A mastectomy is surgery to remove the entire breast. It is usually done to treat breast cancer.

Breast removal surgery; Subcutaneous mastectomy; Total mastectomy; Simple mastectomy; Modified radical mastectomy

You will be given general anesthesia (unconscious and pain-free). The surgeon will make an elliptical cut in your breast:

• For a subcutaneous mastectomy, the surgeon removes the entire breast but leaves the nipple and areola (the pigmented circle around the nipple) in place.
• For a total or simple mastectomy, the surgeon cuts breast tissue free from the skin and muscle and removes it. The nipple and the areola are also removed. The surgeon may do a biopsy of nearby lymph nodes to see if the cancer has spread.
• For a modified radical mastectomy, the surgeon removes the entire breast along with the lining over some of the muscles. Some of the lymph nodes underneath the arm are also removed.
• For a radical mastectomy, the surgeon removes the overlying skin, all of the lymph nodes underneath the arm, and the chest muscles. This surgery is not done unless breast cancer has spread to your chest wall muscles.
• The skin is closed with sutures (stitches) or tape (Steri-Strips).

One or two small plastic drains or tubes are usually left in your chest to remove extra fluid from where the breast tissue used to be.

Your surgeon may be able to reconstruct the breast (with artificial implants or tissue from your own body) during the same operation. You may also choose to have reconstruction later.

See also:

• Breast reconstruction - natural tissue
• Breast reconstruction - implants

Mastectomy generally takes 1 to 3 hours.

WOMAN DIAGNOSED WITH BREAST CANCER

The most common reason for a mastectomy is breast cancer. Mastectomy may treat several types of breast cancer: invasive ductal carcinoma, invasive lobular carcinoma, medullary carcinoma, mucinous and tubular carcinomas, inflammatory carcinoma, Paget's disease, ductal carcinoma in situ (DCIS), and lobular carcinoma in situ (LCIS).

If you are diagnosed with breast cancer, talk to your doctor about your choices:

• Surgery where only the breast cancer and tissue around the cancer are removed. This is called breast conservation therapy (breast lump removal). Part of your breast will be left.
• Mastectomy: all breast tissue is removed.

You and your doctor must consider:

• The size of your tumor, where in your breast it is located, whether you have more than one tumor in your breast, how much of your breast the cancer affects, and the size of your breasts
• Your age, family history, overall health, and whether you have reached menopause
• Whether the cancer has spread to your lymph nodes or other parts of the body
• The type of breast cancer you have. This is important because some types of breast cancer are more likely to spread or come back.

The choice of what is best for you can be difficult. Sometimes, your doctor may recommend one type of surgery. This is because your doctor can tell you what is known about the type of cancer you have and your risk factors. Other times, your doctor will talk with you about two or more surgical treatments that would be good for your cancer.

WOMEN AT HIGH RISK FOR BREAST CANCER

Your doctor may do either a subcutaneous or total mastectomy to reduce your risk of breast cancer if you are at very high risk of developing breast cancer. This is called prophylactic mastectomy.

You may have a higher risk of getting breast cancer if one close family relative, or more, has had breast cancer, especially at an early age. Genetic tests (such as BRCA1 or BRCA2) may also show you have a high risk. This surgery should be done only after very careful thought and discussion with your doctor, a genetic counselor, your family, and others.

Mastectomy greatly reduces, but does not eliminate, the risk of breast cancer.

Risks for any surgery are:

• Blood clots in the legs that may travel to the lungs
• Breathing problems
• Infection, including in the surgical wound, lungs (pneumonia), bladder, or kidney
• Blood loss
• Heart attack or stroke during surgery
• Reactions to medications

The risks for breast removal are:

• Skin loss or long-term wounds on the chest wall
• Bleeding into the area where the breast used to be. Sometimes a second operation is needed to control bleeding.

Risks when you have lymph nodes removed during surgery are:

• Shoulder pain and stiffness occur in most women. Some may have severe stabbing or burning pain. They may also feel pins and needles where the breast used to be and underneath their arm.
• Swelling of the arm (called lymphedema) on the same side as the breast that is removed. This swelling is not common, but it can be an ongoing problem.
• Damage to nerves. This may cause numbing on the inside of the arm or weakness in muscles of the back and chest wall.

There are also risks related to breast reconstructive surgery.

You will have many blood and imaging tests (such as CT scans, bone scans, and chest x-ray) after your doctor finds breast cancer. Your surgeon will want to know whether your cancer has spread to the liver, lungs, bones, or somewhere else.

Always tell your doctor or nurse if:

• You could be pregnant.
• You are taking any drugs or herbs you bought without a prescription.

During the week before the surgery:

• Several days before your surgery, you may be asked to stop taking aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve, Naprosyn), vitamin E, clopidogrel (Plavix), warfarin (Coumadin), and any other drugs that make it hard for your blood to clot.
• Ask your doctor which drugs you should still take on the day of the surgery.

On the day of the surgery:

• Do not eat or drink anything after midnight the night before the surgery.
• Take your drugs your doctor told you to take with a small sip of water.
• Shower the night before or the morning of the procedure.
• Your doctor or nurse will tell you when to arrive at the hospital.

You may stay in the hospital for 1 to 3 days, depending on the type of surgery you had. If you have a simple mastectomy, you may go home on the same day. Most women go home after 1 to 2 days. You may stay longer if you have breast reconstruction.

Many women go home with drains still in their chest. The doctor then removes them later during an office visit.

You may have pain around the site of your incision after surgery.

Fluid may collect in your armpit. This is called a seroma and is relatively common. It usually goes away on its own, but it may need to be drain.

Most women recover well after mastectomy.

In addition to surgery, you may need other treatments for breast cancer. These treatments may include hormonal therapy, radiation therapy, and chemotherapy. All have their own side effects. Talk to your doctor.

Your breast cancer may respond differently to surgery and other treatments for many reasons. Talk to your doctor about these reasons.

Robson M and Offit K. Clinical practice. Management of an inherited predisposition to breast cancer. N Engl J Med. 2007;357(2):154-162.

Khatcheressian JL, Wolff AC, Smith TJ, Grunfeld E, Muss HB, Vogel VG, et al. American Society of Clinical Oncology 2006 update of the breast cancer follow-up and management guidelines in the adjuvant setting. J Clin Oncol. 2006;24(31):5091-5097.

Abeloff MD, Wolff AC, Weber BL, Zaks TZ, Sacchini V, McCormick B. Cancer of the breast. In: Abeloff MD, Armitage JO, Niederhuber JE, Kastan MB, McKena WG, eds. Clinical Oncology. 4th ed. Philadelphia, Pa: Elsevier Churchill Livingstone; 2008:chap 95.

Iglehart JD, Smith BL. Diseases of the breast. In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 18th ed. Philadelphia, Pa: Saunders Elsevier; 2008:chap 34.