What is a mastectomy?
A mastectomy is a surgical breast cancer treatment option where the entire breast is removed in order to remove the entire cancerous breast tumor. Mastectomies are alternatives to a lumpectomy — a breast-conserving surgery. Women who are not candidates for lumpectomies or women who are high risk for cancer recurrence choose to get a mastectomy procedure. In very high-risk patients, a double mastectomy is an option — this is when both breasts are removed.
Types of mastectomies
Types of mastectomies include:
Simple or total mastectomy
During a simple mastectomy the entire breast and lining of the chest muscle is removed. Total mastectomy is most appropriate for patients who have ductal carcinoma in situ (DCIS), Paget disease of the breast with DCIS or other underlying non-invasive breast cancer, invasive breast cancer or those who have a breast cancer recurrence.
Modified radical mastectomy
During a modified radical mastectomy, your entire breast, the lining of the chest muscles and some axillary lymph nodes are removed. Modified radical mastectomy is most appropriate for candidates who have early stage breast cancer, advanced but localized breast cancer, inflammatory breast cancer or Paget disease of the breast with an underlying condition such as DCIS.
During a radical mastectomy, your entire breast, nipple, lymph nodes in the armpit and chest muscle wall is removed. A radical mastectomy is most appropriate for candidates who have extensive breast tumors or if cancer cells have invaded the cell wall. Radical mastectomies are the least common mastectomy.
During a partial mastectomy, the tumor, a large amount of breast tissue, chest muscle wall and some lymph nodes are removed. A partial mastectomy is appropriate for patients who have Stage I or Stage II cancer.
A nipple-sparing mastectomy is a newer technique where the breast skin envelope and nipple are left intact during surgery. During the procedure, your surgeon will remove all the breast glandular tissue from underneath the skin. Some women have this procedure if they are high risk for breast cancer.
Who is a candidate for a mastectomy?
Patients who fit the following criteria are candidates for a mastectomy:
- Have DCIS - cancer in the breast milk ducts
- Are in an early stage of breast cancer
- Have advanced breast cancer that is localized
- Have inflammatory breast cancer
- Have Paget disease of the nipple (breast)
- Breast cancer has recurred after lumpectomy and radiation therapy treatment
What are the risks associated with a mastectomy?
Complications associated with a mastectomy include:
- Scar tissue formation at surgery site
- Pain the shoulder
- Numbness under the arm
- Blood or fluid buildup at surgery site
- Breast hardness
What are the benefits associated with a mastectomy?
Research indicates that a mastectomy can reduce the risk of your breast cancer recurring by one to three percent. Many patients will need radiation therapy or chemotherapy after surgery.
What to expect during a mastectomy?
What you can expect during a mastectomy will vary based on the type of mastectomy you have. A mastectomy that also involves an axillary lymph node dissection can take as long as three hours. If you are having a breast reconstruction after the surgery, it will take longer.
In most types of mastectomy, your surgeon will make an oval incision around the nipple, separate the skin from the chest wall muscle underneath and remove all the breast tissue in between. In most cases, your doctor will perform an axillary lymph node dissection or sentinel node biopsy. If you are having a breast reconstruction, your surgeon will likely perform it during the procedure as well.
After the tumor and lymph node removal and breast reconstruction, your surgeon will evaluate you for bleeding and insert surgical drains to drain excess fluid that accumulates in the space where the tissue was removed. After all is cleared, your doctor will close the incision and dress the wound.
Recovery from a mastectomy
After your mastectomy procedure, you will stay in the hospital for one to two nights before being discharged. Your doctor will provide you with a home recovery plan that will outline how much assistance you need during recovery, how quickly you can return to your daily activities, how to care for your incision site, diet, medication schedule and follow-up schedule. Most women can return to normal activities within a month, but some patients will need a few months recovery.