Mastectomy

Types of mastectomy

Why mastectomy is done

• Breast cancer: when the tumor is large relative to the breast, there are several tumors in different areas, radiation is not possible, previous lumpectomy margins were not clear, or the person prefers mastectomy. See breast cancer.
• Ductal carcinoma in situ (DCIS) that is widespread.
• Risk reduction: people with a BRCA mutation or other high-risk gene changes may choose preventive mastectomy, which lowers breast cancer risk by about 90% or more.

Mastectomy vs lumpectomy

For many early-stage breast cancers, lumpectomy plus radiation (breast-conserving therapy) offers the same long-term survival as mastectomy. The choice depends on tumor size, location, genetics, ability to have radiation, and personal preference. Mastectomy may avoid radiation in some cases, but not all.

Lymph node surgery

• Sentinel lymph node biopsy: removes the first 1 to 4 nodes that drain the breast. If clear, no more nodes are removed. Lower lymphedema risk.
• Axillary lymph node dissection: removes more nodes when cancer has spread; higher lymphedema risk.

What to expect

Before surgery

You meet with the breast surgeon, and if reconstruction is planned, a plastic surgeon. Genetic counseling may be offered. You may have blood tests and imaging.

The operation

Mastectomy takes about 1 to 3 hours under general anesthesia, longer with reconstruction. One or two thin plastic drains are usually placed to remove fluid.

After surgery

• Many go home the same day or after 1 to 2 nights.
• Drains stay in for 1 to 3 weeks, until fluid falls below a set amount. You record the output.
• Pain is controlled with prescribed medicines and over-the-counter pain relievers.
• Arm and shoulder exercises usually start within days to prevent stiffness.
• Numbness of the chest wall and inner upper arm is common and often permanent, though it may partly improve.

Recovery timeline

Breast reconstruction

Reconstruction can be done at the same time (immediate) or later (delayed):

• Implant-based: often staged with a tissue expander.
• Flap (autologous): uses tissue from the abdomen, back or thighs.
• Going flat: aesthetic flat closure without reconstruction is a valid choice. External breast forms (prostheses) can be worn.

US federal law (the Women's Health and Cancer Rights Act) requires most health plans that cover mastectomy to cover reconstruction.

Risks and complications

• wound infection and delayed healing
• seroma: fluid collecting under the skin, often drained in clinic; see seroma
• bleeding (hematoma)
• numbness and altered sensation
• lymphedema: arm swelling, more likely after axillary dissection and radiation
• shoulder stiffness
• post-mastectomy pain syndrome: persistent burning or shooting pain in the chest wall, armpit or arm
• phantom breast sensations
• body image changes and emotional distress

Life after mastectomy

• Follow-up visits monitor healing and cancer recurrence. Routine mammograms are not needed on a mastectomy side without reconstruction, but the other breast is screened.
• Report any new lump on the chest wall or in the armpit.
• Physical therapy helps with shoulder movement and lymphedema prevention.
• Support groups and counseling help with emotional recovery.

Frequently asked questions

How long does it take to recover from a mastectomy?

Most people recover in about 4 to 6 weeks without reconstruction, and 6 to 8 weeks or longer with reconstruction. Drains usually come out within 1 to 3 weeks. Fatigue and numbness can last longer.

Is a mastectomy better than a lumpectomy?

Not necessarily. For many early breast cancers, lumpectomy plus radiation gives the same survival as mastectomy. The best option depends on tumor size and location, genetics, whether radiation is possible, and personal preference.

Who should consider a preventive mastectomy?

People with a very high risk of breast cancer, such as carriers of BRCA1, BRCA2 or certain other gene mutations, or those who had chest radiation at a young age, may consider it. It reduces breast cancer risk by about 90% or more. Genetic counseling helps with the decision.

Will I have feeling after a mastectomy?

Numbness in the chest wall is common because nerves are cut. Some sensation may return over months to years, but much of the area often stays numb. Nipple-sparing surgery may preserve some sensation, though often reduced.