A double mastectomy is the surgical removal of both breasts. Also known as a bilateral mastectomy, the operation is usually performed in individuals with breast cancer or an increased risk of developing breast cancer.
The decision to have a double mastectomy, also known as a bilateral mastectomy, is not an easy one.
People may opt to have both breasts removed following a breast cancer diagnosis or because they have a significant family history of the disease.
In this article, we discuss what a double mastectomy involves. We also examine the different types of mastectomy and some tips for recovery.
A double mastectomy is the surgical removal of both breasts. There are several types of mastectomy. The most appropriate depends on an individual’s cancer status and tumor size, among other factors.
Types of mastectomy include:
- Total mastectomy: This removes the breast, the fascia of the pectoralis major muscle, and overlying skin.
- Modified radical mastectomy: This surgery removes the breast, the fascia of the pectoralis major muscle, and overlying skin. It is also the removal of the level 1 and level 2 lymph nodes.
- Radical mastectomy: This surgery removes the breast, skin, lymph nodes, and chest muscles.
- Skin-sparing mastectomy: During a skin-sparing mastectomy, the breast, nipple, and areola are removed, but the surgeon saves most overlying skin so they can perform a breast reconstruction.
- Nipple-sparing mastectomy: This approach resembles the skin-sparing procedure, except the nipple and areolar complex are preserved.
Doctors may recommend a double mastectomy, or a person may choose to have one in the following instances:
Treatment of bilateral breast cancer
Generally speaking, breast cancer in both breasts is quite rare. It accounts for
Risk reduction
Genetic factors: If a person has a high risk of breast cancer due to genetic mutations (e.g., BRCA1 or BRCA2), a double mastectomy can
Family history: A strong family history of breast cancer can also be a reason for choosing this surgery to reduce the risk.
Previous cancer in one breast
Some people who have cancer in one breast opt to have a double mastectomy to significantly decrease the risk of developing cancer in the other breast. This is known as a contralateral prophylactic mastectomy.
Symmetry and reconstruction preferences
For some, achieving symmetry during breast reconstruction is important. Removing both breasts can make reconstruction simpler and more symmetrical.
Before a double mastectomy, in the preoperative area, a surgeon will mark the breasts to show where to make incisions. The individual sits up in bed so the surgeon can see where the breast’s natural crease lies.
A nurse then inserts an intravenous (IV) infusion line into their hand or arm, and administers relaxing medication.
Once in the operating room, the anesthetist gives the patient a general anesthetic.
The timing of a double mastectomy surgery will vary significantly based on breast size and the type of mastectomy.
It may take up to 3 hours or longer if the surgeon also reconstructs the breasts.
Usually, a surgeon makes incisions around the nipple and across the width of the breast. However, the incision varies based on the type of mastectomy the patient is having. If the individual has a nipple-sparing mastectomy, the incision is made along the inframammary fold (the natural crease located underneath the breast where the breast tissue meets the chest wall).
Once the surgeon has made the incision, they separate the breast tissue from the skin on top and the chest wall muscle beneath. They then remove all the breast tissue and dissect the lymph nodes if that is part of the surgery plan.
If someone is having breast reconstruction, a plastic surgeon completes this step next.
To finish the surgery, a surgeon checks for bleeding and inserts surgical drains. Drains are plastic tubes that help drain additional fluid the body produces in the space where the breast has been removed. The surgeon secures the drains with stitches and then covers the entire area with bandages that wrap around the chest.
Following the surgery, a medical team carefully monitors the patient and can administer medication to help with pain and nausea from the anesthesia.
People typically stay in the hospital for 3 days or less, though some may go home the same day of their surgery depending on their specific situation. Others may remain in the hospital longer, especially if their surgery also includes breast reconstruction.
The day after the surgery, a healthcare professional will demonstrate exercises that the individual can do to prevent arm and shoulder stiffness and scar tissue formation. People may need to avoid some forms of exercise until a doctor removes the drains.
