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Mastectomy Content Supplied by NHS Choices
Introduction

A mastectomy is an operation to remove the breast.

It's used to treat breast cancer in women or breast cancer in men. It can also be used to reduce the risk of cancer developing in the breast.

If your GP refers you urgently because they think you have cancer, you have the right to be seen by a specialist within two weeks. Read more about NHS waiting times for treatment and why mastectomies are used.

In 2012-13, just under 23,200 mastectomies were carried out in England.

Preparing for a mastectomy

Before having a mastectomy, you'll have the opportunity to discuss the operation with a specialist nurse or surgeon. You can discuss how the procedure might affect you both physically and emotionally.

A specialist nurse can give you practical advice about bras and prostheses (bra inserts), if you need them. Your surgeon will discuss the type of mastectomy you'll have, possible complications and the option of breast reconstruction (see below).

If you're currently taking any medicines, find out whether you should continue taking them before your operation. However, don't stop taking a prescribed medication unless advised to do so by a qualified healthcare professional responsible for your care.

If you smoke, you may be advised to stop smoking before your operation. Smoking can increase the risk of complications during and after your operation, which may increase your recovery time.

There are several different types of mastectomy. The type recommended for you will depend on factors such as how much the cancer has spread. All types of mastectomy use general anaesthetic and involve making a cut (incision) either diagonally or horizontally across your breast so that the breast tissue can be removed.

Before the operation, you may need to have chemotherapy or hormone therapy to reduce the size of any tumours.

Breast reconstruction

After your breast has been removed, you may choose to have a breast reconstruction. This involves creating an artificial breast to replace the breast or breasts that have been removed.

It's sometimes possible for a breast reconstruction to be carried out at the same time as a mastectomy, although it can be delayed until a later date if necessary.

Read more about how a mastectomy is performed.

After surgery

Mastectomies are very safe procedures, with minimal complications. Most people make a good recovery and only need to stay in hospital for one night. However, some people will need to spend a few days in hospital. Generally, it takes three and six weeks to fully recover.

During the early stages of recovery, you may have tubes coming from the wound. These are used to drain away blood and fluids to help prevent swelling or infection. Your scar and stitches will be covered with a dressing.

It's common to experience pain, numbness, tingling and swelling after a mastectomy, but painkillers should provide some relief.

In rare cases, more serious complications can develop following a mastectomy, including infection of the wound and delayed healing.

Read more about recovering from a mastectomy and the possible complications of a mastectomy.

Why a mastectomy may be necessary

A mastectomy is mainly used as a treatment for breast cancer or to reduce the risk of breast cancer developing.

Although breast cancer in men is much rarer than female breast cancer, it can also be treated with a mastectomy.

Treating breast cancer

The aim of a mastectomy operation is to remove all cancerous tissue from the breast. This is very important because if any cancerous cells are left behind, there's a risk that the cancer will grow back and spread to other parts of the body.

A mastectomy isn't always the most suitable treatment for breast cancer, although in many cases it's very effective. The specialist responsible for your care will be able to advise you on this.

A mastectomy may be recommended when:

  • the tumour is large in proportion to the breast
  • the cancer is present in more than one area of the breast
  • pre-cancerous cells, called ductal carcinoma in situ (DCIS), have affected most of the breast

Once a diagnosis of breast cancer has been confirmed, it should be treated as soon as possible. Early detection and treatment of breast cancer improves the chances of a successful outcome and a full recovery.

Preventing breast cancer

Risk-reducing (prophylactic) mastectomies are sometimes carried out on non-cancerous, healthy breasts to reduce the risk of breast cancer developing.

The procedure may be considered if a woman has a very high risk of developing breast cancer. This might be because she has a family history of breast cancer and carries a mutated (altered) version of the BRCA1, BRCA2 or TP53 gene. Having one of these altered genes greatly increases a woman's risk of developing breast cancer.

