Procedure overview
What is a mastectomy?
A mastectomy is a surgical procedure in which all or a portion of a breast is removed as a part of
treatment for breast cancer. In some cases, mastectomy is performed prophylactically (to prevent
cancer from occurring) in women with a high risk for developing breast cancer.
Surgical treatment for breast cancer is generally divided into 2 categories: breast-conserving
therapy (BCT) or mastectomy. BCT involves removing the least possible amount of breast tissue
when removing breast cancer, and usually includes adjuvant (additional) therapy after surgery,
most often radiation therapy.
There are several types of mastectomy procedures:
Total (or simple) mastectomy. Removal of the entire breast, including the nipple, the
areola, and most of the overlying skin.
Modified radical mastectomy. Removal of the entire breast, including the nipple, the
areola, the overlying skin, and the lining over the chest muscles. In addition, some of the
lymph nodes under the arm, also called the axillary lymph nodes, may be removed. The
bean-shaped lymph nodes under the arm drain the lymphatic vessels from the upper arms, the
majority of the breast, the neck, and the underarm regions. Often, breast cancer spreads to
these lymph nodes, thereby entering the lymphatic system and allowing the cancer to spread
to other parts of the body. In some cases, part of the chest wall muscle is also removed.
Radical mastectomy. Removal of the entire breast, including the nipple, the areola, the
overlying skin, the lymph nodes under the arm, and the chest muscles. For many years, this
was the standard operation. However, today a radical mastectomy is rarely performed and is
generally only recommended when the breast cancer has spread to the chest muscles.
Some newer mastectomy procedures may offer additional options for surgery. However, further
studies are needed to learn whether these procedures are as effective as more standard types of
surgery in completely removing or preventing the return of breast cancer:
Skin-sparing mastectomy. In this procedure the breast tissue, nipple and areola are
removed, but most of the skin over the breast is saved. This type of surgery appears to be
similar to modified radical mastectomy in effectiveness for many women. It is used only
when breast reconstruction is performed immediately after the mastectomy and may not be
suitable for tumors that are large or near the skin surface.
Nipple-sparing mastectomy. This is similar to the skin-sparing mastectomy, and it is
sometimes referred to as a "total skin-sparing mastectomy." All of the breast tissue, including
the ducts going all the way up to the nipple and areola, are removed, but the skin of the
nipple and areola is preserved. The tissues under and around the nipple and areola are
carefully cut away and examined by a pathologist. If no breast cancer cells are found close to
the nipple and areola, they can be preserved. Otherwise, nipple-sparing mastectomy is not
recommended.
When all or most of the breast tissue is removed, breast reconstruction surgery may be performed
to rebuild the breast. Reconstruction may be performed at the time of the mastectomy or at a later
time.
Anatomy of the breast
Breast tenderness
Hardness due to scar tissue that can form at the site of the incision
Lymphedema, or swelling, of the arm due to lymph node removal. This is preceded by
early symptoms, which include a feeling of tightness in the arm, pain, redness, and decreased
flexibility of the arm, hand, and wrist.
Phantom breast pain. Symptoms include unpleasant itching, pins and needles, pressure,
and throbbing. These sensations may be managed with medications, exercise, or massage.
Phantom breast pain does not mean that cancer cells are still present in the breast or that the
cancer may return.
Seroma (clear fluid trapped in a wound) is normally present after a mastectomy. Troublesome
seromas can be drained in a surgeons office and treated with compression or an injection that
helps to harden the space in the breast if necessary.
A linear scar is likely to result at the site of the mastectomy, and many patients experience a
pulling sensation near or under their arm after mastectomy.
Depression and feelings of loss of sexual identity may occur after a mastectomy.
There may be other risks depending on your specific medical condition. Be sure to discuss any
concerns with your doctor prior to the procedure.
Cosmetic concerns after mastectomy
Patients undergoing mastectomy may have concerns about the appearance of their breast(s) after
the procedure. Fortunately, breast reconstruction is possible for the majority of patients after
mastectomy. Often, patients undergoing mastectomy may undergo breast reconstruction surgery
during the same procedure.
The advantages to immediate breast reconstruction include not waking up to the trauma of losing
a breast and eliminating the need for additional surgery. Disadvantages include having to
consider reconstruction options during an already stressful time prior to surgery for cancer. In
addition, complications, though rare, may result during the healing process from reconstruction
surgery that may interfere with radiation or chemotherapy treatment.
Your doctor will discuss with you your options regarding reconstructive surgery. Alternative
solutions after mastectomy include the use of an external prosthesis or a special mastectomy bra.
