Mastectomy is surgery to remove a breast, usually to treat or help prevent breast cancer.
If your doctor has recommended a mastectomy, you probably have many questions. In this article, we’ll discuss various types of mastectomies, when they’re used, and what you can expect of recovery.
Mastectomy is a common treatment for breast cancer. There are five main types of mastectomies including:
Total mastectomy is also known as simple mastectomy. It’s a procedure in which the surgeon removes your whole breast, including your nipple, areola, and skin. Sentinel lymph nodes are often removed at the same time so they can be checked for cancer.
Total mastectomy may be an option for early-stage breast cancer that likely hasn’t reached your axillary lymph nodes.
Modified radical mastectomy helps determine whether cancer has reached your lymph nodes under your arm.
This type of mastectomy involves removal of:
- entire breast, including nipple, areola, and skin
- some axillary lymph nodes
In some cases, the surgeon will also remove the lining of your chest muscle.
Radical mastectomy is a complex surgery involving removal of:
- your entire breast, including nipple, areola, and skin
- all axillary lymph nodes
- major and minor pectoral muscles
Radical mastectomy was once standard in breast cancer treatment. Due to improved imaging techniques and radiation treatment, surgeons are now more likely to recommend modified radical mastectomy.
In a partial mastectomy, the surgeon removes the cancerous area, plus some healthy surrounding tissue. It may be used when there’s only one small area of cancerous tissue.
Skin-sparing mastectomy involves removal of your breast tissue, nipple, and areola, but most of your skin stays intact. This surgery is used when breast reconstruction is done at the same time. This technique isn’t used when the primary tumor is large or if cancer is found near the surface of your skin.
A nipple-sparring mastectomy is when all breast tissue is removed, but your areola and nipple are preserved. It’s a good choice when breast reconstruction will begin right away. It’s only used for early-stage breast cancer that does not involve your skin or nipple.
Other terms to know
- Prophylactic mastectomy. This procedure is a surgery that may lower the risk of breast cancer in people who are at a high risk of developing it.
- Unilateral mastectomy. This is the surgical removal of one breast.
- Double or bilateral mastectomy. This is the removal of both breasts, a risk-reducing surgery for those at high risk of developing breast cancer.
- Lumpectomy. During this surgery, the tumor plus a small margin of healthy tissue is removed. It’s a good option for ductal carcinoma in situ (DCIS) or noninvasive breast cancer.
Once your surgeon recommends mastectomy, you’ll want to consider breast reconstruction. Sometimes, reconstructive surgery can start immediately. You can also choose not to have reconstruction at all and wear a prosthesis or “go flat.” Tell your surgeon if you’re undecided.
Here are some things you can do to prepare for surgery:
- Pack a small bag of toiletries and other essentials. Bring a loose-fitting top that buttons or zips in the front.
- Have a small pillow ready for the ride home. Use it to keep the seatbelt’s shoulder harness off your chest.
- Stock up on groceries and other essentials.
As you recover, you may need help for a few days to a few weeks. Try to make arrangements for:
- child care, pet care
- personal care
- household chores and errands
- friend visits
Questions to ask your doctor before a mastectomy
Before scheduling surgery, be sure to investigate your surgeon’s qualifications and experience. You might also want to ask:
- Why do you recommend this particular type of mastectomy?
- What are the side effects and risks?
- How long will I be in the hospital?
- What do I need to know about taking care of bandages, stitches, and drainage tubes?
- Should I buy special mastectomy bras or mastectomy camisoles?
- When will I come in for follow-up?
- When can I get back to typical activities?
- What are my options for reconstruction?
In the hospital, you’ll have an intravenous (IV) line in your arm for fluids and medicine. If you’re having a sentinel node biopsy, a radioactive tracer will be injected near the tumor. This will help the surgeon find the sentinel nodes.
Once you have general anesthesia, the surgeon will make an incision around your breast and remove your breast tissue. Depending on the type of mastectomy, the surgeon will then remove skin, areola, nipple, and lymph nodes. Samples of breast tissue and lymph nodes will go to a laboratory for analysis.
If you’re having breast reconstruction at the same time, this may involve:
- breast tissue expanders
- autologous tissue reconstruction
All incisions will be closed with stitches. The surgical team will leave one or two surgical drains coming from the wound. This is a temporary measure to keep fluids from accumulating in your chest.
The entire procedure can take anywhere from 90 minutes to several hours.
You’ll most likely have some tenderness and pain at the surgical site. Some people also have:
- numbness and tingling in their chest and upper arm
- difficulty moving their arm or shoulder
- itching, burning, or shooting nerve pain in their chest, armpit, upper arm, or shoulder
- phantom breast pain
The level of pain depends on the type of procedure. For example, you may have more pain if you started reconstructive surgery at the same time or if you had complications. Pain and other side effects are different for everyone.
When you leave the hospital, you’ll probably have a prescription for a strong pain reliever. It may work better if you take it before pain gets too severe.
For most people, these side effects fade over a period of weeks. The American Cancer Society says that about
Recovery is different for everyone, but generally takes 3 to 6 weeks. Your recovery may take longer if you had complications or immediate reconstruction.
You’ll leave the hospital with instructions on:
- caring for surgical drains, bandages, and stitches
- bathing and showering
- recognizing symptoms of infection or lymphedema and when to call the doctor
- exercising your arm and shoulder
- when you can wear a bra or soft prosthesis
In the first days and weeks, you might experience:
- tenderness, pain
- itching, burning, or other strange sensations
- redness or discoloration, swelling
Your first follow-up visit will be in a week or 2. At this time, your surgeon may remove the surgical drains. If you didn’t have dissolvable stitches, they’ll be removed as well.
It’s not unusual to have numbness of your skin on anywhere from the top of your ribs to your collarbone. You may regain some feeling in time, but it will probably never feel quite the way it did before.
The main benefit to mastectomy is removal of cancerous tissue. Checking your lymph nodes also helps stage the cancer and inform other treatment decisions.
The risks of any surgery include bleeding and infection. A
Removing lymph nodes increases the risk of developing lymphedema, leading to:
- swelling of your arm, hand, fingers, chest, or back
- limited range of motion
- skin discoloration
Lymphedema is a chronic, often debilitating condition.
Most people recover well from the surgery, usually resuming normal activity within 6 weeks. But everyone’s different and you’ll recover on your own timeline.
Breast cancer outlook depends on many factors, such as the specific type of breast cancer and how far it may have spread before starting treatment.
Treatment may also involve:
- radiation therapy
- hormone therapy or targeted treatments
Before surgery, clinical staging depends the on size of the tumor and the presence of cancer in your lymph nodes and other organs. Testing from your doctor can help you learn more about this.
During surgery, samples of breast tissue and lymph nodes are sent to a lab for analysis. A pathologist sends the new report to your surgeon within 1 to 10 days so your doctor can discuss it with you. Information may include:
- size and weight of tissue
- tumor grade
- surgical margins
- lymph node involvement
- hormone receptor status
- HER2 status
This will help determine the pathologic stage, also called the surgical stage. This new information will help guide further treatment.
A mastectomy is surgery to remove a breast. It’s usually one part of the overall treatment plan for breast cancer. The surgery can help cure breast cancer, especially in the early stages.
Most people recover well following mastectomy. If you’re struggling with the emotional adjustment of losing a breast, that’s totally typical. Consider joining a breast cancer support group, where you can share experiences with others who’ve experienced mastectomy.