A double (bilateral) mastectomy is the surgical removal of both breasts. This procedure is used to treat breast cancer or to reduce the risk of breast cancer in people with a high risk.

In this article, we’ll talk about when double mastectomy is a good option, different types of surgery, potential alternatives, and what you can expect recovery to be like.

Double mastectomy is the surgical removal of both breasts. The purpose is to:

  • remove breast cancer
  • reduce the risk of cancer for those who may be at high risk for breast cancer
  • allow for symmetry
  • avoid ongoing surveillance imaging if you’re at a high risk of breast cancer

Your doctor may recommend a double mastectomy if:

  • You have breast cancer in both breasts: If the stage and characteristics do not make lumpectomy an option, you may have a double mastectomy.
  • You have a high risk of contralateral breast cancer in the second breast: If you have cancer in one breast and have a very high risk of getting a second breast cancer in the remaining breast, you may choose a double mastectomy. A high risk includes having the BRCA1 or BRCA2 gene mutation, or a strong family history of breast cancer.
  • You’re not at high risk for getting a second breast cancer, but you want to avoid worrying about the possibility: You may choose to have the second breast removed, as well as the one with cancer. The medical term for having a second healthy breast removed is contralateral prophylactic mastectomy (CPM). However, there’s no overall survival benefit for removing the contralateral breast, as breast cancers do not spread to the other breast.
  • You want to reduce the risk of developing cancer in the future, even though you do not currently have breast cancer: A bilateral risk-reducing mastectomy is usually done only if you carry one of the genes linked to breast cancer risk, or you have a strong family history of breast cancer.

Are there benefits to having both breasts removed?

There may be some benefit to removing both breasts if you are at a very high risk of getting another breast cancer. (If you carry a BRCA gene mutation or have a strong family history of breast cancer, for example.)

The benefit is less clear for women who are not at high risk, as the risk of getting cancer in the other breast is usually low, according to the American Cancer Society (ACS).

Even so, the number of women choosing CPMs tripled during the first decade of this century and is continuing to rise.

The American Society of Breast Surgeons (ASBrS) discourages CPMs for average-risk females with cancer in just one breast or for males with breast cancer. They point out that CPM surgeries have twice the complication rate as unilateral mastectomy, and the recovery time is longer.

The ASBrS recommends CPM as a good option to consider for female BRCA carriers and those with a strong family history of breast cancer. CPM is rarely a good choice for male cancer, even with the BRCA gene, they say.

  • Skin-sparing or nipple-sparing mastectomy: The surgeon removes the breast tissue but preserves the majority of the skin, and sometimes the nipple and areola for reconstruction.
  • Simple (total) mastectomy: The surgeon removes the breast, areola, nipple, and most of the overlying skin. They may also remove the sentinel lymph nodes.
  • Modified radical mastectomy: In this type, the surgeon removes the breast, areola, nipple, and most of the overlying skin. They also remove the lining over the chest muscles as well as the axillary lymph nodes under the arm.
  • Radical mastectomy: This is the removal of the entire breast, areola, nipple, skin, chest muscles, and underarm lymph nodes. Doctors rarely perform this type.

Many people go home on the same day of the surgery, but some may have a short hospital stay of 1 to 2 days. You may need to stay in the hospital longer if your procedure is more complex, or if you also opt for immediate reconstructive surgery.

You also have an option for a delayed reconstruction or no reconstruction at all. The type of mastectomy you have will also impact when you can resume typical activities, which can be 4 to 6 weeks or more.

There are two stages to double mastectomy surgery. First, you’ll undergo the surgery itself. After the surgery, you’ll go home to recover. Read on to learn what to expect in each stage and how to prepare.

Preparing for surgery

Your doctor will explain the medical specifics. Here are some other things to consider in advance:

The drive home

After surgery, you’ll need someone to drive you home. The seat belt’s shoulder harness may hurt your sore chest. It can help to bring a small, soft pillow to place between your chest and the strap.

What you’ll wear

When you leave the hospital, you’ll still have drainage tubes in your chest. They’ll remain in place for at least a week or 2, maybe longer. Your chest and arms will be sore and stiff.

A post-mastectomy wardrobe typically involves soft, loose-fitting tops that are easy to put on and take off and ideally open at the front. That way, you avoid stretching your arms or pulling your shirt over your head. Specialty stores carry camisoles and tops with pockets for the drainage bulbs, or you can clip the bulb to your clothing. A large zip-up hoodie is a good option.

If you’re not having reconstruction and plan to wear prosthetics, hold off on buying mastectomy bras for now. Your size will change as your swelling goes down.

