What Is a Mastectomy?

What to expect when undergoing this surgery

Doctor showing patient how to do a breast exam
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A mastectomy is a surgery to remove a breast. Most mastectomies are performed on women with breast cancer, but it can be performed on men with breast cancer, as well. It's 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.

Purpose of Surgery

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. Mastectomy reduces the risk of recurrence to between 1 and 3 percent.

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.

Types of Mastectomies

Several types of mastectomies exist. The decision about which type 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 used what's called 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. Radical mastectomy used to be standard, but thanks to the development of less extreme, while still effective, procedures, it's only used now for advanced cases in which cancer has invaded the muscle wall.

    Risks and Contraindications

    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.

    Nipple and skin sparing techniques can be used in combination with most mastectomy surgeries to retain more skin than in a traditional mastectomy. A general guideline for retaining the nipple, areola, and additional skin is this:

    For nipple-sparing and skin-sparing techniques, the area of cancer should be at least two centimeters away from the nipple, areola, and skin that is to be saved. If your cancer is closer than that, you're not a candidate for these techniques.

    Before Surgery

    If you're hoping to have breast reconstruction surgery, you and your doctor will need to make some decisions before your mastectomy, including whether you're a candidate for nipple-sparing and skin-sparing techniques.

    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.

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

    Timing

    A mastectomy typically lasts about 2 to 3 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.

    What to Wear

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

    Most facilities do not want you to shave the surgical area yourself. If you shave your armpits, ask if you should stop prior to surgery, and if so, how far in advance.

    You may also 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. However, you'll want to have a soft but supportive bra to wear home. Also, take a button-down shirt because you won't be able to raise your arms over your head.

    Food and Drink

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

    Cost and Health Insurance

    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 and any out-of-pocket expenses you'll be expected to cover.

    If you don't have insurance, you may want to look into what your state provides.

    What to Bring

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

    During the Surgery

    Pre-Surgery

    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.

    Throughout the Surgery

    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.

    Post-Surgery

    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.

    After Surgery

    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. If you have had immediate reconstruction following your mastectomy or bilateral mastectomy, you need to also make your plastic surgeon aware of your symptoms.

    Numbness

    Numbness in the surgical area is typical and may last for a long time. The feeling does usually return, 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 yourself as having phantom breast pain; call your surgeon and make him or her 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 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.

    Since Lymphedema can happen days, months, or years following breast cancer treatment, it is so important to take steps to prevent it, such as:

    • Avoiding anything that irritates the skin, and caring for hangnails and torn cuticles immediately
    • Not wearing tight-fitting clothing or jewelry
    • Not using steam rooms, whirlpools, or saunas, and not taking 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.

    If you've had reconstruction, you need to make your plastic surgeon aware of any pain or swelling you are experiencing in addition to your cancer surgeon.

    Exercise

    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.

    Post-Surgical Comfort

    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.

    A Word From Verywell

    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.

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