Mastectomy: Surgery to treat or prevent breast cancer

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Mastectomy: Surgery to treat or prevent breast cancer

Learn about mastectomy, including when it's necessary, what's involved and what you can expect after the surgery.
By Mayo Clinic staff

Surgery of any kind can be a challenging experience, but mastectomy — the surgical removal of one or both breasts — may raise special concerns. You may wonder if this surgery is your best option for treating or preventing breast cancer. You also may be concerned about how you'll feel and look after the mastectomy.

Take your time to gather information on the mastectomy procedure and what you can expect before and after the surgery. Researching your options and talking with your doctor can give you the information you need to decide whether mastectomy is right for you.

Who is mastectomy for?
Mastectomy is an effective treatment for breast cancer. Your doctor may recommended mastectomy over other treatment options — such as surgery to remove the tumor only (lumpectomy) plus radiation therapy — if:

You're in the first or second trimester of pregnancy, when radiation creates an unacceptable risk to your unborn child.
You have two or more tumors in separate areas of the breast.
You have widespread or malignant-appearing microcalcifications throughout the breast.
You've previously had radiation treatment to the breast region.
You have a strong family history of breast cancer.
You carry a gene mutation that confers a high risk of developing another breast cancer.
You might also choose mastectomy if:

You have a large tumor relative to the overall size of your breast. You may not have enough healthy tissue left after lumpectomy to achieve an acceptable cosmetic result.
You have a history of connective tissue disease, such as systemic lupus erythematosus, and may not tolerate the side effects of radiation, particularly to the skin.
The tumor is located beneath the nipple and may involve the nipple, making it more difficult to preserve the nipple and areola.
You live a long distance from a radiation facility and being there every day for five to six weeks would be too large a hardship.
You may also consider mastectomy may if you don't have breast cancer but are at high risk of developing the disease. This procedure, called preventive (prophylactic) or risk-reducing mastectomy, removes one or both of your breasts in hopes of preventing or reducing your risk of developing breast cancer in the future.

How do you prepare?
Before your surgery, you'll meet with a surgeon and perhaps an anesthesiologist to discuss your operation, review your medical history and determine the plan for your anesthesia. This is a good time to ask questions and to make sure you understand the procedure, including the reasons for and risks of the surgery.

You'll be asked questions about allergies or other chronic problems you may have and medications you're taking. Some medications — such as aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs) and blood-thinning medications (anticoagulants) — can cause excessive bleeding during surgery. Other medications and herbal supplements may interact with the anesthetics and cause problems. Your doctor may ask you to stop using these medications and supplements for a period of time before and after surgery.

Follow your doctor's directions in preparing for the surgery. This includes restrictions on eating, drinking, and limiting or stopping the use of nicotine products.

How is mastectomy done?
CLICK TO ENLARGE Simple mastectomy and modified radical mastectomy
The surgeon usually makes a single incision across half your chest, allowing for removal of the breast and, if necessary, adjacent underarm (axillary) lymph nodes. The extent of the surgery depends on many factors, such as your diagnosis and whether reconstruction is done immediately after the mastectomy. Types of mastectomies include:

Radical mastectomy — removal of the entire breast, chest wall (pectoral) muscles, all of the lymph nodes under the arm, and some additional fat and skin. Except to treat advanced stages of breast cancer, this type of mastectomy is rarely used.
Modified radical mastectomy — removal of the entire breast, including the breast tissue, skin, areola and nipple, and most of the underarm lymph nodes (complete axillary node dissection). This procedure may be recommended for large tumors or if the cancer has spread to the lymph nodes.
Simple (total) mastectomy — removal of the entire breast, including the breast tissue, skin, areola and nipple, but not all the lymph nodes. A sentinel lymph node biopsy maybe done at the time of the simple mastectomy. Simple mastectomy is also appropriate when the cancer is in multiple sites within the breast but is confined to the ducts (carcinoma in situ).
Skin-sparing mastectomy — removal of all the breast tissue, nipple and areola but not the breast skin. This procedure may be used when breast reconstruction is performed immediately following the mastectomy.
Subcutaneous (nipple-sparing) mastectomy — removal of only breast tissue, sparing the skin, nipple, areola, chest wall muscles and lymph nodes. This is one of several surgical procedures plastic surgeons may perform as a preventive measure for people at high-risk of breast cancer.
What can you expect during the surgery?
Mastectomy is usually performed under a general anesthesia. This means you inhale anesthesia medications or receive them through an intravenous (IV) line so that you're asleep during the surgery.

Mastectomy that doesn't include breast reconstruction usually takes one to four hours. If you're having breast reconstruction done at the same time, the surgery is longer.

After surgery, you wake up in a recovery room, where you'll be monitored for any complications. You may need to stay in the hospital for one to two days.

What can you expect after the surgery?
After surgery, a dressing covers your incision or incisions. Bandages or special wraps may be used to hold the dressing in place. You'll also have small, plastic drainage tubes under your skin near your incision to help drain any fluids that accumulate. The ends of the tubes are connected to a small, plastic bulb. The bulb creates a gentle suction to aid drainage. When drainage slows to less than an ounce of fluid a day, usually after one or two weeks, the tubes are removed.

Most people don't experience extreme pain after a mastectomy. More complain about numbness under the upper inner arm. This occurs because nerves are often cut as part of the surgery. Some of the numbness slowly fades as nerve cells regenerate. Some numbness may be permanent.

If you had lymph nodes removed during the mastectomy, the lymphatic channels that drain fluid from your arm to the rest of your body may have been disrupted. The result can be a buildup of fluid in your arm and hand , causing swelling (lymphedema). This swelling may be mild or quite extensive. Some swelling may be permanent.

Your surgeon or nurse will give you instructions on caring for yourself at home, including:

How to care for your incision and drains
How to recognize problems, such as an infection
When to resume wearing a bra or start wearing a breast prosthesis
Which activities you may need to restrict
How to take your medications
While you're in the hospital, someone also may talk with you or give you information regarding some of the psychological and emotional factors associated with the surgery.

Complete recovery from breast surgery may take months. You may feel tired and need extra rest the first few weeks after surgery. Gradually, you should be able to increase your activity and adjust to the changes in your body.

Breast reconstruction
Some women choose to have breast reconstruction immediately after their breast tissue is removed. Different approaches to breast reconstruction include:

Using breast expanders or implants
Using your body's own tissue (autologous tissue reconstruction)
Using a combination of tissue reconstruction and implants
Breast reconstruction is a complex procedure performed by a plastic surgeon. You may need two or more surgeries to achieve a correctly positioned and symmetrical breast. The process may also entail reconstruction of your nipple, including tattooing to define the dark area of skin surrounding your nipple (areola). And you may choose to have surgery on your opposite breast, even if it's healthy, so that it more closely matches the shape and size of your reconstructed breast.

Breast prosthesis
Not all women are interested in an immediate or even a delayed reconstruction. Instead, they may choose breast prosthesis, wearing a breast facsimile that fits into a brassiere. Breast prosthetics, made of nylon, silicon or Dacron fiberfill, are available in a variety of shapes and sizes, or they can be custom-made. Many insurance companies will cover the cost of breast prosthesis.

What are the risks of mastectomy?
As with any surgery, complications can occur. However, mastectomies are generally safe, and most people recover with no complications. Possible complications include:

Bleeding
Infection
Numbness under the arm, which may be permanent
Scarring
Blood clots
Reduced sensitivity and sexual response
You're likely to feel some anxiety about your condition and the surgical process. Knowing what to expect can help. Use this information to help you talk with your doctor and ask informed questions.

WO00113
Nov. 30, 2007

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