Prophylactic mastectomies can reduce the risk of breast cancer by up to 90% in people at a high risk of developing the condition. In some cases, a lumpectomy (removing a lump from the breast) may be all that's required, rather than removing the whole breast.

If you're concerned about your risk of developing breast cancer in a healthy breast, you should discuss the risks and benefits of surgery with your doctor or surgeon before making a decision. Prophylactic mastectomies aren't usually recommended if there's no evidence of an increased risk of breast cancer.

Non-surgical alternatives

If you're at an increased risk of breast cancer, it may be possible to reduce your chances of developing the condition using medication rather than surgery.

The National Institute for Health and Care Excellence (NICE) recommends two medications called tamoxifen and raloxifene for this purpose. These medications aren't suitable for everyone, but they should be considered before making a decision about having a mastectomy.

For more information, read "Drugs to be offered to women at high risk of breast cancer".

How a mastectomy is performed

There are several different types of mastectomy, depending on the areas that are removed.

Some of the main types of mastectomy include:

  • standard mastectomy - all the breast tissue and most of the skin covering is removed
  • skin-sparing mastectomy - all of the breast tissue is removed, including the nipple, but most of the skin covering the breast is left
  • subcutaneous mastectomy - a skin-sparing mastectomy where the nipple isn't removed
  • radical mastectomy - all of the breast tissue is removed, plus the skin covering it, the two muscles behind the breast and the lymph nodes in the armpit; this procedure is now rarely carried out
  • modified radical mastectomy - a radical mastectomy, where the large muscle behind the breast (the larger of the two pectoral muscles) is left in place

Removing the breast tissue

All mastectomies are carried out under general anaesthetic, which means you'll be asleep during the operation and won't feel any pain or discomfort. However, you will feel sore when you wake up after the operation, which usually takes between one and two hours.

During the operation, a diagonal or horizontal cut is made across your breast so the breast tissue can be removed. The amount of skin removed will depend on the type of mastectomy you're having. The surgeon will usually leave one or two drainage tubes in place to stop fluid building up in the breast space.

Lymph nodes

In some cases, surgery may be carried out on the lymph nodes at the same time as the mastectomy. Lymph nodes are small, oval-shaped tissues that remove unwanted bacteria and particles from the body. They're part of the immune system (the body's natural defence against infection and illness).

It's possible for breast cancer to spread to the lymph nodes under your arm. If this is the case, most or all of your lymph nodes may be removed at the same time as your mastectomy.

It's standard practice for all removed tissue to be sent to a laboratory to be examined. Your surgeon will explain the reasons for this before your operation, as well as any further treatment you may need if your lymph nodes are affected.

Once the procedure is complete, stitches will be used to close the wound.

Read about recovering from a mastectomy.

Breast reconstruction

Breast reconstruction is surgery to make a new breast to replace the tissue removed during a mastectomy. The new breast can be created using:

  • a silicone implant
  • tissue from another part of your body, such as your abdomen (tummy) or back
  • a combination of both

The aim is to create a shape that matches the removed breast or breasts.

Breast reconstruction can often be carried out at the same time as a mastectomy, or it can be performed at a later date. Some people decide not to have breast reconstruction at all. It's your decision and your specialist will discuss the options with you.

Lipomodelling

Lipomodelling is a procedure recommended by the National Institute for Health and Care Excellence (NICE). It uses a person's own fat cells after breast reconstruction or breast-conserving surgery. The aim is to restore the size and shape of the breast.

Fat is collected using a needle and syringe, usually from the abdomen, outer thigh or from the side of the body. The fat cells are separated and cleaned before being injected into the breast. Several treatment sessions are usually needed.

Following lipomodelling, some of the repositioned fat is often re-absorbed during the first six months. There's also some concern that it may make mammogram images more difficult to interpret in the future.

Lipomodelling is a safe and, in many cases, effective procedure. Out of 820 people who had the procedure after mastectomy and breast reconstruction, just 34 people (4%) reported long-term breast asymmetry (unequal breast size and shape).

