions or problems, even at night and on weekends
  • How much you will have to pay for the test or procedure

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