What Is a Mastectomy?

A mastectomy is a surgery to remove a breast. Most mastectomies are performed on women with breast cancer, but the procedure can be performed on men with the disease as well. Mastectomy is also done cosmetically for some men who have a condition called gynecomastia, which causes their breast tissue to become overdeveloped.

When both breasts are removed, it's called a bilateral mastectomy. Some women who are extremely high risk for breast cancer have bilateral mastectomies to lower their chance of developing the disease. This is called a prophylactic bilateral mastectomy.

A mastectomy is performed not just to remove a cancerous tumor in a breast, but to eliminate most or all of the breast tissue due to the possibility that cancer cells may have invaded those tissues. That can lead to a recurrence of cancer, so getting rid of the entire breast is often the safest option.

While some women may be able to have a lumpectomy, which preserves a portion of the breast, mastectomy is almost always the appropriate choice for men with breast cancer because male breasts typically contain much less tissue.

Several types of mastectomies exist. Nipple- and skin-sparing techniques can be used in combination with most of them, if you're a candidate.

The decision about which type of mastectomy is best for you should be made by a team including the surgeon, your oncologist, and the plastic surgeon who's handling breast reconstruction, if that's something you've chosen.

Your emotional needs should also be considered; however, try to keep in mind that the location and severity of your cancer may take certain options off the table.

• Simple mastectomy: In a simple mastectomy, also called a total mastectomy, the surgeon removes the entire breast that contains the tumor. The term traditional total mastectomy means the areola and nipple are removed as well. You may be able to have your surgeon use nipple-sparing techniques, so you'll have your natural nipple after reconstruction. The muscle beneath the breast is left intact.
• Modified radical mastectomy: Sometimes, a simple mastectomy is combined with a procedure that removes lymph nodes from under the arm. In that case, it's called a modified radical mastectomy. It, too, is sometimes done using nipple-sparing techniques.
• Radical mastectomy: Also called a Halsted mastectomy, this surgery involves removal of all tissues in the affected breast, all of the lymph nodes under the arm on the same side, plus the muscle under the breast. The only thing left is the skin needed to close the incision is left.

Risks of mastectomy include:

• Bleeding
• Infection
• Pain
• Swelling in the arm (lymphedema)
• Scar tissue formation at the surgical site
• Fluid collecting under the scar, which may need to be drained
• Numbness along the incision
• Shoulder pain, stiffness, or numbness under the arm (if lymph nodes are removed)

Your surgeon should talk to you about which side effects are worrisome and warrant calling or getting medical attention right away.

Having one or both breasts removed may also lead to depression. Talk to your doctor if this is a problem for you.

Mastectomy is not recommended for people with metastatic breast cancer or those who can't tolerate general anesthesia.

Generally speaking, if your cancer is less than 2 centimeters away from the nipple, area, and skin that is to be saved, you are not a candidate for nipple/skin-saving techniques.

If you're hoping to have breast reconstruction surgery, you and your doctor will need to make some decisions before your mastectomy.

You'll also need to decide when reconstruction will be done. It's sometimes performed immediately after the mastectomy, but other times it's done later.

Your hospital may have you come in for a pre-surgical appointment, during which you'll sign forms and be familiarized with the facility and procedures. If not, be sure you arrive early enough to take care of these things before the scheduled time for your surgery.

Ask about any medications or supplements you take and whether you'll need to stop taking them prior to surgery (and if so, when).

Also, ask about shaving; your doctor may want you to stop shaving your armpits.

A mastectomy typically lasts about two to three hours. However, if you're having lymph nodes removed or planning reconstructive surgery right away, it'll take longer.

Expect to stay in the hospital for a maximum of three days if you're not having reconstruction at the same time. Reconstruction could add a few days to your stay.

You may be asked not to use products such as lotion or deodorant the day of surgery.

You'll wear a hospital gown for the surgery and most of your stay. You don't need to wear a special outfit the day of your procedure.

Do not wear jewelry, makeup, or nail polish to the hospital.

You'll need to fast prior to the surgery. Be sure you follow the instructions you're given and how to take any medications you're permitted to take the day of surgery.

The cost of a mastectomy, without reconstruction, can range anywhere from $15,000 to $55,000. Reconstruction can add $12,000 or more.

Be sure to check with your insurance company about what it does and doesn't cover, as well as any out-of-pocket expenses you'll be expected to cover.

If you don't have insurance, you may want to look into what kind of coverage you may be eligible for through the state or federal government.

In case of a long wait before surgery, you may want to have a book or electronic device for entertaining yourself.

Then, of course, you'll need to pack for a few nights in the hospital and an appropriate outfit to wear home. Bring a soft but supportive bra and a button-down shirt, as you won't be able to raise your arms over your head.

Someone else should be ready to bring these things to you once you're settled into your room after surgery.

You will interact with several members of the healthcare team before, during, and after your procedure. This will include nurses, an anesthesiologist, your surgeon, and others.