Before the procedure
Your doctor will explain the mastectomy procedure to you and give you a chance to ask
any questions that you might have.
You will be asked to sign a consent form that gives permission to do the procedure. Read
the form carefully and ask questions if something is not clear.
In addition to a complete medical history, your doctor may perform a complete physical
examination to ensure you are in good health before undergoing the procedure. You may
undergo blood tests or other diagnostic tests.
You will be asked to fast for 8 hours before the procedure, generally after midnight.
If you are pregnant or suspect that you may be pregnant, you should notify your health
care provider.
Notify your doctor if you are sensitive to or are allergic to any medications, iodine, latex,
tape, or anesthetic agents (local and general).
Notify your doctor of all medications (prescription and over-the-counter) and herbal
supplements that you are taking.
Notify your doctor if you have a history of bleeding disorders or if you are taking any
anticoagulant (blood-thinning) medications, aspirin, or other medications that affect blood
clotting. You may need to stop these medications prior to the procedure.
You may receive a sedative prior to the procedure to help you relax.
Based on your medical condition, your doctor may request other specific preparation.
A mastectomy typically requires a stay in the hospital. Procedures may vary depending on your
condition and your doctor's practices.
Generally, a mastectomy follows this process:
You will be asked to remove clothing and will be given a gown to wear.
The anesthesiologist will continuously monitor your heart rate, blood pressure, breathing,
and blood oxygen level during the surgery.
The skin over the surgical site will be cleansed with an antiseptic solution.
An incision, or cut, will be made in the breast. The type of mastectomy to be performed
will determine the type of incision(s) made. (The areas removed during surgery are shaded in
green in the illustrations.)
Lymph nodes may be removed after the breast or breast tissue has been removed.
Breast tissue and any other tissues that are removed will be sent to the lab for
examination.
One or more drainage tubes may be inserted into the affected area.
The extent of pain depends on the amount and location of tissue removed during surgery. Most
soreness may last a few days, although many mastectomy patients do not experience soreness
after surgery. Take a pain reliever for soreness as recommended by your doctor. Aspirin or
certain other pain medications may increase the chance of bleeding. Be sure to take only
recommended medications.
Radiation therapy or chemotherapy may or may not be necessary after a mastectomy.
Your doctor will advise you about this depending on your particular situation.
At home
Once you are home, it is important to keep the surgical area clean and dry. Your doctor will give
you specific bathing instructions. Unless instructed otherwise, the narrow strips of tape across
the incision can become wet during a shower. You may be instructed to replace a wet dressing
with a clean, dry one.
You will be instructed about how to take care of the drainage tube, which should be removed
after about 2 weeks at the first follow-up examination.
If lymph node dissection (removal) was performed with your mastectomy, your doctor may
recommend that you do exercises to help limber up the shoulder and arm area. Soreness after
lymph node dissection may cause you to keep your arm and shoulder as still as possible, leading
to arm and shoulder stiffness. Overdoing the exercises could result in injury so they should be
started gradually and performed consistently, progressing a little each day. You may be advised
to perform these exercises even if lymph node dissection was not a part of your procedure.
Normal activities can usually be resumed within a few weeks, based on a recommendation by
your doctor. Meanwhile, you should avoid strenuous activities, particularly those that involve
extensive use of the arm, such as cleaning windows or vacuuming for long periods. Your doctor
will advise you about when you can start driving again and when you can return to work.
If you have problems dealing with your recovery, your doctor may refer you to a volunteer
agency or group for support.
Notify your doctor if you have any of the following:
Your doctor may give you additional or alternate instructions after the procedure, depending on
your particular situation.
Arm care after lymph node removal
Removal of lymph nodes may affect the drainage of lymphatic fluid from the arm on the surgical
side. Problems with lymphatic drainage may result in arm swelling and an increased risk for
infection from trauma to the arm. In addition, there is an increased risk for blood clots in the
veins of the armpit because of surgical trauma in the area.
Lifelong precautions to help prevent problems in the affected arm after lymph node dissection
include, but are not limited to, the following:
Elevate the arm, with the hand above the elbow, to assist with drainage of lymphatic fluid
Wear gloves when gardening or performing any activity in which there is a risk for skin
puncture of the fingers and/or hands, or when using strong or harsh chemicals, such as
detergents or household cleaners
Avoid sunburns
Use an electric shaver rather than a razor with a blade to shave under the arm
Avoid any constrictive items on the affected arm, such as elastic cuffs or tight watches or
other jewelry
Avoid insect bites or stings by using insect repellents and/or wearing long sleeves