Removal of the breast (mastectomy) for breast cancer

Surgery Overview

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.

  • Simple mastectomy (total mastectomy) is removal of the whole breast.
  • Modified mastectomy (modified radical mastectomy) is removal of the breast, some of the lymph nodes under the arm, and sometimes part of the chest wall muscles. This is the most common form of mastectomy.
  • Skin-sparing mastectomy leaves most of the skin that was over the breast, except for the nipple and the areola. This type of mastectomy removes about as much breast tissue as a modified radical mastectomy, but leaves less scar tissue and a reconstructed breast that seems more natural.
  • Radical mastectomy (Halsted radical mastectomy) is the removal of the breast, chest muscles, and all of the lymph nodes under the arm. For many years, this was the most common operation for breast cancer. It is rarely used now, because it does not improve survival or lower the chance of the cancer coming back when compared to other forms of mastectomy. Radical mastectomy also has a greater chance of complications such as lymphedema.

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.

Click here to view a Decision Point. Should I have breast reconstruction after mastectomy?

In addition to surgery, you may have radiation therapy, chemotherapy, hormone therapy, or a combination of these treatments.

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.

You will also learn to take care of your incision. You most likely cannot shower or take a bath until your stitches are out, so you will need to take sponge baths for a few days.

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 about 5 days so your doctor can be sure there is good blood supply to the skin over the reconstruction.1

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 stages I and II breast cancer, having a lump or part of the breast removed (breast-conserving surgery) with radiation therapy has the same survival rate as mastectomy and some of the same side effects. 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 have a strong family history of breast cancer and feel more comfortable getting rid of more breast tissue through mastectomy.

Women with 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.2

Risks

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 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.

There is also a risk that the cancer will come back, or recur. Some studies show that there is less than a 7% chance (1 in about every 13 people) that cancer will come back within 6 years. Having reconstructive surgery does not seem to change the chance of the cancer coming back.3

What To Think About

Mastectomy is a better choice than breast-conserving surgery if the tumor is larger than 2 in. (5 cm) or if you have two or more tumors that are too far apart to remove through one surgical opening. Radiation is not always necessary after mastectomy, so mastectomy can be a good choice if you don't want to have radiation or if you cannot have radiation treatment.

Radiation therapy:

  • Has to be done on a set schedule—usually 5 days a week for several weeks. If you do not think you can go to every appointment, talk to your doctor about other treatment options.
  • Is not recommended for people who have serious connective tissue diseases such as scleroderma.
  • Should not be done on women who are pregnant. Radiation can harm the fetus. If radiation therapy can be safely delayed until after the baby is born, breast-conserving surgery may be possible for a pregnant woman.
  • Should usually not be done where radiation therapy has been done before. If you have had previous radiation therapy to the same breast, your doctor will decide whether having more radiation after surgery would be too much for you.

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. Studies show that prophylactic mastectomy can lower the chance of getting breast cancer to less than 2%, or about 1 in 60 women.1 In one study of high-risk women, this was a decrease of over 90% compared to their sisters who did not have the surgery.4 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.5

Prophylactic mastectomy is also an option for a woman with 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%.5

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.

Complete the surgery information form (PDF)(What is a PDF document?) to help you prepare for this surgery.

References

Citations

  1. Singletary SE (2004). Techniques in surgery: Therapeutic and prophylactic mastectomy. In JR Harris et al., eds., Diseases of the Breast, 3rd ed., pp. 836–844. Philadelphia: Lippincott Williams and Wilkins.
  2. 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.
  3. Morrow M, Harris J (2004). Local management of invasive cancer: Breast. In JR Harris et al., eds., Diseases of the Breast, 3rd ed., pp. 719–744. Philadelphia: Lippincott Williams and Wilkins.
  4. Morrow M, Gradishar W (2002). Breast cancer. BMJ, 324(7334): 410–414.
  5. Davidson NE (2007). Breast cancer. In DC Dale, DD Federman, eds., ACP Medicine, section 12, chap. 7. New York: WebMD.

Other Works Consulted

  • Franz J (2004). Simple mastectomy. In AJ Senagore, ed., Gale Encyclopedia of Surgery: A Guide for Patients and Caregivers, vol. 3, pp. 1318–1322. Cleveland: Thomson Gale.

Last Updated: August 18, 2009

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