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Mastectomy

Mastectomy is surgery to remove all the breast tissue to treat or prevent breast cancer.

Mastectomy is surgery to remove all the breast tissue to treat or prevent breast cancer.

Some types of mastectomy remove the entire breast, while other types can keep some or all of the breast skin, the nipple, and the areola intact.

 

What is mastectomy?

A mastectomy is surgery that removes all of the breast tissue, either to treat breast cancer or to prevent it from developing in people at high risk for the disease.

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

Some lymph nodes from the underarm on the side of the tumor are usually removed as well to see if the cancer has spread beyond the breast. However, lymph nodes are usually not removed when mastectomy is done to prevent breast cancer.

With mastectomy, breast reconstruction surgery is usually an option to restore 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).

If you have immediate reconstruction, you may be able to choose a type of mastectomy that leaves most of the breast skin intact (called skin-sparing mastectomy) or a type that leaves the breast skin, nipple, and areola intact (called nipple-sparing mastectomy).

If you don’t want to have breast reconstruction, you can choose to “go flat” after mastectomy. You can ask your surgeon to perform a procedure called aesthetic flat closure that creates a smooth, flat chest wall. Prosthetic breast forms are an option for women who don’t have breast reconstruction but want the appearance of having breasts.

After a mastectomy, most women lose sensation in their breast area. This is because the nerves in the breast skin, nipple, and areola are damaged or removed during a mastectomy.

It’s important to know that your breasts may not be symmetrical (matching in size, shape, and position) if only one breast is removed and reconstructed, or if both breasts are reconstructed and afterwards you have radiation therapy to one breast. Usually, surgery to make your breasts match better in size, shape, or position is an option.

Take the time you need to learn about all your surgical options, get your questions answered by your doctors, and do your own research. 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. 

 

Is mastectomy right 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.

Mastectomy may be recommended for you if:

  • the tumor is larger than 5 centimeters

  • there are two or more tumors in different parts of your breast

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

  • you have inflammatory breast cancer 

  • you have multiple or very large areas of ductal carcinoma in situ (DCIS)

  • your breast is small and a lumpectomy would leave you with very little breast tissue

  • 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 clear margins

  • your doctor recommends you avoid radiation therapy because 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

  • you had breast cancer before in the same breast

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

In some cases, getting a mastectomy means you can avoid radiation therapy.

It’s important to know that if you have been diagnosed with early-stage breast cancer, mastectomy doesn’t necessarily give you a better chance of long-term survival compared with lumpectomy followed by radiation. Research shows that survival rates are similar for both. 

Learn more about deciding between Mastectomy vs. Lumpectomy.   

 

Types of mastectomy

There are several different types of mastectomy. You and your doctors will work together to decide which is best for your individual situation.

Learn more about Types of Mastectomy.

 

Deciding whether you want breast reconstruction

When making decisions about having a mastectomy, you’ll want to think about whether you want to have breast reconstruction.

Some people choose to have breast reconstruction surgery to restore the shape and appearance of one or both breasts.

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

Your medical team should discuss breast reconstruction options with you and give you a referral to meet with a plastic surgeon before the mastectomy. It’s a good idea to meet with a plastic surgeon before the mastectomy, even if you think you’ll wait to have reconstruction at a later date, are leaning towards not having reconstruction, or haven’t made up your mind yet.

If you aren’t offered a referral to a plastic surgeon when planning your mastectomy, make sure you ask for one. You can also do your own research to find plastic surgeons who specialize in breast reconstruction to consult with.

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. Twenty-eight states have passed additional laws requiring insurance companies to cover breast reconstruction. In addition, Medicare covers breast reconstruction, while Medicaid coverage can vary from state to state.

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

Breast reconstruction can be done at the same time as the mastectomy (“immediate reconstruction”) or months or years later (“delayed reconstruction”). Your options depend on your individual situation, for example, immediate reconstruction may not be possible if you have advanced disease or if the cancer involves a large portion of the skin.

There are several techniques for reconstructing the breasts, including the use of breast implants, or tissue transplanted from another place on your body (called autologous or “flap” reconstruction).

Learn more about:

 

Choosing your surgical team for mastectomy

Before you have a mastectomy, you’ll need to select your surgical team. 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. The role of the breast surgeon is to remove the cancer and all of the breast tissue, and to remove underarm lymph nodes so they can be checked for cancer cells.

Make sure the surgeons you consult with have experience with the types of surgery 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 surgeon should be able to discuss the advantages and disadvantages of each of your surgical options.

It’s also important that you’re comfortable with how your surgeon communicates with you. Select one who takes the time to answer your questions and cares about your preferences and goals.

Before the mastectomy, it’s also helpful to meet with one or more board-certified plastic surgeons who specialize in breast reconstruction and accept your insurance. The plastic surgeon’s role is to perform breast reconstruction either during the mastectomy or at a later date. If you choose to “go flat” (not get breast reconstruction), a plastic surgeon can help you get a good cosmetic result by performing a procedure called an aesthetic flat closure.

If you’re having breast reconstruction at the same time as the mastectomy (immediate 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. Look for a plastic surgeon who has experience with all types of reconstruction and can advise you on all of your options.

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.

Your appointments don’t all have to be in person. A lot of surgeons now offer telemedicine appointments by phone or online video, and Medicare, Medicaid, and most private insurers often cover those visits.

But keep in mind that depending on the regulations in the state where you live, there may be some limitations on seeking a second opinion or setting up ongoing care through telemedicine with a doctor in a different state. You may need to get a written referral from a doctor in your own state, or you may be unable to get a consultation from a doctor who is not licensed to practice in your state.

