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Mastectomy

Definition

A mastectomy is surgery to remove the entire breast, including the skin and nipple. It is usually done to treat breast cancer.

Alternative Names

Breast removal surgery; Subcutaneous mastectomy; Total mastectomy; Simple mastectomy; Modified radical mastectomy

Description

Before surgery begins, you will be given general anesthesia . This means you will be asleep and pain-free during surgery.

There are different types of mastectomys. Which one your surgeon uses depends on the type of breast problem you have.

The surgeon will make a cut in your breast:

  • For a subcutaneous mastectomy, the surgeon removes the entire breast but leaves the nipple and areola (the colored circle around the nipple) in place.
  • For a 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. In some rare breast cancers, a simple mastectomy is performed on both breasts.
  • For a modified radical mastectomy, the surgeon removes the entire breast along with some of the lymph nodes underneath the arm.
  • For a 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 sutures (stitches).

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.

If all the cancer tissue is removed, a plastic surgeon may be able to reconstruct the breast during the same operation. You may also choose to have breast reconstruction with implants or natural tissue later.

Mastectomy usually takes 2 - 3 hours.

Why the Procedure Is Performed

WOMAN DIAGNOSED WITH BREAST CANCER

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 or partial mastectomy. 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.

You and your doctor should 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 choice of what is best for you can be difficult. You and the health care providers who are treating your breast cancer will decide together what is best.

WOMEN AT HIGH RISK FOR BREAST CANCER

Women who have a very high risk of developing breast cancer may choose to have a preventive (or prophylactic) 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.

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

Mastectomy greatly reduces, but does not eliminate, the risk of breast cancer.

Risks

Risks for any surgery are:

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

Risks when more invasive surgery, such as a radical mastectomy, is done are:

  • 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 many 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:

  • Follow instructions from your doctor or nurse about eating or drinking before surgery.
  • Take the drugs your doctor told you to take with a small sip of water.

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

After the Procedure

Most women stay in the hospital for 1 - 3 days. But this depends on the type of surgery you had. If you have a simple mastectomy, you might go home on the same 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 have pain around the site of your cut after surgery. The pain is moderate after the first day and then quickly goes away. You will 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 (aspiration).

Outlook (Prognosis)

Most women recover well after mastectomy.

In addition to surgery, you may need other treatments for breast cancer. These treatments may include hormonal therapy, radiation therapy, and chemotherapy. All have their own side effects. Talk to your doctor.

References

Carlson RW, Allred DC, Anderson BO, Burstein HJ, Carter WB, Edge SB, et al. Breast cancer. National Comprehensive Cancer Network Clinical Practice Guidelines in Oncology. v2. 2010.

Hunt KK, Green MC, Buchholz TA. Diseases of the breast. In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 19th ed. Philadelphia, Pa: Saunders Elsevier; 2012:chap 36.

Cuzick J, DeCensi A, Arun B, Brown PH, Catiglione M, Dunn B, et al. Preventive therapy for breast cancer: a consensus statement. Lancet Oncol. 2011;12:496-503.

Giuliano AE, Hunt KK, Ballman KV, Beitsch PD, Whitworth PW, Blumencranz PW, et al. Axillary dissection vs no axillary dissection in women with invasive breast cancer and sentinel node metastasis: a randomized clinical trial. JAMA. 2011;305:569-575.


Review Date: 12/10/2012
Reviewed By: Robert A. Cowles, MD, Associate Professor of Surgery, Yale University School of Medicine, New Haven, CT. Review provided by VeriMed Healthcare Network. Also reviewed by A.D.A.M. Health Solutions, Ebix, Inc., Editorial Team: David Zieve, MD, MHA, David R. Eltz, and Stephanie Slon.
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