A double mastectomy is the surgical removal of both breasts. 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 is not an easy one. People may need one or both breasts removed following a breast cancer diagnosis or because they have a significant family history of the disease.
In this article, we discuss the procedure of a double mastectomy. 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, overlying skin, and possibly the lymph nodes under the arm.
- Modified radical mastectomy: This removes the breast, some of the lymph nodes under the arm, and the lining covering the chest muscles.
- Radical mastectomy: This removes the breast, skin, lymph nodes, and chest muscles.
- Skin-sparing mastectomy: This removes the breast, nipple, and areola, but the surgeon saves most overlying skin so they can perform a breast reconstruction.
- Subcutaneous mastectomy: The surgeon makes an incision in the breast and removes the breast tissue, leaving the skin and nipple in place. They then reconstruct the breast.
- Nipple-sparing mastectomy: This approach resembles the skin-sparing procedure. However, the surgeon removes the tissue under the nipple and areola and sends it away for pathology testing.
Before someone has double mastectomy surgery, they must fast for 8–12 hours.
A surgeon marks 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 takes the person into an anesthesia room, inserts an intravenous infusion (IV) line into their hand or arm, and administers relaxing medication. Once in the operating room, the anesthetist gives the patient a general anesthetic.
Mastectomy surgery may take 2–3 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. If the individual is having a skin-sparing mastectomy, the incision will be smaller.
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, the surgeon completes this step next.
To finish the surgery, a surgeon checks for bleeding and inserts surgical drains. Drains are tubes that allow excess fluid to seep away from the surgical site. 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, although this may be longer if the 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 provide a prescription for 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 bandage 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 1–2 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 infection signs. A person should seek urgent medical attention if the wound becomes red, hot, or 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 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
Depending on the type of mastectomy procedure, a person’s recovery may take several weeks. Full recovery may take a few months.
Following a mastectomy, a person may consider breast reconstruction to rebuild the breast. A reconstruction can happen during the same surgery as the breast removal or later, after the individual recovers from the initial procedure.
People should discuss their options with their surgical team before the mastectomy to allow them to plan the best treatment. This also allows the patient time to discuss the surgery with their insurance company, so they have peace of mind that their policy covers them.
Some people opt for using a breast prosthesis, which provides the contour of a breast beneath clothing without surgery.
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 in 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 manage the pain and stiffness in their arms and shoulders after a mastectomy.
- Lymphedema: If an individual had a lymph node removed during their mastectomy, they might develop swelling in the arms. Anyone with swelling in the arms should call their doctor immediately.
After undergoing a double or single mastectomy, it is entirely normal for a person to feel a flood of emotions.
Before the surgery, people may worry if they are making the right decision and have feelings of anxiety. Losing one or both breasts can be a significant life change, and commonly people feel some level of depression.
People preparing for a mastectomy should seek support from their friends and family or from professional counselors who can help them through the process.
Following a 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 impact how someone is feeling.
No matter what an individual feels, they should feel able to acknowledge they are having a hard time and need moral and physical support to recover from their mastectomy.
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 hospital following a double mastectomy, recovery can take a few weeks to a couple of months.
While recovering, people should rest and ask their family and friends for support.