If possible, ask a family member, friend, or someone else who cares about you to join you at the appointments (either in-person, by phone, or by online video) to take notes, ask questions, and help 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 smartphone to record the audio) so that you can listen to it later.

To find breast surgeons and plastic surgeons to consult with, ask for recommendations from people you trust, such as your primary care physician, ob-gyn, oncologist, and your family, friends, and 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.

When you meet with a breast surgeon or plastic surgeon, 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.

 

Mastectomy: What to expect

Learn what you can expect on the day of the mastectomy surgery and during the recovery period in the weeks following the surgery.

Read Mastectomy: What to Expect.

 

Mastectomy risks

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 in your individual situation.

Mastectomy surgery carries many of the same risks as other breast surgeries, such as:

  • bleeding

  • problems with anesthesia

  • infection in the area of the surgery

  • wound healing problems like hematoma (blood collecting in a surgical wound) or seroma (clear fluid collecting in a surgical wound)

  • unexpected scarring

Other risks are unique to mastectomy. These include:

Breast skin necrosis

After a mastectomy, there is a risk that the breast skin won’t heal properly. Sometimes the blood vessels that supply blood to the tissue are damaged, often because the skin was thinned too much when tissue was removed during the mastectomy. 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. You also may get a fever or feel sick. Work with your care team to make sure you get prompt and proper treatment if you develop necrosis.

If you only have a small amount of skin compromised skin, your doctor may trim away some of the dead tissue and/or treat the area with basic wound care. If you have a larger area of skin necrosis that is not healing, you will usually need to have surgery to remove the dead tissue. Your plastic surgeon may have to replace some of the skin using a skin graft (skin taken from another place on your body). If the breast tissue has become infected and you had reconstruction at the same time as the mastectomy, your surgeon may also need to remove your tissue expanders or implants during this surgery. 

A few months later, after the skin has healed and the infection has cleared, you could have another surgery to correct any distortion to the breasts caused by the skin necrosis. For example, your plastic surgeon might recommend:

  • redoing your reconstruction if you had to have expanders or implants removed

  • getting your nipples reconstructed if they were affected by the necrosis

  • transplanting a flap of tissue from another part of your body to fill in an area of the breast where you lost some skin and tissue

  • you may be at greater risk for developing breast skin necrosis if your surgeon inserted a breast implant that was too large and put too much pressure on the fragile skin. Also, if you smoke, are obese, or have diabetes, your skin may be less likely to heal well after a mastectomy. 

Lymphedema

If you have any procedure in which underarm lymph nodes are removed or you have radiation to the underarm area, you are at some risk for developing lymphedema. Most mastectomies include the removal of underarm lymph nodes, unless the mastectomy is done to prevent breast cancer.

Lymphedema is abnormal swelling in the arm, hand, breast area, underarm, or torso. It occurs when the normal flow of lymph – a thin, clear fluid that circulates throughout the body to remove wastes from tissues – is disrupted. Lymph fluid normally drains from body tissues through the lymph nodes and lymph channels. If some lymph nodes and channels are removed or damaged during surgery, lymph fluid may not drain properly and can collect in the tissues on the side of the body where the lymph nodes were removed.

Symptoms of lymphedema include swelling, achiness, tingling, heaviness, tightness, or a feeling of fullness in the hand, arm, chest, or armpit area.

Lymphedema can develop days, months, or years following breast cancer treatment and can be temporary or ongoing. It usually develops gradually over time and the swelling can be mild, moderate, or severe.

You may be at greater risk for developing lymphedema if you had an axillary lymph node dissection (in which about 10 or more under arm lymph nodes are removed) and not just a sentinel lymph node dissection (in which one to five lymph nodes are removed) and then had radiation therapy to the area where the lymph nodes were removed. Also, some research suggests that the risk of lymphedema is higher and any lymphedema that does develop is more severe in women who are overweight or obese. 

Learn more about Lymphedema.

Post-mastectomy pain syndrome (phantom breast pain)

While you’re healing from a mastectomy, you may experience some pain, discomfort, and sensations such as tingling in the breast area, armpit, and/or arm for the first few months. However, if pain and sensations such as tingling, burning, pins and needles, and unbearable itching continue or crop up after you’ve healed and become a chronic problem, you may have post-mastectomy pain syndrome (also known as phantom breast pain). It’s typically caused by the damage to the sensory nerves in the chest and armpit that occurred during the mastectomy.

You’re more likely to develop post-mastectomy pain syndrome if you had a mastectomy at a younger age, had radiation therapy after the mastectomy, and/or had an axillary lymph node dissection (in which about 10 or more under arm lymph nodes are removed) and not just a sentinel lymph node dissection (in which one to five lymph nodes are removed).

If you think you might have post-mastectomy pain syndrome, talk with your doctor about treatments. Some treatments that can help include various kinds of pain medicines, nerve-stabilizing medicines such as Lyrica (pregabalin) and Neurontin (gabapentin), muscle relaxants, acupuncture, and physical therapy. You may want to look into seeing a doctor who specializes in pain after cancer treatment, such as a cancer rehabilitation physician, physiatrist, or pain medicine specialist.

Learn more about Phantom Breast Pain.

Post-Mastectomy Pain Syndrome: What It Is and How It's Treated

Oct. 30, 2018
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There are also some risks that are unique to each type of breast reconstruction surgery. Learn about the risks of breast implant reconstruction.

— Last updated on May 13, 2022, 6:58 PM

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