Read the NICE guidance on Breast reconstruction using lipomodelling after breast cancer treatment (PDF, 103kb).

Endoscopic mastectomy

Endoscopic mastectomy is surgery to remove the breast using a small cut in the armpit or around the edge of the nipple. An endoscope (a long, thin, flexible tube with a light and camera at one end) is used, along with special tools to remove the breast tissue.

This type of surgery isn't routinely used, because there's not enough evidence to confirm its safety and effectiveness. Endoscopic mastectomies may be carried out as part of medical research (clinical trials), but only in units that specialise in breast cancer management and by surgeons trained in both breast cancer surgery and endoscopy.

Read the NICE guidance on Endoscopic mastectomy and endoscopic wide local excision for breast cancer (PDF, 92.5kb).

Recovering from a mastectomy

Most people who have a mastectomy recover well after the procedure and don't develop complications.

In most cases, it takes three to six weeks to fully recover.

After the operation

When you wake up after the operation, you will probably feel sore. This pain can be controlled with painkillers. It's very important to tell your doctor or nurse when you're in pain, because they can adapt your medication accordingly.

After the operation, you may have a drip in your arm so that you can be given fluids until you're able to eat and drink again.

Wound care

Following a mastectomy, you may have one or more drainage tubes coming from the wound site. The purpose of these tubes is to drain blood and tissue fluid away from the wound to prevent it collecting and causing swelling or infection. Your surgeon will decide how long the tubes need to stay in for. It may be as short as 24 hours, or up to a few days.

The dressing over your wound will need to stay in place for at least a couple of days. During this time, it may need to be replaced and the wound cleaned. In some cases, the same dressing will need to stay on for a week or so.

You may have dissolvable stitches that don't need to be removed. However, some people have stitches or metal clips that need to be removed after 7 to 10 days. Your wound should have healed during this time.

Preparing for home

The length of your hospital stay will depend on the type of surgery you have, but you'll usually need to stay in hospital for about two or three days. However, it isn't unusual to only stay in hospital for one night.

Before you leave hospital, your specialist or nurse will talk to you about what to do when you get home. You will probably need a lot of rest. Gentle exercises may be recommended to overcome the stiffness of your arm and to encourage healthy circulation in the area that's been operated on.

Your specialist or nurse will discuss suitable bras and prostheses (bra inserts) if you haven't had breast reconstruction. If this is the case, you'll be given a lightweight artificial breast shape that you can put inside your bra. This is usually temporary, until your wound has completely healed. You'll eventually be given a permanent prosthesis.

Scars

After having a mastectomy, you'll have a scar going across your chest and under your arm, although the shape may be different if you had an immediate breast reconstruction.

Your specialist or nurse will advise you on how to look after your scar. If you're uncomfortable about how your scar looks, there are a number of possible treatments, such as further corrective surgery and using make-up, to cover the scar.

Read more about treating scars.

Recovering at home

Avoid the following activities during the first three to four weeks after surgery:

  • driving - don't drive until you're confident you can handle the car
  • lifting anything heavy or doing repetitive movements - such as vacuuming or ironing
  • swimming or playing sports

Your specialist can advise you on when you can return to work.

Talking to others

Recovering from a mastectomy can be emotionally difficult. Some people find it helpful to talk to others who have had the operation, both before and after the mastectomy.

You can get information on contacting others who have had a mastectomy from your specialist breast cancer care nurse and from organisations such as:

  • Macmillan Cancer Support - has information on groups you can join and a support line you can call for free 0808 808 0000 (Monday to Friday, 9am-8pm)
  • Cancer Research UK - provides advice on coping emotionally and a helpline you can call free of charge on 0808 800 4040 (Monday to Friday, 9am-5pm)

You can also find cancer support services in your area.

Complications of a mastectomy

In most cases, recovery from a mastectomy is straightforward and without complications.

It's normal to experience certain side effects, such as short-term pain and swelling of the tissue over your chest wall. You'll also have a scar.

