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What is a mastectomy?

Mastectomy is a surgery that removes breast tissue. It is usually done to treat breast cancer, but it may also be performed to prevent breast cancer in women who are at high risk. Most surgeons will not choose to perform a mastectomy if a lumpectomy can successfully remove cancer and preserve some normal breast tissue. 

There are other treatments for breast cancer that don’t involve removing at least one breast, but your doctor may recommend a mastectomy instead of a breast-conserving procedure in certain cases, such as when:

  • you have two or more tumors in different areas of the breast
  • you have malignant calcium deposits
  • you’ve had radiation therapy to treat cancer, and the cancer has returned
  • you’re pregnant and do not wish to risk your child’s health with radiation therapy
  • after a lumpectomy, cancer is still present
  • you have a gene mutation that puts you at high risk for developing another breast cancer
  • your tumor is very large

Types of mastectomy

A mastectomy can remove one or both breasts. Removing one breast is called unilateral mastectomy, and removing both breasts is called bilateral mastectomy.

There are five common types of mastectomy: A partial mastectomy, a total (or simple) mastectomy, a radical mastectomy, a modified radical mastectomy and nipple- or skin-sparing mastectomies.

  • Partial mastectomy – A partial mastectomy, also referred to as a segmental mastectomy or quadrantectomy, is a surgery to remove the part of the breast that contains the cancerous cells. It generally involves removing more tissue than a lumpectomy. Lymph nodes may also be removed during this procedure.
  • Simple or Total mastectomy – A total mastectomy, also called a simple mastectomy, is a surgery to remove breast tissue only. It does not involve removing lymph nodes or areas of muscle tissue beneath the breast tissue. 
  • Modified radical mastectomy – A modified radical mastectomy involves removing the whole breast and doing an axillary node dissection, but no muscles are removed. 
  • Radical Mastectomy – The most extensive type of mastectomy, a radical mastectomy includes removing the whole breast, lymph nodes and muscles underneath the breast (chest wall muscles). This is usually reserved for women who have tumors that have spread to the chest wall.
  • Some doctors are using mastectomy techniques that can preserve the skin of the breast or the nipple. This can leave women’s breasts with a more natural appearance after surgery. Mastectomies using these procedures are called skin-sparing or nipple-sparing mastectomies. The details and characteristics of your tumor (size, subtype, location) will determine whether these are an option. 

Breast reconstruction and mastectomy

Breast reconstruction is often an option during or after mastectomy. It can be done immediately following the breast removal, during the same procedure, or it can be done during a second procedure on another date.

Many women choose to have breast reconstruction surgery so they can feel and look more natural. This is a very personal decision, so you should carefully weigh the pros and cons and think about what you want and what is best for you. As long as your doctor says it’s safe, this decision should be entirely up to you. 

What to expect before and after surgery

If you are going to have a mastectomy, your doctor will talk with you about the procedure and what you should expect before, during, and after the surgery. While everyone’s surgery and recovery are different, there are some things you can expect when having a mastectomy. 

Before a mastectomy

Once you have a diagnosis of breast cancer and you and your doctor have decided a mastectomy is the right procedure for you, your doctor will talk to you about what type of mastectomy is best and what will happen during and after the procedure. 

If you’re having a unilateral mastectomy – without breast reconstruction – your surgery will take between one and three hours. It will most likely be done on an outpatient basis, and you should be able to go home the same day. If you have a bilateral mastectomy, your surgery will take longer, and you may stay one night in the hospital. 

Before your surgery begins, a doctor will give you general anesthesia so you will be unconscious for the procedure. You will also receive pain medication. 

If you are having a sentinel node biopsy along with the mastectomy, a radioactive tracer along with blue dye will be injected into the area around your tumor. The dye and tracer will travel to your sentinel node(s), which makes it easier to see which nodes need to be removed during surgery. If nodes are removed, it’s called a lymph node dissection.

During the procedure, your surgeon will make an incision around your breast so the breast tissue and other surrounding areas can be removed. Any tissue and lymph nodes your surgeon removes will go to a pathology lab to be analyzed. 

If you choose to have reconstruction surgery at the same time as your mastectomy, your reconstructive surgeon and breast surgeon will work together.

There are several options for breast reconstruction. You and your reconstructive surgeon should go over all of them prior to your surgery so you can decide what fits in best with your treatment plan. After your surgery, your doctor will stitch your incision closed using stitches. He or she may use dissolvable stitches or stitches that will have to be removed later. 

If necessary, your doctor will place fluid drains where your breast or breasts were removed. These drains help remove fluids that can accumulate after surgery. The drains are sewn into place, and they have bags at the end to collect the fluid drainage. Before you are discharged, you’ll learn how to care for your drains. They’ll be removed at a follow-up visit to your surgeon, usually two to three weeks after surgery.

After your mastectomy

Immediately after surgery, you will be taken to a recovery room where your team will monitor your vital signs. When you wake up, you will have a bandage covering the surgery site, and you may feel some pain, numbness, or other discomfort in or around your underarm. This is normal. 

Before you leave the hospital, your nurse or doctor will give you instructions about what to do at home to take care of yourself and your surgical wound. The instructions will go over your post-surgery limitations and when to call your doctor. For example, if you have signs of an infection, you will want to call your doctor right away. Also, you don’t want to do anything after surgery that might interfere with your healing. The instructions will help you understand what you can and can’t do.

Pain control is important to the healing process. Your doctor will likely prescribe some sort of pain medication after surgery. Make sure you talk with your doctor if you are having uncontrolled pain.

Post-mastectomy treatment

Surgery is usually not the only treatment for breast cancer. You may have to undergo radiation therapy, chemotherapy, hormone therapy, or breast reconstruction. 

Healing from a mastectomy can take weeks or even months. And once your body is healed, you may still feel the effects of the surgery for a long time. Many women find comfort in support groups or individual talk therapy to help them cope with the fear, anxiety, stress, and depression that is so common in people who have had cancer and cancer treatment. Beaumont’s survivorship program is an excellent resource for optimizing health and healing of the mind, body and spirit after a cancer diagnosis.

Radiation after mastectomy

Sometimes radiation is recommended for the chest wall and nearby lymph nodes after mastectomy. The decision for or against radiation is complex and depends on several factors, including the number of involved lymph nodes, tumor size, status of the surgical margins and other individual factors. Depending on these factors, the radiation oncologist will determine the appropriate radiation therapy approach for treatment following a mastectomy.

Radiation to the lymph nodes increases the risk of an abnormal accumulation of fluid, called lymphedema. To minimize the risk, the Lymphedema Program at Beaumont provides information about lymphedema prevention, as well as prompt treatment.

Beaumont’s Comprehensive Breast Care Program

The Comprehensive Breast Care Program at Beaumont Hospitals integrates cancer prevention, early detection, rapid diagnosis, leading-edge therapies, and several support, education, and community-support programs. For an expedited and comprehensive breast evaluation, call 888-924-9460.