Mastectomy

If you’ve been diagnosed with breast cancer or are at high risk of developing breast cancer, your doctor may recommend a mastectomy. There are a few types of mastectomy and options for you to consider if you want breast reconstruction.

A mastectomy is surgery that removes breast tissue. It’s used to treat breast cancer or to lower the risk of breast cancer developing in people at high risk for the disease (prophylactic mastectomy).

Some types of mastectomy remove the entire breast, while other types keep some or all of the breast skin, the nipple, and the areola intact. The type of mastectomy that you choose will likely depend on your breast size and shape, the size and location of your cancer if you have been diagnosed with breast cancer, the type of diagnosis you have, and what you would like your chest to look like after the surgery.

Surgically removing one breast is called single (or unilateral) mastectomy. Removing both breasts is called double (or bilateral) mastectomy.

If you’ve been diagnosed with breast cancer, your surgeon will likely also remove lymph nodes from your armpit during the mastectomy. Examining the lymph nodes close to the cancer helps your doctors to see if the cancer has spread beyond the breast. 

With mastectomy, breast reconstruction surgery is usually an option for those who wish to maintain the shape and appearance of the breasts. Breast reconstruction may be done at the same time as the mastectomy (called immediate reconstruction) or at a later date (called delayed reconstruction).

Take time to talk with your doctor and other members of your health care team so you understand all your surgical options and what might be best for you. You may feel like you should start treatment as soon as possible, but in most cases, you have time to carefully think through your options. Together, you and your doctors can figure out what will work best for you. 

Some women with early-stage breast cancers can choose between a mastectomy (which removes all of the breast tissue) or a lumpectomy (which removes only the tumor and a small amount of surrounding tissue). Radiation therapy is usually recommended after lumpectomy. In some cases, getting a mastectomy means you can avoid radiation therapy.

Your doctor may recommend a mastectomy if:

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  you had prior radiation to the same breast, you have a disease that makes you sensitive to radiation side effects (such as scleroderma or lupus), or you are pregnant

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  you have a tumor that is larger than 5 centimeters or large relative to your total amount of breast tissue

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  you have multiple or very large areas of ductal carcinoma in situ (DCIS) or other tumors in different parts of your breast

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  your surgeon has already made multiple attempts to remove the tumor with lumpectomy, but has not been able to completely remove the cancer and get a rim of healthy tissue surrounding it (called the clear margin)

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  you have an inherited gene mutation that increases your risk of developing a second breast cancer, such as a BRCA1 or BRCA2 mutation

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  you have inflammatory breast cancer 

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  you believe mastectomy would give you greater peace of mind than lumpectomy

There are many factors to consider when deciding between mastectomy and lumpectomy. If you’ve been diagnosed with early-stage breast cancer, studies have shown that the chances of long-term survival are the same with mastectomy compared to lumpectomy followed by radiation.

Read more about mastectomy versus lumpectomy. 

There are several different types of mastectomy:

Simple (or total) mastectomy: The surgeon removes all breast tissue, breast skin, the nipple, and areola (the dark area around the nipple). If you have been diagnosed with breast cancer, the surgeon will also remove around one to three lymph nodes from the armpit on the side of the cancer (called sentinel lymph node dissection).

Modified radical mastectomy: This surgery is similar to a simple mastectomy, except the surgeon removes a greater number of lymph nodes from the armpit on the side of the cancer (called axillary lymph node dissection). 

Nipple-sparing mastectomy: The surgeon removes all breast tissue, but the nipple, areola, and the skin over the breast is left intact. Depending on the diagnosis, the surgeon will perform either a sentinel lymph node or axillary lymph node dissection.

Skin-sparing mastectomy: The surgeon removes all breast tissue, the nipple, and areola, but the skin over the breast is left intact. When done for a cancer diagnosis, the surgeon will perform either a sentinel lymph node or axillary lymph node dissection depending on the stage of the cancer.

Radical mastectomy: The surgeon removes all breast tissue, breast skin, the nipple and areola, and the chest wall muscles under the breast. The surgeon also performs an axillary lymph node dissection. This extensive surgery is usually only done in rare cases where cancer is growing in the chest wall muscles.

You and your doctors will work together to decide which of these surgeries is best for your individual situation.

Learn more about what to expect when you get a mastectomy and how to prepare for recovery from a mastectomy.

Before you decide whether to have a mastectomy, make sure you understand the risks, benefits, and whether you might be able to have a lumpectomy instead.

Some of the risks of a mastectomy include:

Infection happens when harmful bacteria, viruses, parasites, or fungi enter a site in the body and reproduce. If you’re experiencing fever, increasing pain, and redness or swelling, you should seek immediate care, as these are signs of infection.

