What Is a Mastectomy?

A mastectomy is a way to treat breast cancer by surgically removing a breast and sometimes nearby tissues. For a while, the standard treatment for breast cancer was a radical mastectomy, with total removal of the breast, lymph nodes in the underarm, and some chest muscles under the breast. But surgical advances have given people more options than ever. Less-invasive breast-conserving treatments are available to many women.

The type of mastectomy that’s best for you depends on several things, including your:

• Age
• General health
• Menopause status
• Tumor size
• Tumor stage (how far it’s spread)
• Tumor grade (its aggressiveness)
• Tumor’s hormone receptor status
• Lymph nodes and whether they’re involved

What Is a Partial Mastectomy?

Women with stage I or stage II breast cancer may have this procedure. It’s a breast-conserving method in which the doctor removes only the tumor and the tissue around it.

The surgery is often followed by 6 to 8 weeks of radiation therapy, with powerful X-rays that target the breast tissue. The radiation kills cancer cells and prevents them from spreading or coming back.

There are two kinds:

• A lumpectomy removes the tumor and a small area of normal tissue surrounding the tumor.
• A quadrantectomy removes the tumor and more of the breast tissue than a lumpectomy.

In some cases, you may need more surgery after a partial mastectomy . Sometimes, if cancer cells are still in breast tissue, your doctor may have to remove the entire breast.

What Is a Radical Mastectomy?

A less traumatic and more common procedure is the modified radical mastectomy (MRM). The doctor removes your breast, including the skin, breast tissue, areola, and nipple, and most of the lymph nodes under the arm. The lining over the large muscle in the chest is also removed, but the muscle itself is left in place. This way, you aren’t left with a hollow in your chest as with a radical mastectomy.

You might get breast reconstruction afterward.

Depending on the size of your tumor and whether the cancer has spread to your lymph nodes, your doctor might recommend that you have radiation after your surgery.

What Is a Skin-Sparing Mastectomy?

The doctor removes breast tissue, the nipple, and the areola but saves most of the skin over the breast. It’s used only when breast reconstruction follows immediately after a mastectomy. It may not be a good choice if your tumors are large or near the skin’s surface.

What Is a Nipple-Sparing Mastectomy?

You might also hear it called a total skin-sparing mastectomy. The doctor removes all the breast tissue, including the ducts going all the way up to the nipple and areola. But they save the skin of the nipple and areola and cut out tissues under and around them. If these areas are cancer-free, they can be saved. This method also calls for reconstruction right after the mastectomy.

Before the procedure

Your doctor or nurse will tell you when to arrive at the hospital. A mastectomy without reconstruction usually takes one to three hours. The surgery is often done as an outpatient procedure, and most people go home on the same day of the operation.

If you’re having both breasts removed (a double mastectomy), expect to spend more time in surgery and possibly an additional day in the hospital. If you’re having breast reconstruction following a mastectomy, the procedure also takes longer, and you may stay in the hospital for a few additional days.

If you’re having a sentinel node biopsy, before your surgery a radioactive tracer and a blue dye are injected into the area around the tumor or the skin above the tumor. The tracer and the dye travel to the sentinel node or nodes, allowing your doctor to see where they are and remove them during surgery.

After a Mastectomy

• Lymph nodes that were removed will be sent to a lab to see whether the cancer  has spread to them.
• You’ll go to a recovery room where staff can keep an eye on your heart rate, body temperature, and blood pressure.
• After you wake up, you’ll be admitted to a hospital room. You’ll probably stay for 1 or 2 days, though it might be longer if you had reconstruction.
• Someone from your health care team will talk to you about:
  • • Medications. Your doctor will prescribe medication for any pain you feel after surgery. After a week or two, you can usually treat your discomfort with over-the-counter pain relievers.
    • How to care for:
      • • • • The incision. The bandage will probably stay in until your first follow-up visit.
            • Drains. Sometimes, they come out before you leave the hospital, but they might stay in for up to 3 weeks.
            • Stitches. Yours will probably dissolve on their own, but non-dissolving types and staples will be removed at your follow-up visit.

• • • Exercises. They’ll help prevent stiffness on the side where you had surgery. You’ll probably start the morning after surgery.
    • When you can wear a prosthesis or bra. Your surgery site needs to heal first. You’ll find out how long you have to wait.

 

Mastectomy Risks

A mastectomy is generally safe and effective, but like all surgical procedures, it can have risks.

They include:

• Bleeding
• Infection
• Swelling of the arm (lymphedema)
• Pockets of fluid under the incision (seromas)
• Risks from general anesthesia

Some people have numbness in the upper arm after surgery. It’s caused by damage to small nerves in the area where the lymph nodes are taken out. There’s a good chance that you’ll regain most of the feeling in your arm over time.

Tips for Mastectomy Recovery

Once you are home, make sure you follow the plan your doctor gave you. Also make sure that you:

• Rest: Get plenty of it the first few weeks after surgery. It takes a lot out of you.
• Take your meds: Don’t tough it out. Take the medication as prescribed. You’ll probably feel a mix of pain and numbness.
• Keep the site dry: Take sponge baths only (no tub baths or showers) until your drains and stitches are out.
• Do your exercises: They’ll keep your arm from getting stiff.
• Ask for help: Don’t be shy. It takes time to get better. Get all the help you can with meal prep, shopping, housework, childcare, pet care, rides to doctors’ appointments, and whatever else you aren’t ready to take on by yourself.

Results

The results of your pathology report should be available within a week or two after your mastectomy. At your follow-up visit, your doctor can explain the report.

If you need more treatment, your doctor may refer you to:

• A radiation oncologist to discuss radiation treatments, which may be recommended if you had a large tumor, many lymph nodes that tested positive for cancer, cancer that had spread into the skin or nipple, or cancer remaining after the mastectomy
• A medical oncologist to discuss other forms of treatment after the operation, such as hormone therapy if your cancer is sensitive to hormones or chemotherapy or both
• A plastic surgeon, if you’re considering breast reconstruction
• A counselor or support group to help you cope with having breast cancer