A mastectomy is surgery to remove all breast tissue from a breast as a way to treat or prevent breast cancer.
For those with early-stage breast cancer, a mastectomy may be one treatment option. Breast-conserving surgery (lumpectomy), in which only the tumor is removed from the breast, may be another option.
Deciding between a mastectomy and lumpectomy can be difficult. Both procedures are equally effective for preventing a recurrence of breast cancer. But a lumpectomy isn't an option for everyone with breast cancer, and others prefer to undergo a mastectomy.
Newer mastectomy techniques can preserve breast skin and allow for a more natural breast appearance following the procedure. This is also known as skin-sparing mastectomy.
Surgery to restore shape to your breast — called breast reconstruction — may be done at the same time as your mastectomy or during a second operation at a later date.
During a total (simple) mastectomy, the surgeon removes the breast tissue, nipple, areola and skin. Other mastectomy procedures may leave some parts of the breast, such as the skin or the nipple. Surgery to create a new breast is optional and can be done at the same time as your mastectomy surgery or it can be done later.
A mastectomy is used to remove all breast tissue if you have breast cancer or are at very high risk of developing it. You may have a mastectomy to remove one breast (unilateral mastectomy) or both breasts (bilateral mastectomy).
A mastectomy may be a treatment option for many types of breast cancer, including:
Your doctor may recommend a mastectomy instead of a lumpectomy plus radiation if:
You might also consider a mastectomy if you don't have breast cancer, but have a very high risk of developing the disease.
A preventive (prophylactic) or risk-reducing mastectomy involves removing both of your breasts and significantly reduces your risk of developing breast cancer in the future.
A prophylactic mastectomy is reserved for those with a very high risk of breast cancer, which is determined by a strong family history of breast cancer or the presence of certain genetic mutations that increase the risk of breast cancer.
Risks of a mastectomy include:
Before your surgery, you'll meet with a surgeon and an anesthesiologist to discuss your operation, review your medical history and determine the plan for your anesthesia.
This is a good time to ask questions and to make sure you understand the procedure, including the reasons for and risks of the surgery.
One issue to discuss is whether you'll have breast reconstruction and when. One option may be to have the reconstruction done immediately after your mastectomy, while you're still anesthetized.
Breast reconstruction may involve:
Breast reconstruction is a complex procedure performed by a plastic surgeon, also called a reconstructive surgeon. If you're planning breast reconstruction at the same time as a mastectomy, you'll meet with the plastic surgeon before the surgery.
You'll be given instructions about any restrictions before surgery and other things you need to know, including:
A mastectomy is an umbrella term used for several techniques to remove one or both breasts. In addition, the surgeon may also remove nearby lymph nodes to determine whether the cancer has spread.
During an axillary node dissection, the surgeon removes a number of lymph nodes from your armpit on the side of the tumor.
In a sentinel lymph node biopsy, your surgeon removes only the first few nodes into which a tumor drains (sentinel nodes).
Lymph nodes removed during a mastectomy are then tested for cancer. If no cancer is present, no further lymph nodes need be removed. If cancer is present, the surgeon will discuss options, such as radiation to your armpit. If this is what you decide to do, no further lymph nodes will need to be removed.
Removing all of the breast tissue and most of the lymph nodes is called a modified radical mastectomy. Newer mastectomy techniques remove less tissue and fewer lymph nodes.
Other types of mastectomy include:
Skin-sparing mastectomy. A skin-sparing mastectomy involves removal of all the breast tissue, nipple and areola, but not the breast skin. A sentinel lymph node biopsy also may be done. Breast reconstruction can be performed immediately after the mastectomy.
A skin-sparing mastectomy may not be suitable for larger tumors.
Your doctor or nurse will tell you when to arrive at the hospital. A mastectomy without reconstruction usually takes one to three hours. The surgery is often done as an outpatient procedure, and most people go home on the same day of the operation.
If you're having both breasts removed (a double mastectomy), expect to spend more time in surgery and possibly an additional day in the hospital. If you're having breast reconstruction following a mastectomy, the procedure also takes longer and you may stay in the hospital for a few additional days.
If you're having a sentinel node biopsy, before your surgery a radioactive tracer and a blue dye are injected into the area around the tumor or the skin above the tumor. The tracer and the dye travel to the sentinel node or nodes, allowing your doctor to see where they are and remove them during surgery.
A mastectomy is usually performed under general anesthesia, so you're not aware during the surgery. Your surgeon starts by making an elliptical incision around your breast. The breast tissue is removed and, depending on your procedure, other parts of the breast also may be removed.
Regardless of the type of mastectomy you have, the breast tissue and lymph nodes that are removed will be sent to a laboratory for analysis.
If you're having breast reconstruction at the same time as a mastectomy, the plastic surgeon will coordinate with the breast surgeon to be available at the time of surgery.
One option for breast reconstruction involves placing temporary tissue expanders in the chest. These temporary expanders will form the new breast mound.
For women who will have radiation therapy after surgery, one option is to place temporary tissue expanders in the chest to hold the breast skin in place. This allows you to delay final breast reconstruction until after radiation therapy.
If you're planning to have radiation therapy after surgery, meet with a radiation oncologist before surgery to discuss benefits and risks, as well as how radiation will impact your breast reconstruction options.
As the surgery is completed, the incision is closed with stitches (sutures), which either dissolve or are removed later. You might also have one or two small plastic tubes placed where your breast was removed. The tubes will drain any fluids that accumulate after surgery. The tubes are sewn into place, and the ends are attached to a small drainage bag.
After your surgery, you can expect to:
Sentinel node biopsy identifies the first few lymph nodes into which a tumor drains. The surgeon uses a harmless dye and a weak radioactive solution to locate the sentinel nodes. The nodes are removed and tested for signs of cancer.
The results of your pathology report should be available within a week or two after your mastectomy. At your follow-up visit, your doctor can explain the report.
If you need more treatment, your doctor may refer you to: