Mastectomy: Overview

A mastectomy is the surgical removal of a breast, either to treat or to prevent breast cancer. There are different types of mastectomy procedures depending on an individuals's diagnosis.

This article explains what is involved in a mastectomy procedure. It also covers different types of mastectomy surgeries, potential risks, as well as recovery.

What Is a Mastectomy?

A mastectomy is performed in a hospital under general anesthesia, or a medication that prevents pain. The procedure typically lasts two to three hours. It may take longer if a procedure to remove the lymph nodes, or glands that protect the body from infection, is planned.

During a mastectomy, the following steps are generally taken:

  • An incision 6 to 8 inches in length is made that begins on the inside of the breast, near the breastbone, and extends upward and outward toward the armpit.
  • Once the breast tissue, and sometimes the lymph nodes underneath the arm, are removed, the incision is closed with either staples or absorbable ​sutures, or stitches.
  • A drain may also be placed, which helps remove excess fluid from the body to promote healing and decrease swelling. The drain will be under a bandage to protect the surgical site and help keep the drain in place.

Both the staples and the drain will be removed during an office visit after you are discharged from the hospital.

After a mastectomy, you can decide if you want to rebuild the breast that was removed. This is called breast reconstruction. It may be performed at the time of the mastectomy, which is called immediate reconstruction. It can also be done after the mastectomy incisions have healed and you have completed all of your breast cancer treatments.

Reconstructive surgery may lengthen the amount of time of the procedure if it is being performed immediately after the mastectomy.

What Are the Different Types of Mastectomies?

Depending on various factors, most notably the stage of breast cancer, a surgeon, or doctor qualified to practice surgery, will perform one of these types of mastectomies:

  • Simple (total) mastectomy: All of the breast tissue is removed from the affected breast.
  • Modified radical mastectomy: All of the breast tissue is removed along with the lymph nodes from the armpit on the affected side of the body.
  • Radical mastectomy: All of the breast tissue from the affected breast is removed along with the underarm lymph nodes and the chest muscle that lies underneath the breast.

During a simple or modified radical mastectomy, if an individual is undergoing immediate breast reconstruction, the surgeon may consider performing techniques such as:

  • Skin-sparing mastectomy: This technique preserves the skin of the breast, but not the nipple and areola, which are removed.
  • Nipple-sparing mastectomy: With this technique, the incision to remove the breast tissue is made around the areola, thus preserving both the nipple and areola.

The skin or nipple-sparing mastectomies are reserved for individuals whose area of cancer is a minimum of two centimeters away from the tissue that is to be saved.

Simple Mastectomy

A simple mastectomy is a procedure that removes all of the breast tissue of the affected breast. The most common form of the surgery, referred to as traditional total mastectomy, includes the removal of the areola and nipple. However, the surgery can be performed using skin and nipple sparing techniques. It also leaves the muscle under the breast intact.

The procedure is performed using an elliptical incision 6 to 8 inches in length that begins on the inside of the breast, near the breastbone, and extends upward and outward towards the armpit. The incision can also be altered to remove scar tissue from previous procedures.

Once the breast tissue is removed, the incision is closed with either absorbable ​sutures, or staples.

What is a double mastectomy?

During a double, or bilateral mastectomy, both breasts are removed. This surgery is usually performed as a simple mastectomy on both breasts.


Modified Radical Mastectomy

A modified radical mastectomy is a procedure that combines the removal of all breast tissue from the affected breast with lymph node removal from the armpit on the affected side of the body. This surgery typically includes the removal of both the nipple and areola. However, the surgery can be performed using skin and nipple sparing techniques.

Like a simple mastectomy, the procedure is performed using an elliptical incision 6 to 8 inches in length that begins on the inside of the breast, near the breastbone, and extends upward and outward toward the armpit.

Once the breast tissue is removed, the incision is closed with either absorbable sutures or staples that are removed during an office visit 10 to 14 days after surgery.

Radical Mastectomy (Halsted Mastectomy)

A radical mastectomy, also known as a Halsted mastectomy, is not a commonly performed procedure. It is only performed on individuals who have advanced breast cancer that has invaded the muscle wall under the breast tissue.

A radical mastectomy removes all of the breast tissue of the affected breast. It also removes all of the lymph nodes under the arm on the affected side and the muscle that lies under the breast. Only the skin required to close the incision is left in place.

This surgery leaves very little tissue other than skin over the rib bones. The scar left after this surgery is 6 to 8 inches long, with enough skin left to close the incision with sutures or staples.

Skin Sparing Mastectomy

This technique preserves the skin of the breast, but not the nipple and areola, which are removed. The breast tissue is then removed through that area. For individuals with large breasts, an additional incision may be made to allow the breast tissue to be removed, but the vast majority of skin is left behind after surgery.

Nipple Sparing Mastectomy

The incision to remove the breast tissue is made around the areola, thus preserving both the nipple and areola. This procedure, like the skin-sparing procedure, may result in a larger incision than is necessary compared to the traditional procedure, especially if the breast is large.

Nipple and skin sparing techniques can be used in combination with most mastectomy surgeries. In some cases, a total skin-sparing mastectomy can be performed that preserves the skin of the breast, as well as the nipple and areola.

What Are the Contraindications?

A mastectomy may be contraindicated in the following cases:

  • If an individual has distant metastatic breast cancer, or breast cancer that has spread to other parts of the body
  • If the individual is older and has other significant medical conditions
  • If an individual has a high risk of death from the surgery or from anesthesia
  • If the surgery is technically difficult because of the size of the cancer

What Is the Purpose of a Mastectomy?

The main purpose of a mastectomy is to treat breast cancers such as:

  • Ductal carcinoma in situ (DCIS), or non-invasive breast cancer in the milk duct
  • Invasive breast cancers such as invasive ductal carcinoma
  • Difficult to treat cancers, such as triple-negative breast cancer, or an aggressive type of breast cancer
  • Less common breast cancers, like Paget disease of the breast, or a rare cancer that impacts the nipple or areola

Other Reasons for a Mastectomy

A mastectomy may also be done to prevent breast cancer. This is called a prophylactic mastectomy. It may be performed if:

  • An individual has a genetic mutation, like the BRCA gene, that increases their risk for developing breast cancer
  • An individual has a strong family history of breast cancer
  • An individual underwent chest radiation before the age of 30
  • An individual has or had cancer in one breast

Mastectomy or Breast-Conserving Surgery?

Individuals with early-stage breast cancer often have the option of choosing between a lumpectomy, a breast-conserving surgery (BCS) that removes a "lump" of breast tissue that contains the cancer, or a mastectomy. If an individual chooses breast-conserving surgery, they will most likely also need radiation.

Research shows that a mastectomy does not improve a person's chance of long-term survival when compared to BCS with radiation. As a result, most individuals choose BCS with radiation.

However, according to the American Cancer Society, a mastectomy may be advised in these cases:

  • An individual cannot undergo radiation, possibly because of an underlying medical condition that makes them sensitive to the side effects of this treatment
  • An individual has inflammatory breast cancer, a rare type of cancer that causes the breasts to appear swollen
  • The breast was treated with radiation in the past
  • An individual already had BCS and not all of the cancer was removed
  • There are two areas of cancer within the same breast that are too far apart
  • A breast cancer that is larger than 5 centimeters across, or is large relative to the patient's breast size
  • An individual is pregnant and would require radiation during pregnancy
  • An individual has a genetic mutation that increases their risk for a second breast cancer

How Do I Prepare for a Mastectomy Procedure?

After you have scheduled your mastectomy surgery, your healthcare provider will give you instructions for how to prepare for your upcoming procedure. While instructions may vary, on the day of your surgery you should:

  • Wear comfortable clothes
  • Avoid wearing jewelry, makeup, lotion, deodorant, or nail polish
  • Stop eating after midnight the night before your surgery
  • Stop certain medications for a period of time before your surgery
  • Bring personal items like your toothbrush, hairbrush, and phone
  • Plan on having someone take you home once you are discharged

Speak with your healthcare provider if you have any questions about how to prepare for your upcoming surgery. Make sure you fully understand the instructions, especially in regards to your medication regimen.

What Should I Expect on the Day of Surgery?

On the day of your surgery, you will arrive at the hospital and be taken to a pre-operative room. You will then:

  • Be given a hospital gown to put on
  • Have an IV placed in your hand for delivering fluids and medications
  • Have your vital signs checked, like your heart rate, breathing, and blood pressure

You will meet with members of the surgical and anesthesia team who will discuss the surgery with you and answer any questions you may have. You will then be taken into the operating room. There you will be given anesthesia medications to help with pain and put you to sleep.

What Is Recovery Like?

The recovery from mastectomy surgery begins in the post-anesthesia care unit (PACU), where you will be monitored while the anesthesia drugs wear off.

After that, you will be taken to a hospital room where you will stay for one or two nights before being discharged home.

