Mastectomy

Also known as: Breast surgery, simple mastectomy, total mastectomy, modified mastectomy, radical mastectomy, nipple sparing mastectomy, skin sparing mastectomy, double mastectomy, breast cancer surgery, subcutaneous mastectomy

Surgery overview
Mastectomy is the surgical removal of the breast. It is usually performed by a general surgeon as local therapy to treat breast cancer. Mastectomy may also be performed as a preventive measure in men or women who are considered at high risk of developing breast cancer.

In a traditional mastectomy, all of the breast tissue, along with the overlying skin and nipple, is removed. The size and location of the tumor and where the cancer might have spread may sometimes require surrounding tissue to be removed as well.

There are a number of different types of mastectomy:

  • Total or simple (traditional) mastectomy, which is the removal of all of the breast tissue, including the skin and nipple.
  • Modified radical mastectomy, which is the removal of the breast tissue, the overlying skin and nipple, some of the lymph nodes under the arm (axillary lymph node dissection), and sometimes part of the chest wall muscles.
  • Radical mastectomy, which is the removal of the breast tissue, skin and nipple, chest muscles, and all of the lymph nodes under the arm. This surgery is rarely used now.
  • Skin-sparing mastectomy (SSM). Depending on the location of the tumor in the breast or other factors, some women may be able to have a skin-sparing mastectomy. Skin-sparing mastectomy leaves most of the skin that was over the breast, except for the nipple and the areola.
  • Nipple-sparing mastectomy (SSN)(AKA subcutaneous mastectomy) may also be performed if the tumor location allows. This procedure preserves the skin over the breast as well as the nipple and areola. The benefit is a more natural look after reconstruction.

Breast reconstruction after mastectomy
Some women choose to have breast reconstruction after a mastectomy. Reconstruction can sometimes be done during the same surgery as the mastectomy, or it may be done later as a separate procedure. Your reconstruction may be affected by any additional cancer treatment you may undergo. If possible, seek advice from a qualified plastic surgeon to discuss your options prior to your surgery.

Lymph node dissection
Lymph nodes are often removed during surgery and examined for the presence of cancer cells. Cancer cells in the lymph nodes may indicate a higher chance that cancer cells have spread to other parts of the body, and may indicate the need for additional treatment. Lymph node removal falls into two categories:

  • Sentinel lymph node biopsy (SLNB). The surgeon removes the first one or two nodes into which a tumor drains, known as sentinel nodes. These nodes are examined under a microscope to check for cancer cells. If cancer is found in those lymph nodes, more lymph nodes may be removed.
  • Axillary lymph node dissection (ALND). The surgeon removes some or all of the lymph nodes in your axilla (your armpit). This is usually done if tests performed before your surgery suggests that there is cancer in the lymph nodes.

Visit our Health Information Library for more information on the importance of lymph node dissection in staging breast cancer.

What to expect after surgery
Your post-surgical care will differ depending on the type of mastectomy you had and whether or not you also underwent reconstruction.

Mastectomy is done using general anesthesia. After your surgery, you will be taken to a recovery room.

When you wake up from surgery, you will have a bandage over the surgery site. You will also have one or two drainage tubes to collect fluid and keep it from building up around the surgery area. If these tubes are still in place when you go home, your nurse will teach you how to take care of them.

Your doctor or nurse will give you instructions on pain control and caring for your incision.

Most people go home within 24 hours after a mastectomy. But, if you have breast reconstruction during the same surgery that utilizes your own tissue, you may stay in the hospital for several days.

Exercise and activities after surgery
There are certain exercises you should perform to help prevent arm and shoulder stiffness and, if you’ve undergone reconstruction, the formation of significant scar tissue. Your doctor or nurse will explain these exercises and should also give you written, illustrated instructions on how to do them. You will need to avoid strenuous activity for several weeks after surgery. Your doctor will let you know how soon you can increase your activity level after surgery.

Why it is done
Mastectomy is done to remove as much cancer as possible and give the greatest chance of staying cancer-free.

How well it works
For early-stage breast cancer, having a lump or part of the breast removed (breast-conserving surgery) along with radiation therapy has the same survival rate as mastectomy. But, mastectomy may be better for a number of situations such as:

  • women who have already had radiation therapy to the affected breast or chest wall, or who have already had a lumpectomy that did not completely removed the cancer (recurring local cancer)
  • women with inflammatory breast cancer
  • women with large tumors; two or more primary tumors; or diffuse, malignant-appearing microcalcifications in the breast.
  • women who may not be able to undergo radiation therapy, such as those with connective tissue disease or who are pregnant (except patients in the third trimester who can receive radiation after the child is born)
  • women with a cancer that is large relative to her breast size, which might result in an unappealing cosmetic result if a lumpectomy were performed
  • women with a high risk for breast cancer who opt for prophylactic (preventative) removal of the breasts
  • male breast cancer patients

Risks
Complications can include infection, bleeding, poor wound healing, or a reaction to the anesthesia used in surgery. Blood or clear fluid may also collect in the wound and need to be drained. You may have feelings of pulling, pinching, tingling, or numbness.

If you have lymph nodes removed from under your arm, there is a chance of developing lymphedema (swelling of the arm). This is because fluid is less able to drain out of the tissues through the lymph system after this procedure. Tell your doctor or nurse right away if you have swelling or pain in your arm on the side where you had your surgery. Your doctor or nurse may refer to you a physical therapist specially trained in lymphedema management to learn how to prevent or manage this condition.

The nerve that controls skin sensation on the inner upper arm is also in the area of these lymph nodes. If the nerve is damaged during surgery, you may have numbness in this area.

What to think about
Mastectomy may be a better choice than breast-conserving surgery depending on the size of the tumor or if you have two or more tumors that are too far apart. Radiation therapy is often not needed after mastectomy, so mastectomy can be a good choice if you don't want to have radiation or if you cannot have radiation treatment.

Some women choose to have breast reconstruction either at the same time as mastectomy or later on. Before you have your mastectomy, talk to a plastic surgeon about reconstruction to decide whether this added procedure is right for you.

Prophylactic or preventive mastectomy
Some women who know that they are at very high risk for breast cancer—but do not have breast cancer—choose to remove both breasts. This is called prophylactic mastectomy. Removing the breasts can greatly lower the risk for breast cancer, but it cannot completely prevent breast cancer.

It is not yet known whether this surgery is better than having careful screening and then early treatment of any breast cancer that may develop. 1

Prophylactic mastectomy is also an option for a woman who has cancer in one breast. At the time of cancer surgery, some women also have the other breast removed.

Some women who are at high risk for breast cancer may have their ovaries removed after they are done having children, or after age 35. Removing the ovaries has been shown to decrease the risk of breast cancer by 50%. 1

If you are thinking of having a prophylactic mastectomy, learn as much as you can about it from your doctors. See if you can also talk to other women who have had this surgery. Carefully consider how you feel about the benefits and changes, both physical and emotional.

Learn more
Learn more about breast cancer and available treatments by visiting our online Health Information Library.

Read about Providence General Surgery Services or find a general surgeon.

Citations

  1. Davidson NE (2007). Breast cancer. In DC Dale, DD Federman, eds., ACP Medicine, section 12, chap. 7. New York: WebMD.