When you’re ready, a doctor will write a prescription for breast forms (prosthetics) and mastectomy bras, which may be covered by insurance.

What you’ll eat

You may not feel up to cooking after surgery, so consider preparing in advance if you can. Stock your kitchen, and if time permits, prepare a few meals for the freezer.

How you’ll nest

What helps you feel good? A thick novel, aromatherapy, your grandmother’s knitted blanket? Make sure it’s within easy reach of your favorite comfy chair or sofa.

Have a water bottle nearby so you can easily stay hydrated. Gather your essentials, such as your phone and charger, high protein snacks, and anything else you may need or want.

Asking for help

Your friends mean well when they say, “Let me know if I can do anything.” But don’t leave it to chance. Get your calendar out and get commitments ahead of time. Be sure to consider:

  • babysitting
  • transportation
  • meals
  • picking up prescription medications

Do you want to be left alone, or do you thrive on friends dropping by? Will there be holidays or special events during your recovery? Now’s the time to lay it all out and let people know what you need.

Have one family member or friend who can help send updates to your larger circle so that you don’t have to. Additionally, consider trying out a website or app for coordinating people who can help. One example is Caringbridge.org.

If you need more help

Make a list of organizations you can contact if needed. Consider babysitting, housecleaning services, and transportation.

The ACS provides a wealth of information on support programs and services in your area. A local support group may also be a good resource for information from others who have had similar experiences.

Managing your emotions

With or without reconstruction, having a double mastectomy can be an emotional experience. Know upfront that whatever feelings you have are valid. You’re allowed to have positive and negative emotions, and every type in between.

Don’t beat yourself up over any of them. They’re normal. Things won’t change overnight, so give yourself time to sort through it all.

The process of recovering from mastectomy is different for everyone. One reason it’s so variable is that not all mastectomies are the same.

There’s also an emotional component to mastectomy that may affect your recovery and change over time. Speak with your healthcare team about any distress that you may feel, especially if it interferes with your ability to take care of yourself or if it’s impacting your well-being.

Your cancer clinic may have professionals trained to support people with cancer about their emotional health.

What to know before leaving the hospital

After surgery, you’ll move to the recovery room, where nurses will monitor your vital signs. You’ll have a dressing and several drains coming out of your chest. You’ll likely receive pain medication, and your chest may feel numb.

You’ll be released for recovery at home or be transferred to a hospital room for the night. As sensation returns, you might feel pain and strange sensations in your chest and underarms.

You’ll receive instructions on:

  • managing the drains
  • noticing signs of infection, such as blood or fluid collection or lymphedema
  • showering
  • removing bandages
  • taking medications
  • stretching exercises for arms and shoulders
  • returning for a follow-up appointment
  • instructions about when you may return to normal activity

In your postsurgical recovery, it might be difficult to keep track of discharge instructions. You’ll probably get written instructions, too, but it’s a good idea to have someone else there to listen.

You’re probably relieved that the surgery is behind you, and you can begin your recovery process. Expect to have a bit of pain and discomfort. In the beginning, you will probably need to:

  • take time off work
  • avoid driving
  • get help with daily activities

Your chest, underarms, and shoulders may be sore at first. You may also experience numbness across your chest, which may get better, or may be permanent. Your doctor may prescribe medication for pain, or you may be able to get by with over-the-counter pain relievers.

If surgical drains were inserted inside your breast area during surgery, they will usually remain in place for 1 to 2 weeks.

Watch carefully for signs of infection or blood clots, which are risks of any surgery. Be sure to contact your surgical team right away if the area of your surgery becomes significantly red, swollen, or warm to the touch or if you develop a fever of 99°F to 99.5°F (37.2°C to 37.5°C). These can be signs of infection, and you may need to take antibiotics.

Guidelines for at-home recovery following a double mastectomy surgery

Recovery may go more smoothly if you keep these things in mind:

  • Nutritious food and exercise help recovery: Eat well, do the stretching exercises recommended by your doctor, and go for short walks if you can.
  • The tubes are temporary: You’ll have to empty the drainage tubes and keep track of the amount of fluid you empty from them. If your arms are stiff, you might need assistance. Also, you’ll probably need to sponge-bathe for a while.
  • Your body will heal: You might be told to remove the surgical bandages at home instead of having your doctor do it. You might want to have someone on hand for support. Remember, you’ve just had surgery and the healing process has only just begun.
  • It’s OK to call your doctor: You’re expected to call if recovery isn’t going as anticipated. That’s how you’ll get the help you need.
  • Recovery isn’t a direct route: Some days will seem like two steps forward and one step back. It’s all part of the process.
  • It takes time: If you’re not having reconstruction, you may be anxious to get your prosthetics. Know that it takes a few weeks before you’ll be able to get a good fitting.

