Mastectomy is surgery to remove one or both of your breasts to prevent or treat cancer. When your breast is removed, you may also have lymph nodes removed to see if the cancer has spread.
Lymph nodes are the size of a pea, and are found throughout your body. The lymph system consists of lymph nodes that store blood cells (lymphocytes) to fight infection and vessels that carry fluid, nutrients, and wastes between your body and your bloodstream. Many types of cancer spread through the lymph system. Removing nearby lymph nodes can limit how far the cancer can spread.
When is it used?
Mastectomy is often done when a cancer is too large to be removed without removing the whole breast, or if there are many small areas of cancer in your breast.
Mastectomy may be done to prevent breast cancer if you are at very high risk for the disease.
Ask your healthcare provider about your choices for treatment and the risks. Also, it is helpful to have a family member or friend listen to the choices with you.
How do I prepare for this procedure?
Before you have a mastectomy, talk with your surgeon about your options for breast reconstruction. This is a plastic surgery procedure to rebuild the shape of your breast. It may be done at the same time as a mastectomy or later.
Plan for your care and find someone to give you a ride home after the procedure.
Tell your provider if you have had kidney problems or an allergy to chemicals, such as contrast dye. Contrast dye is used for some scans.
You may or may not need to take your regular medicines the day of the procedure, depending on what they are and when you need to take them. Some medicines (like aspirin) may increase your risk of bleeding during or after the procedure. Tell your healthcare provider about all medicines and supplements that you take. Ask your healthcare provider if you need to avoid taking any medicine or supplements before the procedure.
Follow any other instructions your healthcare provider gives you.
Ask any questions you have before the procedure. You should understand what your healthcare provider is going to do.
What happens during the procedure?
You will be given general anesthesia to keep you from feeling pain during the procedure. General anesthesia relaxes your muscles and you will be asleep.
Different types of mastectomies are:
Total (simple) mastectomy: The surgeon removes your whole breast, including the nipple. Lymph nodes are only removed if they are part of the breast tissue that is being removed. No muscles are removed from under your breast. This is the most common breast cancer surgery.
Modified radical mastectomy: The surgeon removes your whole breast, including the nipple. Lymph nodes are removed from under your armpit. No muscles are removed from under your breast.
Radical mastectomy: The surgeon removes your whole breast, including the nipple, along with lymph nodes under your armpit, and chest muscles. This kind of surgery is not common.
Skin-sparing mastectomy: The surgeon removes your whole breast, but leaves most of the skin in place. Your nipple may also be left in place if the cancer is small, not near the nipple, and in an early stage. Lymph nodes may be removed from under your armpit. No muscles are removed from under your breast. This procedure may be a choice if you plan to have breast reconstruction at the same time as the mastectomy.
What happens after the procedure?
You may stay in the hospital about 24 hours. You will have a tight bandage around your chest and 1 or 2 drains to remove extra fluid from the area of the surgery. Your provider will tell you how to care for the bandage and the drains. You may need to return to the provider’s office 5 to 7 days after the surgery for removal of the drains.
Ask your healthcare provider:
How and when you will hear your test results
How long it will take to recover
What activities you should avoid, including how much weight you can lift and when you can return to your normal activities
How to take care of yourself at home
What symptoms or problems you should watch for and what to do if you have them
Make sure you know when you should come back for a checkup.
What are the risks of this procedure?
Your healthcare provider will explain the procedure and any risks. Some possible risks include:
Anesthesia has some risks. Discuss these risks with your healthcare provider.
You may have infection, bleeding, or blood clots.
Several days after surgery fluid may cause swelling in the area where you had surgery. This usually happens after the drains have been removed. The fluid can be removed by your healthcare provider with a needle and syringe.
Nerves in the area of the surgery are damaged. As a result, the underside of your arm may be numb. After the surgery you may have trouble moving some of your shoulder muscles because of tenderness. Special exercises will help you regain normal movement of your shoulder.
You may develop arm swelling, called lymphedema. Removal of the lymph nodes under your armpit can change the way the lymph fluid drains from the arm. Radiation treatment can also cause damage. Lymphedema can happen right after surgery or months to years later. A mild injury, such as from a blood test, a blood pressure cuff that is too tight, or an infection in the arm can cause lymphedema or make it worse. Ask your provider how you can help avoid this problem. It is important to report any injury or infection in the arm or hand on the side of the mastectomy because early treatment may prevent lymphedema.
A lumpy scar, called a keloid, may develop. Tell your provider if you have other scars that have healed this way.
This procedure may not remove all of the cancer cells and further treatment may be necessary.
The cancer may come back.
Every procedure or treatment has risks. Ask your healthcare provider how these risks apply to you. Be sure to discuss any other questions or concerns that you may have.
Adult Advisor 2015.1 published by RelayHealth. Last modified: 2014-06-09 Last reviewed: 2013-12-02
This content is reviewed periodically and is subject to change as new health information becomes available. The information is intended to inform and educate and is not a replacement for medical evaluation, advice, diagnosis or treatment by a healthcare professional.
http://www.nccn.org. NCCN Clinical Practice Guidelines in Oncology-Breast cancer,v.2.2011. BINV-2 Locoregional treatment of clinical stage I, IIA, or IIB disease or T3, N1, M0. BINV-D Surgical Axillary Staging, StageI, IIA and IIB. Also see Principles of reconstruction following surgery BINV-H Accessed 01/23/12.
Is the WHO analgesic ladder still valid? Twenty-four years of experience. Vargas-Schaffer G. Canadian Family Physician. June 2010 vol 56 (6), 514-517.