Mastectomy (Breast Removal Surgery)

What is a Mastectomy?

A mastectomy is a way to treat breast cancer by surgically removing a breast and sometimes nearby tissues. In the past, a radical mastectomy with complete removal of the breast, lymph nodes in the underarm, and some chest muscles under the breasts, was the standard treatment for breast cancer. But surgical breakthroughs over the past 2 decades have given women more options than ever before. Less invasive breast-conserving treatments are available to many women.

The type of mastectomy that’s right for you depends on several things, including:

  • Your age
  • General health
  • Menopause status
  • Tumor size
  • Tumor stage (how far it's spread)
  • Tumor grade (its aggressiveness)
  • Tumor's hormone receptor status
  • Whether or not lymph nodes are involved

What Is a Total Mastectomy?

With this procedure, also called simple mastectomy, your doctor removes your entire breast, including the nipple. Your lymph nodes, the small glands that are part of your immune system, may sometimes be removed from your underarm.

You’re most likely to have a total mastectomy if the cancer has not spread beyond the breast or if you’re having a preventative mastectomy to lower your risk of getting breast cancer.

What Is a Preventive Mastectomy?

Women who have a high risk of breast cancer may choose to have a preventive mastectomy, also called prophylactic mastectomy.

Studies show that women with a high risk of breast cancer may be as much as 90% less likely to get the disease after preventive mastectomy.

Usually, a total mastectomy -- removing the entire breast and nipple -- is recommended. In some cases, women have both breasts removed. This is called a double mastectomy.

Some women who've had breast cancer in one breast will decide to have a preventive mastectomy to remove the other breast. This can reduce the chance of cancer reoccurrence.

If you plan to have breast reconstruction, it can be done at the time of the preventive mastectomy (immediate reconstruction) or at a later time (delayed reconstruction). During breast reconstruction, the surgeon may use synthetic implants or tissue flaps from another part of your body to create a breas

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What Is a Partial Mastectomy?

Women with stage I or stage II breast cancer may have this procedure. It’s is a breast-conserving method in which the tumor and the tissue surrounding it are all that’s removed.

The surgery is often followed by radiation therapy to the remaining breast tissue. With radiation therapy, powerful X-rays target the breast tissue. The radiation kills cancer cells and prevents them from spreading, or reoccurring.

There are two kinds:

  • lumpectomy removes the tumor and a small cancer-free area of tissue surrounding the tumor.
  • quadrantectomy removes the tumor and more of the breast tissue than a lumpectomy.

In some cases, more surgery is required after a partial mastectomy. Sometimes, if cancer cells are still in breast tissue, it may be necessary to remove the entire breast.

What Is a Radical Mastectomy?

A radical mastectomy is the complete removal of the breast, including the nipple. The surgeon also removes the overlying skin, the muscles beneath the breast, and the lymph nodes. Because radical mastectomy typically isn't more effective than less extreme forms of mastectomy, it's rarely performed today. It’s only recommended when the cancer has spread to the chest muscle.

What Is a Modified Radical Mastectomy?

A less traumatic and more widely used procedure is the modified radical mastectomy (MRM). With the modified radical mastectomy, the doctor removes your entire breast along with the underarm lymph nodes. Your chest muscles are left intact but the skin covering your chest wall may or may not be. You might get breast reconstruction afterward.

What Is a Skin-Sparing Mastectomy?

The doctor removes breast tissue, the nipple, and the areola but saves most of the skin over the breast. It’s only used when breast reconstruction follows immediately after a mastectomy. It may not be a good choice if your tumors are large or near the skin surface.

What Is a Nipple-Sparing Mastectomy?

You might also hear it called a total skin-sparing mastectomy. The doctor removes all the breast tissue, including the ducts going all the way up to the nipple and areola. But he saves the skin of the nipple and areola and cuts out tissues under and around them. If these areas are cancer-free, they can be saved. This method also calls for reconstruction right after the mastectomy.

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Before a Mastectomy

Prior to surgery:

  • First, you’ll change into a hospital gown.
  • You’ll wait in a preoperative holding area. After you get changed, your friends and family can visit, usually a couple at a time.
  • A nurse might use a felt-tip marker to draw on your breast where the incision will be.
  • You’ll get anesthesia. The nurse will put a needle connected to a long tube of medication into your hand and tape it in place and you’ll start to relax.

During a Mastectomy

Once you’re in the operating room:

  • You’ll probably be there for 2-3 hours -- more if you’re getting reconstruction afterward.
  • The doctor makes an incision and separates breast tissue to be removed from the skin above and muscle below it.
  • If you’re getting sentinel node dissection or axillary lymph node dissection, those procedures take place next.
  • If you’re getting reconstruction, the plastic surgeon takes over.
  • If not, your breast surgeon will place drains into your breast and armpit prevent fluid from collecting where the tumor was.
  • The surgeon stitches up the incision and covers the site with a bandage that wraps around your chest.

After a Mastectomy

Once the surgery is over:

  • You’ll go to a recovery room where staff can keep an eye on your heart rate, body temperature, and blood pressure.
  • After you wake up, you’ll be admitted to a hospital room. You’ll probably stay around 1-2 days, though it might be longer if you have reconstruction.
  • Someone from your health care team will talk to you about:
    • Medications. You’ll find out about the pain meds you have and how to take them.
    • How to care for:
      • The incision. The bandage will probably stay in until your first follow-up visit.
      • Drains. Sometimes they come out before you leave the hospital, but they might stay in until your first follow-up visit.
      • Stitches. Yours will probably dissolve on their own, but non-dissolving types and staples will be removed at your follow-up visit.
    • Complications. You’ll need to know how to spot signs of infection and lymphedema, swelling that often follows lymph node removal.
    • Exercises. They’ll help prevent stiffness on the side where you had surgery. You’ll probably start the morning after surgery.
    • When you can wear a prosthesis or bra. Your surgery site needs to heal first. You’ll find out how long you have to wait.

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Tips for Mastectomy Recovery

Once you’re home, make sure you follow the plan your doctor gave you. Also make sure that you:

  • Rest. Get plenty of it the first few weeks after surgery. It takes a lot out of you.
  • Take your meds. Don’t tough it out. Take the medication as prescribed. You’ll probably feel a mix of pain and numbness.
  • Keep the site dry. Take sponge baths only (no tub baths or showers) until your drains and stitches are out.
  • Do your exercises. They’ll keep your arm from getting stiff.
  • Ask for help. Don’t be shy. It takes time to get better. Get all the help you can with meal prep, shopping, housework, childcare, pet care, rides to doctors’ appointments, and whatever else you aren’t ready to take on by yourself.
WebMD Medical Reference Reviewed by Laura J. Martin, MD on March 17, 2019

Sources

SOURCES:

American Cancer Society: "Surgery for Breast Cancer." “Mastectomy.”

National Comprehensive Cancer Network: "Breast Cancer: Treatment Guidelines for Patients."

Cancer Net: "Guide to Breast Cancer."

BreastCancer.org: "What is Mastectomy?" “Mastectomy: What to Expect.”

John Hopkins Medicine: “Mastectomy.”

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