Mastectomy (Removal of the Breast) for Breast Cancer
Mastectomy is removal of the breast. Other nearby tissue may also be removed if it appears that cancer may have spread to these areas.
All mastectomies remove the whole breast. Because the size and location of tumors and where the cancer might have spread differ from one person to another, the amount of other tissue removed during surgery also varies.
Mastectomy procedures include:
- Total or simple mastectomy, which is the removal of the whole breast.
- Modified radical mastectomy, which is the removal of the breast, some of the lymph nodes under the arm, and sometimes part of the chest wall muscles.
- Radical mastectomy, which is the removal of the breast, chest muscles, and all of the lymph nodes under the arm (axillary lymph node dissection). This surgery is rarely used now.
Men with breast cancer usually have a modified radical mastectomy.
Depending on the location of the tumor in the breast or other factors, some women may be able to have a skin-sparing or nipple-sparing mastectomy. Skin-sparing mastectomy leaves most of the skin that was over the breast, except for the nipple and the areola. Nipple-sparing mastectomy saves the skin over the breast as well as the nipple and areola.
Some women choose to have breast reconstruction after a mastectomy. Reconstruction can be done during the same surgery as the mastectomy, or it may be done later as a separate procedure.
What To Expect After Surgery
Mastectomy is done using general anesthesia . After your surgery, you will be taken to a recovery room. A nurse will be able to help with any nausea, pain, or anxiety you might have.
When you wake up from surgery, you will have a bandage over the surgery site. You will also have one or two drainage tubes to collect fluid and keep it from building up around the surgery area. If these tubes are still in place when you go home, your nurse will teach you how to take care of them.
Your doctor or nurse will give you instructions on pain control and caring for your incision. Typically, you can remove the bandage and take a shower on the day after the surgery.
Most people go home within 24 hours after a mastectomy. If you have breast reconstruction during the same surgery, you will stay in the hospital for several days.
A physical therapist may show you exercises while you are still in the hospital. These should help keep your shoulder from getting stiff. You will need to avoid strenuous activity for several weeks. Your doctor will let you know how soon you can increase your activity level.
Why It Is Done
Mastectomy is done to remove as much cancer as possible and give the greatest chance of staying cancer-free.
How Well It Works
For early-stage breast cancer, having a lump or part of the breast removed (breast-conserving surgery) along with radiation therapy has the same survival rate as mastectomy. But many women still have a mastectomy, even though it is a more extensive surgery. They may be unwilling or unable to have the radiation therapy that usually follows breast-conserving surgery. Or they may feel that by having a mastectomy, they are taking every possible action they can to prevent the return of cancer.
Women who have metastatic breast cancer do not always have surgery. But one study shows that even if breast cancer is not discovered until it has already spread to other organs, survival may be increased by doing surgery to totally remove the primary tumor in the breast. footnote 1
Complications can include infection, bleeding, poor wound healing, or a reaction to the anesthesia used in surgery. Blood or clear fluid may also collect in the wound and need to be drained. You may have breast pain and feelings of pulling, pinching, tingling, or numbness.
If you have lymph nodes removed from under your arm, there is a chance of getting lymphedema (swelling of the arm). This is because fluid is less able to drain out of the tissues through the lymph system after this procedure. Tell your doctor or nurse right away if you have swelling or pain in your arm on the side where you had your surgery. The nerve that controls skin sensation on the inner upper arm also is in the area of these lymph nodes. If the nerve is damaged during surgery, you may have numbness in this area.
What To Think About
Mastectomy may be a better choice than breast-conserving surgery depending on the size of the tumor or if you have two or more tumors that are too far apart. Radiation therapy is not always needed after mastectomy, so mastectomy can be a good choice if you don't want to have radiation or if you cannot have radiation treatment.
Some women choose to have breast reconstruction either at the same time as mastectomy or later on. Before you have your mastectomy, talk to your doctor about reconstruction to decide whether this added procedure is right for you.
Prophylactic or preventive mastectomy
Some women who know that they are at very high risk for breast cancer-but do not have breast cancer-choose to have a mastectomy on both breasts. This is called prophylactic mastectomy. Removing the breasts can greatly lower the risk for breast cancer, but it cannot completely prevent breast cancer. A few women still get breast cancer, because tiny bits of breast tissue may remain in the skin or underarm after surgery.
But it is not yet known whether this surgery is better than having careful screening and then early treatment of any breast cancer that may develop. footnote 2
Prophylactic mastectomy is also an option for a woman who has cancer in one breast. At the time of cancer surgery, some women also have the other breast removed.
Some women who are at high risk for breast cancer may have their ovaries removed after they are done having children, or after age 35. Removing the ovaries has been shown to decrease the risk of breast cancer by 50%. footnote 2
If you are thinking of having a prophylactic mastectomy, learn as much as you can about it from your doctors. See if you can also talk to other women who have had this surgery. Carefully consider how you feel about the benefits and changes, both physical and emotional.
- Rapiti E, et al. (2006). Complete excision of primary breast tumor improves survival of patients with metastatic breast cancer at diagnosis. Journal of Clinical Oncology, 24(18): 2743-2749.
- Davidson NE (2007). Breast cancer. In DC Dale, DD Federman, eds., ACP Medicine, section 12, chap. 7. New York: WebMD.
Current as of: November 14, 2014
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