To prepare you for the procedure, a nurse will place an IV in your hand for delivering fluids and medications. Your vital signs will be recorded and monitored. Any body hair in your surgical area may be shaved or clipped, and the area will be cleaned. The breast to be operated on will likely be marked to avoid any mistakes.

You'll be under general anesthesia for the surgery. The anesthesiologist will likely come talk to you as you're being prepped to let you know what to expect.

Once you're anesthetized, the surgeon will make an elliptical incision that's about 6 to 8 inches long. It typically starts on the inside of the breast, near the breastbone, then extends upward and outward toward your armpit. If you have scar tissue from prior surgeries, the incision may be altered to remove that and leave you with a better cosmetic result.

Specific techniques may mean differences in the incision:

• Skin-sparing mastectomy: If this technique is used, the surgeon will leave the skin of the breast intact but will remove the nipple and areola. If you have large breasts, an additional incision may be required.
• Nipple-sparing mastectomy: With this technique, the incision curves around the areola, preserving it and the nipple. This may result in a longer incision, especially if you have large breasts.
• Total skin-sparing mastectomy: This procedure is also known as a subcutaneous mastectomy. The incision is made in the fold underneath the breast, where it's less visible later, or around the areola. The skin, nipple, and areola are all preserved.

The necessary tissues will then be removed via the incision.

After the tissue is removed, the incision is closed. Usually, that's done with sutures or with staples. You may also have a drain installed to help remove excess fluids from your body, promote healing, and decrease swelling.

Then you'll be taken to recovery to be monitored as you come out from under the anesthesia. Once you're awake and alert, you'll be moved to your hospital room.

Since you'll have a short hospital stay, you'll be taken care of after surgery. While you may wish you could be home, take advantage of this time to get your recovery off to a good start.

Especially once you've gone home, it's important to be aware of what's "normal," when to call your doctor, and when to get emergency care.

Infection

Watch for any signs of infection, such as odor, swelling, oozing, or pain. You need to be seen by your breast surgeon as soon as possible if any of these symptoms occur.

Numbness

Numbness in the surgical area is typical and may last for a long time. Feeling usually returns, though.

Phantom Breast Pain

Many women have phantom breast pain, which is a feeling of pain that seems to be coming from the breast that was removed. It's similar to what happens after limb amputation.

According to medical science, your brain continues to send signals to the now-severed nerves in the breast area, even when the breast is not there anymore.  This usually diminishes over time but may occur sporadically for several years.

Phantom breast pain is often described as:

• Pain and discomfort
• A pinching sensation
• Throbbing
• Pins and needles
• Tingling or burning

If you have any of these symptoms, don’t self-diagnose phantom breast pain; call your surgeon and make them aware of what you are experiencing. Be ready to answer whether these symptoms come and go or are persistent, or if they interfere with your ability to sleep, take care of yourself, or perform routine activities.

Lymphedema

Lymphedema is swelling of the soft tissues caused by a build-up of lymph fluid. This type of swelling can occur in the hand, arm, chest, or back on the side of your body where lymph nodes were removed by breast cancer surgery or damaged by radiation therapy.

Lymphedema can occur soon after surgery and lead to pain and other problems. Be sure to inform your surgeon if you have any signs of swelling in your hand, arm, or the trunk of your body.

Lymphedema can also show up months or years after cancer treatment is over.  Sometimes, it lasts for years. Other times, it's short-lived.

To treat lymphedema, your doctor may have you wear a compression sleeve and/or see a physical therapist or rehabilitation specialist.

You can take steps to prevent lymphedema, such as:

• Avoiding anything that irritates the skin
• Caring for hangnails and torn cuticles immediately
• Not wearing tight-fitting clothing or jewelry
• Not using steam rooms, whirlpools, or saunas, and avoiding really hot baths
• Not sunbathing
• Not getting injections, blood draws, or blood pressure taken on your affected arm (If you've had a bilateral mastectomy, ask your surgeon how to best deal with these things.)
• Paying special attention to the effects of risky activities, such as playing tennis, golf, racquetball, or bowling
• Avoiding heavy shoulder bags

The National Lymphedema Network recommends avoiding lifting objects weighing more than 8 pounds.

Wanting to get back the routine you had before surgery is only natural. However, you need to consult your surgeon(s) about when you can begin exercising again. They'll need to sign off on what exercises are appropriate while you are healing.

For help staying or getting back in shape, you may want to consider getting a referral to a certified cancer exercise specialist.

Finding clothes and, if necessary, a prosthetic to wear after mastectomy can be challenging. You may want to look for a post-breast-surgery boutique.

It may be hard to accept the way your body looks after the surgery. You may feel depressed, confused, or avoiding intimacy.

If you feel you need help coping with the changes, talk to a friend, support group, your doctor, or a therapist. Try to discuss your feelings with your intimate partner so they can help you through the transition.

You may face more breast cancer treatments after surgery, such as chemotherapy, radiation, or hormonal therapy. While you may be anxious to get back on your feet, take the time you need to recover well from your surgery so you can enter the next phase of treatment feeling as well as possible.