Mastectomy

A mastectomy is surgery to remove the entire breast, in order to treat breast cancer. There are different types of mastectomies. Which one your surgeon uses depends on the type of breast problem you have.

Before surgery begins, you’ll be given general anesthesia. This means you’ll be asleep and pain-free during surgery. The surgeon will make a cut in your breast.

Types of Mastectomy

Subcutaneous mastectomy

The surgeon removes the entire breast but leaves the skin and may leaves nipple and areola (the colored circle around the nipple) in place.

Total or simple mastectomy

The surgeon cuts breast tissue free from the skin and muscle and removes it. The nipple and the areola are also removed. The surgeon may do a biopsy of lymph nodes in the underarm area to see if the cancer has spread.

Modified radical mastectomy

The surgeon removes the entire breast along with some of the lymph nodes underneath the arm.

Radical mastectomy

The surgeon removes the skin over the breast, all of the lymph nodes underneath the arm, and the chest muscles. This surgery is rarely done.

The skin is closed with stitches, and one or two small plastic drains or tubes are usually left in your chest to remove extra fluid from where the breast tissue used to be.

Mastectomy usually takes 2 to 3 hours.

WHY THE PROCEDURE IS PERFORMED

The most common reason for a mastectomy is breast cancer. If you are diagnosed with breast cancer, talk to your doctor about your choices. Lumpectomy is when only the breast cancer and tissue around the cancer are removed. This is also called breast conservation therapy. Part of your breast will be left. Mastectomy is when all breast tissue is removed. Mastectomy is a better choice if the area of cancer is too large to remove without deforming the breast.

Your doctor will consider:

The size and location of your tumor

How many tumors there are in the breast

How much of the breast is affected

The size of your breast

Your age

Family history

Your general health and whether you have reached menopause

The most common reason for a mastectomy is breast cancer. If you are diagnosed with breast cancer, talk to your doctor about your choices. Lumpectomy is when only the breast cancer and tissue around the cancer are removed. This is also called breast conservation therapy. Part of your breast will be left. Mastectomy is when all breast tissue is removed. Mastectomy is a better choice if the area of cancer is too large to remove without deforming the breast.

WOMEN AT HIGH RISK FOR BREAST CANCER

Women who have a very high risk of developing breast cancer may choose to have a preventive mastectomy to reduce your risk of breast cancer. You may be more likely to get breast cancer if one or more close family relatives has had it, especially at an early age. Genetic tests (such as BRCA1 or BRCA2) may help show that you have a high risk. Mastectomy greatly reduces, but does not eliminate, the risk of breast cancer.

Preventative mastectomy should be done only after very careful thought and discussion with your doctor, a genetic counselor, your family, and loved ones.

MASTECTOMY RISKS

All surgeries carry risks. For more invasive surgery, however, such as a radical mastectomy there are additional risks.

General surgical risks include:

Blood clots in the legs that may travel to the lungs

Blood loss

Breathing problems

Infection, including in the surgical wound, lungs (pneumonia), bladder, or kidney

Heart attack or stroke during surgery

Reactions to medications

Scabbing, blistering, or skin loss along the edge of the surgical cut may occur.

Risks for invasive surgery include:

Shoulder pain and stiffness. You may also feel pins and needles where the breast used to be and underneath the arm.

Swelling of the arm (called lymphedema) on the same side as the breast that is removed. This swelling is not common, but it can be an ongoing problem.

Damage to nerves that go to the muscles of the arm, back, and chest wall.

BEFORE THE PROCEDURE

You may have blood and imaging tests (such as CT scans, bone scans, and chest x-ray) after your doctor finds breast cancer. Your surgeon will want to know whether your cancer has spread.

Always tell your doctor or nurse if:

You could be pregnant

You are taking any drugs or herbs or supplements you bought without a prescription

During the week before the surgery:

Several days before your surgery, you may be asked to stop taking aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve, Naprosyn), vitamin E, clopidogrel (Plavix), warfarin (Coumadin), and any other drugs that make it hard for your blood to clot.

Ask your doctor which drugs you should still take on the day of the surgery.

On the day of the surgery:

Take the drugs your doctor told you to take with a small sip of water.

Follow instructions from your doctor or nurse about eating or drinking before surgery.

Your doctor or nurse will tell you when to arrive at the hospital.

AFTER THE PROCEDURE

Most women stay in the hospital for 1 to 3 days. But this depends on the type of surgery you had. If you have a simple mastectomy, you might go home on the next day. You may be in the hospital longer if you have breast reconstruction.

Many women go home with drainage tubes still in their chest. The doctor will remove them later during an office visit. A nurse will teach you how to look after the drain, or you can have a home care nurse help you. You may also have pain around the site of your cut after surgery. The pain is moderate after the first day and then quickly goes away. You’ll receive pain medicines before you are released from the hospital.

Fluid may collect in the area of your mastectomy after all the drains are removed. This is called a seroma. It usually goes away on its own, but it may need to be drained using a needle.

Subcutaneous mastectomy before-after cases:

OUTLOOK (PROGNOSIS)

Most women recover well after mastectomy. However, in addition to surgery, you may need other treatments for breast cancer, such as hormonal therapy, radiation therapy, and chemotherapy. All have their own side effects.

WHAT TO EXPECT AT HOME

Full recovery may take 4 to 8 weeks. You may have shoulder, chest, and arm stiffness. This stiffness gets better over time and can be helped with physical therapy. You may also go home with drains in your chest to remove extra fluid. Your surgeon will decide when to remove these drains, usually in a week or two.

Some women develop swelling in the arm on the side of your surgery known as lymphedema. Lymphedema usually occurs much later and can be permanent, although it can be managed with physical therapy.

You may also need time to adjust to losing your breast. Talking to other women who have had mastectomies can help you deal with these feelings. Ask your health care provider about local support groups. A mental health care provider can help as well.

ACTIVITY

When sitting, keep your arm on the side of your surgery up as high as your heart in order to help prevent swelling. It’s okay to use your arm on the side of your surgery. But don’t overdo it until the stitches or staples and all drains have been removed and you’ve seen your surgeon. Your doctor, nurse, or therapist can also show you some simple exercises to relieve tightness.

You can start doing most normal activities again 2 weeks after surgery, but avoid doing things for which you will need to use the arm on the side of your surgery, or that make you keep your arm raised. You should drive only if you aren’t taking pain medication and can easily turn the steering wheel without pain.

Ask your surgeon when you can return to work. When and what you can do may vary, depending on the work you do and whether you also had a lymph node dissection.

WOUND CARE

Caring for your wound:

Don’t sit in a bathtub, pool, or hot tub until your doctor tells you it is okay.

Don’t wash or scrub the strips of surgical tape or surgical glue. Let them fall off on their own.

If you have a dressing, change it every day until your doctor says you don’t need to.

Wash the wound area with mild soap and water.

You may shower after all of your dressings have been removed.

MANAGING YOUR PAIN

Your surgeon will give you a prescription for pain medication. Get it filled right away so you have it available when you go home. Remember to take your pain medication before your pain becomes too bad.

Try using an ice pack on your chest and armpit if you have pain or swelling. Do this only if your surgeon says it’s okay. Wrap the ice pack in a towel before applying it. This prevents cold injury of your skin. Don’t use the ice pack for more than 15 minutes at a time.

FOLLOW-UP

Your surgeon will tell you when you need to have your next visit. You may also need appointments to talk about more treatment, such as chemotherapy or radiation.