Possible side effects of a double mastectomy surgery

Some potential physical side effects include:

  • Fatigue: You’ll be tired for a couple of days, and it might be hard to get comfortable in bed. Try arranging pillows around your torso or sleeping in a recliner. Get some rest during the day, too.
  • Phantom feelings: Phantom breast pain isn’t uncommon. You may experience sensations in your chest and underarms, like itchiness, tingling, or pressure. Your chest may be numb or overly sensitive to touch. This is normal.
  • Trouble with your arms: Mastectomy and lymph node removal affect your shoulders and arms. Stretching exercises and time should relieve pain and stiffness.
  • Lymphedema: Lymph node removal increases the risk of arm swelling or infection.

Emotional changes following a double mastectomy surgery

It’s hard to predict how you’ll feel immediately following mastectomy or in the months ahead.

Common emotions involve:

  • sadness, sense of loss, and mourning
  • body image issues
  • anxiety over intimacy
  • fear of cancer and treatment

You’re entitled to your feelings. You’ll hear a lot about having a positive attitude, but that doesn’t mean you have to put on a happy face when you’re not feeling it. It’s fine to acknowledge that you may be having a hard time.

Tips for coping during recovery

During recovery, you may find it helpful to keep the following suggestions in mind:

  • Acknowledge your emotions so you can work through them. Share your thoughts with someone you trust.
  • If you need some alone time, say it and take it.
  • When you’re longing for company, tell your friends.
  • Get back to your favorite hobbies, books, or movies. Whatever made you feel good before surgery should make you feel good after.
  • Check out support groups.
  • Tell your doctor if you have intense feelings of depression that won’t go away.

Recovery time from a double mastectomy varies from person to person. Factors that can affect your recovery time may include:

  • age
  • underlying conditions
  • amount of home care
  • type and extent of surgery
  • mental outlook

It can take 2 to 3 weeks for wounds to heal and a few more weeks for you to resume normal activities. If you also had breast reconstruction, your recovery time will probably be a bit longer.

It may take several months before you resume all your previous activities and are fully active again. Your doctor will advise you when you can begin certain activities like driving or returning to work.

Recovering from a double mastectomy is unique to each person, so resist the urge to hold yourself up to someone else’s standards.

Nobody knows your life better than you do. Offer yourself the same compassion you would a dear friend.

If you didn’t have breast cancer but had surgery to reduce risk, you likely won’t need further treatment unless you have complications from surgery. If you have a diagnosis of breast cancer, treatment can depend on factors such as:

Your doctor can explain which options are likely to be most effective for you. Some treatments for breast cancer include:

Even after a double mastectomy, it’s likely that you still have some breast cells.

Research published in 2018 suggests that future imaging may be required in some people who had breast cancer and a single or double mastectomy.

The ACS does not have specific guidelines for breast imaging in women who have been treated for breast cancer.

Cancer can return in the skin or on the chest wall. Physical exams and breast self-exams can help catch abnormalities early. If you have an area of concern, the next step may be a breast ultrasound or MRI.

After treatment, it’s important to schedule and keep follow-up appointments. Whether you’ve had reconstructive surgery or not, your doctor can tell you what type of screening they recommend.

According to the National Cancer Institute, about 55% to 72% of females who inherit a harmful BRCA1 mutation and 45% to 69% who inherit a harmful BRCA2 variant will develop breast cancer by 70 to 80 years of age. About 13% of the general population develop breast cancer during their lifetime.

Prophylactic mastectomy is one strategy in breast cancer risk reduction for breast cancer gene mutation carriers.

What are the alternatives to double mastectomy for those at high risk?

Some risk factors, like age and family history, are not within your control. If you have a strong family history of breast cancer and haven’t had genetic testing, consider seeing a genetic counselor for more information.

Also, speak with your doctor about breast cancer risk factors when taking or considering oral contraceptives or hormone replacement therapy.

Some medicines, such as raloxifene, tamoxifen, and aromatase inhibitors, may help reduce breast cancer risk.

Options for early detection include:

In a double mastectomy, a surgeon will remove both breasts. It’s usually done to avoid the risk of cancer in someone with a high risk or to treat cancer when other treatments are not an option.

If a double mastectomy is the best option for you or your loved one, it’s important to be prepared by understanding how to get ready for the procedure and what to do after the surgery for an easier recovery. Getting support from family, friends, and breast cancer support networks can also help.