You may have swelling at the site of your operation due to body fluid collecting underneath the skin. This is called seroma. It often disappears without treatment, although it may need to be drained with a needle and syringe. Speak to your surgeon or breast care nurse if you think you're developing seroma.

If you've had the lymph nodes removed under your arm, you may experience numbness and tingling around this area. This often goes away as the area heals, but in some cases it's permanent. There's also a small chance that any pain you experience after having a mastectomy will be long-lasting.

Other complications include infection and a condition called lymphoedema (a side effect of mastectomies, that involve the armpit). Speak to your specialist or breast care nurse immediately if you think that you may be experiencing any of the symptoms described below.

Wound infection

Your wound may be infected if the wound site:

  • becomes red
  • becomes more painful and swollen
  • is leaking fluid (discharge)

This can be treated with antibiotics.

Lymphoedema

If you've had some lymph nodes removed, you're more at risk of developing a condition called lymphoedema. This usually starts some time after surgery, but it can also develop many months or years later.

Lymphoedema is a build-up of fluid in the arm that causes swelling, pain and tenderness in your arm and hand.

Your nurse will tell you how to prevent lymphoedema using skincare techniques and exercises. If it occurs, lymphoedema can be controlled with early treatment in a specialised lymphoedema clinic.

Risks of breast reconstruction

If a breast implant was put in after your mastectomy, there's a slight risk of it becoming infected. If this happens, the implant may need to be removed.

The implant may also be removed if your skin fails to heal properly. The risk of this happening is higher in people who have diabetes or smoke.

'I wouldn't have changed my decision at all'

Emma Duncan was diagnosed with breast cancer twice in four years, once in each breast.

Her first treatment was a lumpectomy with chemotherapy and radiotherapy. Her second treatment included a full mastectomy, removing both breasts, followed by reconstructive plastic surgery.

"I asked my GP if there was any screening programme that they could put me into when I was 25, because my mother had died from breast cancer when she was 32. They referred me to the Royal Victoria Infirmary, and I used to come once a year just for a check-up.

"A few years later, I was in the bath and I noticed a lump under my left armpit. I didn't quite know what to make of it; I was quite worried at first. I went to see my GP the next day and he suspected that it might just be a cyst because I was only 28 at the time, but because of my family history they did a referral anyway.

"At the hospital I had an ultrasound, a mammogram and a needle biopsy. When I returned a week later for the results, they confirmed that I did have breast cancer and that I would need to come in for lumpectomy surgery 10 days later.

"I had chemotherapy for six months after my first diagnosis, followed by five weeks of radiotherapy. It was really, really hard. All my hair fell out and it made me feel so ill.

"My husband Graham was great, he tried to support me as best he could throughout it; my sister-in-law was never off the phone, and my best friend Claire was lovely.

"My sister handled it in a very different way; she had watched my mum become very, very poorly and then her older sister was diagnosed. She found it hard to deal with and just couldn't handle coming to see me. She later admitted being terrified that it might be her next.

"The second time I was diagnosed, I had a bigger operation - a double mastectomy. The decision to have a mastectomy was quite easy to make - for me, the only decision when you've had cancer twice.

"The reality after the event was very different. With the reconstructive surgery as well, I knew it would be a long recovery, but I don't think anything prepared me for just how long. I cried every single day because I was so uncomfortable.

"I was referred to a psychologist, who told me I wasn't going mad. Anybody who had been through what I had would be expected to have a few tearful days. Things settled down, then it was just a case of trying to get back to normal.

"Looking back at everything, I wouldn't have changed my decision at all - it was definitely for the best.

"I now have check-ups every six months. I see my oncologist, my breast surgeons and the family clinic. I'm seen quite regularly. I see my plastic surgeon, my geneticist and have an ultrasound once a year, plus a blood test every four months as part of the ovarian screening programme. The Macmillan Breast Care nurses ring me up every once in a while to keep me up-to-date and to check that I'm alright. I'm very well looked after!