Often, the hospital provides the following instructions about recovering from a double mastectomy at home:
- Take pain medication: A surgeon will prescribe pain medication, which the individual should take as the doctor directs.
- Care for the dressing: A nurse will show the individual how to care for their incisions correctly. They may need to leave the dressing in place until a follow-up visit.
- Care for the surgical drain: If the person has a drain in their breast area or armpit, a nurse may remove this before they leave the hospital. Alternatively, the drain may remain in position until the first follow-up visit, usually between 1 to 2 weeks after the surgery. In this case, the individual must empty the fluid from the drain’s collection container several times each day.
- Recognize signs of infection: It is vital that the individual monitors the surgical site and how they feel in general for any signs of infection. A person should get urgent medical attention if the wound becomes red or hot, if it oozes pus, or if they have general signs of infection such as fever, chills, nausea, or vomiting.
Most surgeons use stitches that dissolve, meaning that a person does not need to have a healthcare professional remove them. However, occasionally, someone may notice the end of the suture appearing out of the surgical incision. In this case, the individual should contact their surgeon.
Aside from allowing the surgical site to heal, people may need to take other steps to recover from a double mastectomy, including:
- resting and relaxing as much as possible
- taking sponge baths until a doctor removes the drains
- performing arm exercises daily to prevent stiffness
- asking for the support of friends and family
- looking for local support groups
- taking part in enjoyable activities
However, it’s crucial that a person has a discussion with their surgeon about these steps, as recommendations can vary among different medical professionals.
Depending on the type of mastectomy procedure, a person’s recovery may take several weeks. Full recovery may take a few months.
Following a double mastectomy, a person may consider breast reconstruction to
People
It also provides an opportunity to coordinate with their insurance company. Since most breast reconstruction procedures
If an individual has a double mastectomy, they may experience the following side effects:
- Fatigue: Many people feel tired for several days following the surgery and find restful sleep difficult. People should nap during the day whenever possible.
- Phantom breast pain: Some individuals experience sensations in the chest and underarms that feel itchy or tingly. These sensations are normal.
- Difficulty with the arms: People can use stretching and exercise to relieve the pain and stiffness in their arms and shoulders after a mastectomy.
- Lymphedema: While it is not a side effect as such, if an individual had a lymph node removed during their mastectomy, they might develop swelling in the arms. Anyone who has or develops lymphedema should talk with their doctor.
After undergoing a double mastectomy, it is normal for a person to feel a flood of emotions.
Before the surgery, people may have feelings of anxiety and worry if they are making the right decision. Losing one or both breasts can be a significant life change, and people commonly feel some level of depression.
People preparing for a double mastectomy may want to consider seeking support from their friends and family or a professional counselor who can help them work through the process.
Following a double mastectomy, people may feel a sense of loss, mourning, and concern over their body image. If cancer and treatment are also concerns, this can further affect how someone is feeling.
No matter what an individual feels, being and feeling able to acknowledge they are having a hard time and needing moral and physical support to recover from their double mastectomy is important.
Below are some commonly asked questions about a double mastectomy.
How long is a person on bed rest after a mastectomy?
Mastectomy recovery time can last a few weeks after surgery and longer if a person had reconstruction at the same time. It’s important that a person takes the time they need to rest and heal.
What is the downside of a double mastectomy?
A double mastectomy, like any surgical procedure, comes with potential risks and adverse events. Some of the challenges include:
- risk of a blood clot
- feeling weak and lacking strength after the procedure
- bleeding from the wound
- nerve pain
- shoulder stiffness
- potential scarring
Having both breasts removed may have significant emotional and psychological effects on a person too, potentially affecting their self-image and self-esteem.
A double mastectomy is the surgical removal of both breasts to prevent or remove breast cancer.
Although people typically spend less than 3 days in the hospital following a double mastectomy, recovery can take a few weeks to a couple of months.
While recovering, it’s important that people rest and consider reaching out to friends and family for support.