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Mastectomy

Definition

A mastectomy is surgery to remove the entire breast. It is usually done to treat breast cancer.

Alternative Names

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

Description

You will be given general anesthesia (unconscious and pain-free). 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 pigmented 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.
  • 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 overlying skin, 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.

A plastic surgeon may be able to reconstruct the breast (with artificial implants or tissue from your own body) during the same operation. You may also choose to have reconstruction later.

See also:

  • Breast reconstruction - implants
  • Breast reconstruction - natural tissue

Mastectomy generally takes 2 to 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 of your tumor, where in your breast it is located, whether you have more than one tumor in your breast, how much of your breast the cancer affects, and the size of your breasts
  • Your age, family history, overall health, and whether you have reached menopause

The choice of what is best for you can be difficult. Sometimes, it is hard to know whether lumpectomy or mastectomy is best. 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 prophylactic mastectomy. Your doctor may do either a subcutaneous or total mastectomy to reduce your risk of breast cancer if you are at very high risk for developing breast cancer. This is called prophylactic mastectomy.

You may have a higher risk of getting breast cancer if one or more close family relatives has had breast cancer, especially at an early age. Genetic tests (such as BRCA1 or BRCA2) may also show you have a high risk. This surgery should be done only after very careful thought and discussion with your doctor, a genetic counselor, your family, and others.

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

Risks

Risks for any surgery are:

  • Blood clots in the legs that may travel to the lungs
  • Blood loss
  • Breathing problems
  • Infection, including in the surgical wound, lungs (pneumonia), bladder, or kidney
  • Heart attack or stroke during surgery
  • Reactions to medications

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 to the lymph nodes, liver, lungs, bones, or somewhere else.

Always tell your doctor or nurse if:

  • You could be pregnant
  • You are taking any drugs or herbs 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

You may stay in the hospital for 1 to 3 days, depending on the type of surgery you had. If you have a simple mastectomy, you may go home on the same day. Most women go home after 1 to 2 days. You may stay longer if you have breast reconstruction.

Many women go home with drains still in their chest. The doctor then removes them later during an office visit.

You may have pain around the site of your cut after surgery.

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.

Robson M and Offit K. Clinical practice. Management of an inherited predisposition to breast cancer. N Engl J Med. 2007;357(2):154-162.

Khatcheressian JL, Wolff AC, Smith TJ, Grunfeld E, Muss HB, Vogel VG, et al. American Society of Clinical Oncology 2006 update of the breast cancer follow-up and management guidelines in the adjuvant setting. J Clin Oncol. 2006;24(31):5091-5097.

Abeloff MD, Wolff AC, Weber BL, Zaks TZ, Sacchini V, McCormick B. Cancer of the breast. In: Abeloff MD, Armitage JO, Niederhuber JE, Kastan MB, McKena WG, eds. Clinical Oncology. 4th ed. Philadelphia, Pa: Elsevier Churchill Livingstone; 2008:chap 95.

Iglehart JD, Smith BL. Diseases of the breast. In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 18th ed. Philadelphia, Pa: Saunders Elsevier; 2008:chap 34.