Mastectomy: What to Expect

Before mastectomy surgery

In the hospital on the day of surgery, you’ll change into a hospital gown and wait in a preoperative holding area. Some hospitals will allow you to have one or two friends or family members with you in the room.

Your surgeon or a nurse may draw markings on your breast that show where the incision will be made. Usually this is done with a felt-tip marker. You’ll be sitting up while this happens so that the natural crease of your breast can be marked.

You will be taken into the anesthesia room, where a nurse will insert a needle connected to a long tube — an intravenous infusion (IV) line — into your hand or arm and tape it into place. Soon after this, you’ll be given relaxing medication through the IV line. Once you are wheeled into the operating room, you will be given general anesthesia.

During mastectomy surgery

Mastectomy with axillary dissection (modified radical mastectomy) can take 2-3 hours. If reconstruction is performed at the same time, surgery will take longer.

Most mastectomy incisions are in the shape of an oval around the nipple, running across the width of the breast. If you are having a skin-sparing mastectomy, the incision will be smaller, including only the nipple, areola, and the original biopsy scar.

After the incision is made, the breast tissue is separated from the overlying skin and from the chest wall muscle underneath. All of the breast tissue — which lies between the collarbone and ribs, from the side of the body to the breastbone in the center — is removed. If you are having a full radical mastectomy, some of your chest muscle may be removed as well. Your breast surgeon will also perform axillary lymph node dissection if it is part of your surgery plan.

When your breast surgeon has removed your breast tissue — and if immediate breast reconstruction is part of your plan — your plastic surgeon will perform the reconstruction.

In the final stages of the surgery, your breast surgeon will check the surgery areas for bleeding and insert surgical drains. Drains are long tubes that are inserted into your breast area or armpit to collect excess fluid that can accumulate in the space where the tumor was. The tubes have plastic bulbs on the ends to create suction, which helps the fluid to exit your body. After the drains are inserted, your surgeon will stitch the incision closed. The surgery site will then be covered by a bandage that wraps closely around your chest.

After mastectomy surgery

You’ll be moved to the recovery room after mastectomy surgery, where staff will monitor your heart rate, body temperature, and blood pressure. If you are in pain or feel nauseous from the anesthesia, let someone know so that you can be given medication.

You’ll then be admitted to a hospital room. Hospital stays for mastectomy average 3 days or less. If you have a mastectomy and reconstruction at the same time, you may be in the hospital a little longer.

The morning after your surgery, your surgeon or nurse will show you an exercise routine you can do to prevent arm and shoulder stiffness on the side where you had the mastectomy and to help prevent the formation of significant scar tissue. Some exercises should be avoided until drains are removed. Ask your surgeon any questions you may have to make sure the exercise routine is right for you. Your surgeon should also give you written, illustrated instructions on how to do the exercises.

Before you leave the hospital, your surgeon or nurse will give you information about recovering at home:

• Taking pain medication: Your surgeon will probably give you a prescription to take with you when you leave the hospital. You might want to get it filled on your way home or have a friend or family member get it filled for you as soon as you are home so that you have it available.
• Caring for the bandage (dressing) over your incision: Ask your surgeon or nurse how to take care of the mastectomy bandage. The surgeon may ask that you not try to remove the bandage, and instead wait until your first follow-up visit so that he or she can remove the bandage.
• Caring for a surgical drain: If you have a drain in your breast area or armpit, the drain might be removed before you leave the hospital. Sometimes, however, a drain stays inserted until the first follow-up visit with the doctor, usually 1-2 weeks after surgery. If you’re going home with a drain inserted, you’ll need to empty the fluid from the detachable drain bulb a few times a day. Make sure your surgeon gives you instructions on caring for the drain before you leave the hospital.
• Stitches and staples: Most surgeons use sutures (stitches) that dissolve over time, so there's no longer any need to have them removed. But occasionally, you'll see the end of the suture poking out of the incision like a whisker. If this happens, your surgeon can easily remove it. Surgical staples — another way of closing the incision — are removed during the first office visit after surgery.
• Recognizing signs of infection: Your surgeon should explain how to tell if you have an infection in your incision and when to call the office.
• Exercising your arm: Your surgeon or nurse may show you an exercise routine you can do to prevent arm and shoulder stiffness on the side where you had surgery. Usually, you will start the exercises the morning after surgery. Some exercises should be avoided until drains are removed. Ask your surgeon any questions you may have to make sure the exercise routine is right for you. Your surgeon should also give you written, illustrated instructions on how to do the exercises.
• Recognizing signs of lymphedema: If you have had axillary dissection, you will be given information on taking care of your arm and being alert to signs of lymphedema.
• When you can start wearing a prosthesis or resume wearing a bra: The site of mastectomy surgery, and especially mastectomy with reconstruction, needs time to heal before you can wear a prosthesis or bra. Your doctor will tell you how long you may need to wait.

At-home recovery from mastectomy

It can take a few weeks to recover from mastectomy surgery, and longer if you have had reconstruction. It’s important to take the time you need to heal.

In addition to your surgeon’s instructions, here are some general guidelines to follow at home:

• Rest. When you get home from the hospital, you will probably be fatigued from the experience. Allow yourself to get extra rest in the first few weeks after surgery. Read more about managing fatigue.
• Take pain medication as needed. You will probably feel a mixture of numbness and pain around the breast incision and the chest wall (and the armpit incision, if you had axillary dissection). If you feel the need, take pain medication according to your doctor’s instructions. Learn more about managing chest pain, armpit discomfort, and general pain.
• Take sponge baths until your doctor has removed your drains and/or sutures. You can take your first shower when your drains and any staples or sutures have been removed. A sponge bath can refresh you until showers or baths are approved by your doctor.
• Continue doing arm exercises each day. It’s important to continue doing arm exercises on a regular basis to prevent stiffness and to keep your arm flexible.
• Have friends and family pitch in around the house. Recovery from mastectomy can take time. Ask friends and family to help with meals, laundry, shopping, and childcare. As your body heals, don’t feel you should take on more than you can handle.

In the months after mastectomy

Your body will continue to adjust to the effects of the surgery over a period of months. Here are some things to keep in mind:

• You may have “phantom sensations” or “phantom pain” in the months after mastectomy: As nerves regrow, you may feel a weird crawly sensation, you may itch, you may be very sensitive to touch, and you may feel pressure. Your discomfort may go away by itself, or it may persist but you adapt to it. Analgesics and NSAIDs (pronounced EN-seds) such as acetaminophen and ibuprofen usually can address the pain related to this type of nerve injury. Opioids (pronounced OH-pee-oydz) also can be used to treat this type of pain. Read more about managing phantom pain.
• Continue doing regular arm exercises: Stay with your arm exercise routine to keep your arm limber.
• You may experience fatigue from time to time in the early months after surgery: If you’re having trouble with fatigue, ask your doctor about things you can do.