What is a mastectomy?
Some types of mastectomy remove only part of the breast tissue, and others are more extensive. The type that a doctor recommends will depend on the reason for the procedure.
Extensive surgery can change the appearance of the breast, the nipples, or both. If a person wishes to restore their original appearance, reconstructive surgery and prosthetics are two options.
This article looks at what happens when a person has a mastectomy for breast cancer. It explores the types of procedures and what to expect during recovery.
Types of mastectomy
Removing all or part of the breast can be an effective treatment for breast cancer.
There are several types of mastectomy. They include:
Total (simple) mastectomy: This involves the surgeon removing the entire breast but leaving the muscles under the breast and the lymph nodes in place.
Double mastectomy: This involves the surgeon removing both breasts, usually as a preventive measure — if genetic features indicate a high risk of breast cancer, for example.
Radical mastectomy: This involves the surgeon removing the entire breast, the underarm lymph nodes, and the chest wall muscles.
Modified radical mastectomy: This involves the surgeon removing the entire breast and underarm lymph nodes but leaving the chest wall muscles intact.
Skin-sparing mastectomy: This involves the surgeon removing the breast tissue and nipple but leaving the skin intact. A surgeon also reconstructs the breast during the procedure.
Nipple-sparing mastectomy: This relatively new procedure involves leaving the skin, nipple, and peripheral breast tissue intact.
Less invasive procedures — known collectively as breast-conserving surgery — are now an option for many people with a diagnosis of breast cancer.
Examples of these procedures include:
Quadrantectomy: This is a partial mastectomy. It involves removing more breast tissue than in a lumpectomy, but the surgeon still leaves most of the breast tissue intact.
Skin-sparing mastectomy: This newer procedure involves preserving breast skin and reconstructing a more natural-looking breast. It may only be an option if no cancer cells are close to the skin.
Reconstruction is a type of aesthetic surgery that can restore the original appearance of the breasts. A person may have reconstruction during the same procedure as a mastectomy or in a second surgery, often 6–12 months later.
Other people choose to "go flat." They opt not to have reconstructive surgery for various reasons.
Factors affecting the decision
A doctor will recommend a type of mastectomy after considering a range of factors, including:
- the person's age and overall health
- their menopause status
- the size of the tumor
- how far the cancer has spread
- how quickly the cancer is likely to spread
- the likelihood of the cancer returning
- whether a person can tolerate radiation therapy
- individual preferences, including aesthetic concerns and the likely duration of the recovery
If tests show that a tumor may respond to targeted treatment, such as hormone therapy, a doctor may recommend using these drugs to target cancer cells instead of surgery.
Who may need one and why?
Breast cancer and its risk represent the most common reason to have a mastectomy. A doctor may also recommend one if a person has another disease of the breast.
Overall, a doctor is likely to recommend a mastectomy if a person has:
Stage 1, 2, and 3 breast cancer: A mastectomy can help treat breast cancer until it is in its final stage and has spread to more distant parts of the body, such as the lungs.
Inflammatory breast cancer: This is an aggressive form, and the doctor may recommend having chemotherapy before surgery.
Paget's disease of the breast: This rare type of cancer affects the skin of the nipple and areola and often involves either DCIS or invasive breast cancer.
Locally recurrent breast cancer: A mastectomy may be necessary if cancer returns to a breast or area of the breast.
Mastectomy that is not due to cancer
A mastectomy can also play a role in sex reassignment surgery, such as when a person transitions from a female to a male body. In this case, the surgeon will leave the skin intact but remove the breast tissue underneath.
Also, a doctor may recommend a mastectomy for some noncancerous conditions, though this is rare. Some of these conditions include:
- severe chronic breast pain
- fibrocystic breast disease
- dense breast tissue
In addition, some people with a personal or family history of breast cancer may undergo surgery as a preventive measure.
Procedure and risks
A mastectomy is a surgical procedure that involves anesthesia and the removal of tissue. As with any surgery, there are some risks.
- problems with anesthesia
- shoulder pain and general stiffness of the arm
- bleeding and infection
- scabbing, blistering, or skin loss along the site of the incision
- a tingling sensation where the breast used to be and, occasionally, under the arm
- lymphedema, or swelling due to fluid buildup under the armpit and in the arm
- damage to nerves in the back, arm, or chest wall
- the formation of hard scar tissue at the site of the surgery
- a buildup of blood or fluid under the skin at the site
Most of these complications go away over time.
Every year, many people undergo successful mastectomies. Surgeons consider the procedure to be relatively safe, considering its invasive nature.
After surgery, a doctor will monitor the person's heart rate, blood pressure, level of pain, and any feelings of nausea. Medications, such as pain relievers, can help reduce symptoms.
At the hospital
A healthcare team can help with physical and emotional recovery.
On average, a person stays in the hospital for around 3 days after a mastectomy.
However, if the person has had reconstructive surgery at the same time, they may need to stay slightly longer.
A healthcare professional will give advice about:
- exercises that minimize stiffness and scar formation
- activities to avoid during recovery
- appropriate pain medication
- how to care for the wound
- what to expect from any stitches and staples
- how to recognize any signs of infection or lymphedema
- when to resume wearing a bra or start using a prosthesis, if desired
Some bras have been designed to provide comfort and support after surgery, and a healthcare provider can give advice about a suitable option. Many styles are available for purchase online.
Recovery rates vary from person to person. It usually takes a few weeks, but it can take longer if reconstruction is part of the procedure.
There is likely to be:
- a low-level fever
Some people experience a sore throat, as the surgeon inserts a tube down the throat during the procedure.
If symptoms persist or get worse, contact the doctor.
Tips for recovery at home
The following can help improve comfort and speed recovery:
Resting: People often feel tired after surgery. Getting enough rest can help the body heal.
Managing pain: The doctor will advise about pain relief and provide a prescription if necessary. If pain continues or worsens, speak to the doctor, who may change the medication and investigate the cause of the pain.
Washing: Take sponge baths while there are any drains, staples, or sutures.
Managing constipation: Pain relief medication can lead to constipation. Consuming plenty of fluids and high-fiber foods can help.
Exercising: It is important to follow a doctor's advice about when and how to exercise.
Asking for help: Family members and friends are often happy to lend a hand.
It can take several months to recover from a mastectomy. Many people return to work within 3–6 weeks.
In the long term, so-called phantom sensations or pains often occur as the nerves heal.
There may be a crawling or itchy sensation or general oversensitivity in the area.
Doctors sometimes recommend nonsteroidal anti-inflammatory drugs (NSAIDs) if the sensations persist. Ibuprofen is one example of a NSAID.
The physical healing from breast cancer surgery is just one part of the recovery process. Many people have a strong emotional response to a mastectomy, and these feelings may come in response to:
- the experience of losing one or both breasts
- the physical limitations of recovery
- concerns about whether the cancer has been fully removed or will return
Can dietary changes help a person with breast cancer? Find out here.
Appearance and sexuality
Scarves, patterned clothes, and items that show off the back or shoulders can be a good choice after a mastectomy.
Many people feel concern about how they will look after surgery, how they will feel about their body, and how others, including their partner, will see them.
They may also worry about the loss of sensation around the breasts.
According to the American Cancer Society, the predominant reaction from most people's partners is relief that their loved one is alive and well.
Some people find that the following can enhance feelings of sexuality:
- seeking out new erogenous zones, such as the neck and scalp
- wearing attachable nipples
- wearing breast forms inside a bra
- wearing lingerie that gives the look and feel of having breasts
Also, some people prefer to wear clothes that reduce focus on the chest area. Options can include:
- features such as chest pockets
- irregular patterns
- short skirts or high-necked, backless dresses that draw attention to other areas
- scarves or shawls that cover the chest
Some people find that reconstructive surgery gives them a breast shape that they prefer to the one that they had originally. Discussing the reconstruction carefully with a doctor can help ensure the most favorable outcome.
Also, specialist counseling may be available. Ask the doctor about options. Some people prefer to arrange therapy on their own.
Online communities and other groups can also offer support.
In this article, learn more about recovering from a double mastectomy
Some people with a high risk of breast cancer have a preventive, or prophylactic, mastectomy to reduce the chances of cancer developing. In some cases, a surgeon can remove the breast tissue but leave the nipples intact.
A doctor may recommend a preventive mastectomy if a person has:
Mutations in BRCA1 or BRCA2: These two genes help repair damaged DNA. If they are not functioning properly, tumors can grow.
A strong family history of breast cancer: A person may have a strong family history if one or more close family members have had breast cancer before the age of 50.
Lobular carcinoma in situ: This is an area of abnormal cell growth. It is not breast cancer, but it increases the risk. A doctor will usually only recommend a mastectomy if a person has this and a strong family history of breast cancer.
A history of radiation therapy: People who have had radiation therapy in the chest area before the age of 30 years may opt for a mastectomy.
People with BRCA1 and BRACA2 mutations also have a higher risk of developing ovarian cancer.
According to the National Cancer Institute, preventive mastectomy may reduce the risk of developing breast cancer by up to 95% in people with these genetic features and up to 90% in people with a strong family history.
When a doctor recommends a mastectomy, many people experience anxiety and concern.
However, medical advances have dramatically increased the chances of successful breast cancer treatment. At the same time, techniques in aesthetic surgery have been improving.
Anyone who needs a mastectomy should learn as much as they can about surgical and reconstructive options, in order to make the choice that is right for them.