Your healthcare team will provide you with specific instructions regarding:

  • Caring for your surgical site and drain
  • Restricting or avoiding certain activities like driving or running, and for how long
  • Taking medications like pain medications, or antibiotics to help prevent infection
  • Attending follow-up appointments

You may also be given instructions on performing arm exercises on your own or under the guidance of a physical therapist, or movement expert.

While the precise recovery time varies, most individuals can resume normal activities, including work, within about four weeks. If breast reconstruction is performed in addition to the mastectomy, recovery takes a bit longer.

When to Seek Medical Attention

Reach out to your healthcare provider if you have:

  • Fever or chills
  • Pain that isn't helped with medication
  • Swelling near the incision site
  • Discharge or a bad odor from the incision site or drain
  • Constipation, or difficulty going to the bathroom
  • Signs of an allergic reaction to a medication


What Is the Long-Term Care Like Post-Surgery?

Whether or not you undergo breast reconstruction, a mastectomy requires long-term care. Be sure to reach out to your healthcare provider throughout the recovery process if you have any questions or concerns.

After surgery, you may need additional therapies such as:

  • Chemotherapy, a treatment that uses medication to kill cancer cells
  • Hormone therapy, or treatment that slows cancers that use hormones to grow
  • Targeted therapy, or treatment that directly attacks cancer cells
  • Radiation therapy, or treatment that uses radiation to shrink cancer cells

You may be at risk for depression, a group of conditions that can lead to low mood, sadness, and sleep disturbances, after being diagnosed with breast cancer. You may experience depression whether or not you have had a mastectomy procedure. Symptoms of depression can make the recovery process even more difficult, so be sure to reach out to your healthcare provider if you are experiencing this.

Individuals who opt not to have reconstruction may want to use prosthetics that create a balance between a natural breast and a breast that has been removed. There are many mastectomy products available including bras, breast forms, and swimsuits.

Maintaining a healthy weight, quitting smoking, exercising, and limiting alcohol intake can help lower your risk of developing recurrent breast cancer.

What Are Potential Risks and Complications?

As with any surgery, a mastectomy comes with potential risks and complications.

Immediate or short-term complications that may occur after a mastectomy include:

  • Hematoma: A hematoma is a collection of blood within the wound site. It may lead to pain, swelling, and bruising underneath the breast.
  • Seroma: A seroma is a collection of serous fluid, or pale yellow fluid, that may collect in the breast after the mastectomy. A seroma may cause pain and swelling.
  • Wound infection: This complication is rare and usually due to staphylococcal bacteria, which is found normally on the skin. It may cause symptoms like fever, tenderness, warmth, redness, and/or swelling around the surgical site.
  • Skin flap necrosis: Necrosis, or death of the tissue that makes up the skin flap, or the healthy tissue that covers the wound, occurs when the blood supply to the skin flap is insufficient. The necrosis may be partial or more severe.

Potentially long-term complications of a mastectomy include:

  • Persistent post-mastectomy pain (PPMP): This type of long term pain may be described as shooting, stabbing, pulling, tightness, burning, or aching. It may occur in the armpit, breast/chest wall, and upper arm after a mastectomy.
  • Lymphedema: Swelling of the arm may occur if you had lymph nodes removed from your armpit and the fluid doesn't drain properly through the lymph system. This can lead to arm numbness, swelling, stiffness, and pain.
  • Phantom breast syndrome: With this condition, individuals feel pain, itchiness, or a general sensation in their breast after a mastectomy.
  • Scar tissue formation: After the mastectomy procedure, scar tissue may form. This may feel painful.

Summary

A mastectomy is the surgical removal of the breast to prevent or treat cancer. There are several different types of mastectomy procedures that may be performed.

Once your mastectomy is scheduled, your healthcare provider will go over how to prepare for your upcoming surgery, as well as what to expect the day of the procedure.

The amount of time it takes to recover from this procedure will vary from person to person. As with any surgical procedure, there are potential risks and complications.

A Word From Verywell

A mastectomy is a major surgery. Even though the recovery period is typically uncomplicated, it can be an exhausting process. Reach out to your healthcare team if you feel overwhelmed during this time. You may also consider joining a breast cancer support group to connect with others who have gone through a similar experience.

Frequently Asked Questions

  • What is the most common mastectomy?

    A simple mastectomy and modified radical mastectomy are performed more often than a radical mastectomy.

  • What stage of breast cancer typically requires a mastectomy?

    Individuals in stages I, II, or III are typically treated with surgery.

  • Is a mastectomy painful?

    A mastectomy may cause pain and some soreness. The amount of discomfort will vary from person to person.

11 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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Additional Reading