"Now I just want to stay cancer-free. I've done as much as I possibly can to prevent it from coming back or getting a new cancer. I didn't quite make it after my first diagnosis, but I'd like to hit my five-year point.

"My advice to other women would be to speak to your breast care nurse or go on the Cancer Research UK or Cancer Care websites. There are so many recognised sources of information. The internet is full of horror stories, so make sure you get as much information, but from reputable sources."

'After surgery, it was brilliant to see a breast there again'

Pauline Polley, from Dorset, had a mastectomy after she was diagnosed with breast cancer. She had a breast reconstruction 18 months later.

"I found out I had breast cancer when I was 38. I'd noticed my nipple was slightly raised. My GP referred me to the specialist breast clinic, where I was diagnosed with a tumour deep within the breast. My husband and I were dumbstruck.

"I had a lumpectomy 10 days later, but the tumour was big (33mm) and there was cancer in my lymph nodes. So 10 days after the lumpectomy, I had a mastectomy on my left side.

"Washing my breast in the shower for the last time was awful. I put my gown on and thought, 'I'm not going to look at it again', but I couldn't help it.

"When I woke after the surgery, it hit me what had happened. I looked down and one side was dead flat.The other was my normal D-cup. I couldn't have a reconstruction at that stage, as I had to have intensive radiotherapy to the breast area.

"I had chemotherapy for eight months, and then radiotherapy for five weeks. I also started therapy with Herceptin, as part of a medication trial.

"I had a prosthesis (false breast), which goes inside your bra, but I didn't like using it. You need a lightweight, synthetic one during radiotherapy so it doesn't irritate the skin. It doesn't have the weight of a normal breast and I looked lopsided, which was annoying.

"Once, I was walking from my car to the hospital when I realised the prosthesis was all the way up my neck and I hadn't realised. What must people have thought! I also play a lot of golf, and it used to get in the way.

"After the mastectomy I thought I never wanted surgery again, but my friend Sarah had a reconstruction and it looked good. I decided to go for a consultation with the surgeon.

"Because of the surgery and radiotherapy I'd had, there was only one option available to me. The surgeon would take a section of my back muscle, keep it attached to all the nerves and blood supply, put it over a silicone implant on my front, and stitch it all back up again. He'd build me a C-cup, and reduce my right breast to a C-cup later. I decided then and there to go for it.

"In June 2003, I had the reconstruction. I was really looking forward to it: I woke up after the surgery and it was brilliant and exciting to see a breast there again.

"The cut in my back was about 12 inches long, from the spine to my side. It felt weird, a little tight, and the breast seemed very high. They do that so the weight gradually stretches the skin. I didn't have much pain, and didn't take the painkillers I was given.

"It was such a relief to put a bra on and not have to worry about stuffing a prosthesis in. A few weeks later, they reduced my right breast to a C-cup, and took part of my right nipple to make a new nipple on my left breast. It's very clever and the stitching is tiny. I had the nipple centre tattooed in and it looks brilliant. I have sensation in about half of the new breast and the rest of it is numb, and if you touch my back I feel it in my front, which is a strange sensation.

"At first the breast felt alien, but now it's become part of me. After the mastectomy, it was difficult to go into a lingerie shop and see all the bras and tops that I couldn't wear. Now, I can wear anything.

"Having the reconstruction has helped my confidence, and my husband has been brilliant. He doesn't treat my breasts any differently. He said, 'Whatever you decide to do, you know I'll still love you because it's the way you are'.

"In September 2006, I was diagnosed with secondary breast cancer in my liver. With chemotherapy and hormone treatment the tumour has shrunk and stabilised. I have scans every three months, and I'm on Herceptin and hormone treatment.

"If a woman is considering a breast reconstruction, I'd say talk to a surgeon to find out about all your options. Try to see some women in the flesh who've had it done; I'm always happy to show women mine. If it's possible to have a reconstruction done at the same time as your surgery, I think that's a good idea. That way you won't have the feeling of nothing being there for a while."

 
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