A hematoma is a buildup of blood under the skin that looks like a bruise. It is caused by broken blood vessels following a surgery. If you notice a hematoma, tell your doctor. Most hematomas will heal without treatment, but some may require surgery. 

A seroma is a buildup of clear fluid where tissue has been removed by surgery. A seroma will usually go away on its own, but may need to be drained by your doctor. If you notice swelling that becomes painful, tell your doctor.  

Lymphedema is a buildup of clear lymph fluid in the fatty tissues just under the skin that can lead to swelling. Lymphedema happens when your lymphatic system is damaged or overwhelmed and can’t clear the fluid. Symptoms of lymphedema include redness or hardening of the skin and heaviness in the arm, hand, breast, or chest. If you have any of these symptoms, let your doctor know. 

When there isn’t enough blood flow to the skin, areas of the skin on one or both breasts can wither and scab. This breakdown and eventual death of tissue is called "necrosis." Signs that you might be developing necrosis of the breast skin include the skin turning dark blue or black and developing scabs and/or open wounds. If you notice these symptoms, tell your doctor.

Phantom breast pain is feeling pain in the breast that has been removed. The brain continues to send signals to nerves in the breast area that were cut during surgery, even though the breast is no longer there. If your pain is severe, talk with your doctor about options for relief.

When making decisions about having a mastectomy, you’ll also be asked about whether you want to have breast reconstruction surgery. In most cases, breast reconstruction is performed by a plastic surgeon. 

Some people have breast reconstruction surgery at the same time as the mastectomy (called immediate reconstruction), while others wait for months or years later (called delayed reconstruction).

Others choose not to have reconstruction, and may opt for a procedure that creates a smooth, flat chest wall (called an aesthetic flat closure). Prosthetic breast forms are an option for women who don’t have breast reconstruction but want the appearance of having breasts.

The decision is personal and only you know what’s best. Even if you’re leaning toward not having reconstruction, you want to wait, or you haven’t made your mind up, it’s a good idea to meet with a plastic surgeon before the mastectomy so you understand your options. 

Breast reconstruction procedures should be covered by your health insurance plan in most cases. The Women’s Health and Cancer Rights Act (WHCRA) of 1998 requires all group health plans and health insurance companies (including HMOs) that pay for mastectomy to also cover all stages of breast reconstruction. 

Most women who have a mastectomy are candidates for getting breast reconstruction surgery, although not all women are candidates for every type of reconstruction. 

Before you have a mastectomy, you’ll need to select your surgical team. This team often includes a breast surgeon and plastic surgeon. The role of the breast surgeon is to remove the breast tissue as well cancer and lymph nodes. The role of the plastic surgeon is to reconstruct one or both breasts or perform a procedure called an aesthetic flat closure, which achieves the “flat” look. 

Ask people you trust for recommendations for breast surgeons and plastic surgeons. These might include your primary care physician, ob-gyn, oncologist, and your family, friends, or people you know who have had breast cancer. You can also get recommendations by participating in online forums and support groups for people with breast cancer.

It’s smart to meet with more than one breast surgeon who takes your health insurance before you choose the one who will perform your mastectomy. Look for either a board-certified breast surgeon or a board-certified general surgeon who specializes in breast procedures. Similarly, before choosing a plastic surgeon, you may want to talk with several who specialize in breast reconstruction or aesthetic flap closure and accept your insurance.If you’re having breast reconstruction or an aesthetic flat closure at the same time as the mastectomy, you’ll need to choose a plastic surgeon who can work as a team with your breast surgeon and who does surgery at the same hospital. 

Make sure the surgeons you consult with have experience with the types of mastectomy and reconstruction you are considering. For example, if you think you may want a nipple-sparing mastectomy, check that the surgeon has a lot of experience with that procedure. The breast surgeons and plastic surgeons should be able to discuss the advantages and disadvantages of each of your surgical options. Ask to see before-and-after photos of procedures they’ve performed and if you can speak with any of their other patients who’ve had the type of surgery you’re considering.

It’s also important that you’re comfortable with how your surgeons communicate with you. Select surgeons who take the time to answer your questions and respect your preferences and goals.  

If possible, ask a family member, friend, or someone else who cares about you to join you at your appointments (either in-person, by phone, or by online video). They can help by taking notes, asking questions, and helping you form an impression of each surgeon. You might also want to ask the surgeon if you can record the appointment (for example, using your phone to record the audio) so that you can listen to it later. 

Don’t hesitate to get a second or third opinion if the first breast surgeon or plastic surgeon you meet with doesn’t seem right for you. You may need to talk with a few surgeons to get the full picture of what your options are.

— Last updated on April 29, 2025 at 10:55 PM