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
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
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
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
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
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:
You 'll be asked to remove your clothing and given a gown to wear.
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.
You will lie on your back on the operating table.
Your heart rate, blood pressure, breathing, and blood oxygen level will be checked
during the surgery.
The healthcare team will clean the skin over the surgical site with a sterile solution.
The healthcare provider will make a cut (incision) in your breast. The type of cut
made depends on the type of mastectomy you have. .
The provider will gently cut free and remove underlying tissue.
The provider may remove lymph nodes after the breast or breast tissue has been removed.
If you 're having breast reconstruction along with the mastectomy, a plastic surgeon
will do the reconstruction after the mastectomy.
Breast tissue and any other tissues that are removed will be sent to the lab for testing.
One or more drainage tubes may be put in the breast to drain fluid as the area heals.
The skin will be closed with stitches, glue, or adhesive strips.
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 .
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.
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