Mastectomy Procedure - Healthnile.com

Overview

Mastectomy is a surgical method that removes all breast tissue. People often choose this operation to address or lower the chance of breast cancer. Several approaches exist for mastectomy, and these types include:

Type	Description
Total mastectomy	Removes the entire breast, including the nipple.
Skin-sparing mastectomy	Removes the breast tissue but keeps most skin.
Nipple-sparing mastectomy	Keeps the nipple and most of the skin.

Sometimes, surgeons may also remove the skin and nipple, depending on the situation. Breast reconstruction can help restore breast shape, either during the same surgery or later. Full reconstruction may require multiple procedures.

Reasons for Mastectomy

Surgical Removal to Treat Breast Cancer

Doctors may recommend removing all breast tissue to treat several types of breast cancer. This option often treats conditions such as ductal carcinoma in situ (DCIS), a noninvasive type of breast cancer.

Doctors also use it for early-stage cancers, like stage 1 or stage 2, as well as for Paget’s disease of the breast. If breast cancer returns after treatment, doctors may perform a mastectomy to remove the new cancer growth.

For locally advanced conditions like stage 3 breast cancer or inflammatory breast cancer, doctors may perform the surgery after completing chemotherapy. This approach helps shrink the cancer first and makes the operation safer or more successful. Many people with breast cancer can select between two main surgeries:

Mastectomy (removal of all breast tissue).
Lumpectomy (removal of only the cancer and some normal tissue).

A lumpectomy, also called breast-conserving surgery, is often followed by radiation therapy. Doctors might recommend a mastectomy instead of breast-conserving surgery for several reasons:

There is more than one area of cancer in different parts of the breast.
The breast exhibits extensive microcalcifications, which are tiny calcium deposits that have been linked to the presence of cancer.
A person has already had radiation therapy to the chest, and the cancer has come back.
The person is pregnant and cannot have radiation.
A lumpectomy did not remove all the cancer, or cancer was found at the edges of the removed tissue.
Genetic tests indicate a high risk for developing a second breast cancer.
The area of cancer is too large relative to the breast size for a good cosmetic result after a lumpectomy.
The patient has connective tissue conditions, like scleroderma or lupus, and cannot safely receive radiation.

Below is a table showing different types of mastectomy and when doctors might use them:

Type of Mastectomy	When It’s Used
Unilateral Mastectomy	To remove one breast, often for cancer in a single breast.
Bilateral Mastectomy	To remove both breasts, sometimes for cancer in both or high-risk cases.
Partial Mastectomy	To remove only the part with cancer, similar to a large lumpectomy.

Surgery to Lower the Risk of Breast Cancer

Some people choose surgery to remove both breasts, even if they do not have cancer, because they face a high risk of developing it in the future. This is called a preventive mastectomy. It can greatly reduce—but does not remove completely—the possibility of getting breast cancer later.

Other names for this type of operation include risk-reducing mastectomy and prophylactic mastectomy. Those with a strong family history of breast cancer or with genetic changes (for example, in the BRCA1 or BRCA2 genes) may be offered this surgery.

The decision is based on several factors, such as family history, test results, and personal health risk. Some people choose this option over close monitoring or medication to help prevent cancer. Reasons someone might consider preventive mastectomy:

A known strong family history of breast cancer.
Genetic test results showing a high chance of developing breast cancer.
A personal history of breast cancer that makes the risk for a second cancer very high.

While removing both breasts reduces the risk, it does not mean cancer will never develop, as some breast tissue can remain. Some people prefer the peace of mind a major risk reduction provides. Below is a list comparing preventive mastectomy with other options:

Preventive Mastectomy: Removes nearly all breast tissue, highest risk reduction
Close Monitoring: Regular imaging and screening for early signs of cancer
Medication: Some medicines can lower cancer risk but have side effects

Possible Complications

People who have a mastectomy may face several risks. These can include bleeding, infection, and delayed healing at the site where tissue is removed. Some may notice swelling in the arm, especially if lymph nodes are taken out, which is called lymphedema. Other issues might be pain, numbness, or shoulder stiffness.

Steps to Get Ready

Talk with Your Surgeon About Your Choices

A patient usually meets with a breast surgeon or surgical team to go over the upcoming operation. Patients should bring up questions and learn the details of the procedure, other treatment options, and possible risks. This meeting is often the time to talk about a shared decision regarding surgery and what comes next.

Someone planning a mastectomy may want to think about breast reconstruction. This type of surgery can restore the shape of the breast after a mastectomy. A plastic surgeon, also known as a reconstructive surgeon, handles these procedures and often works closely with the breast surgeons.

Sometimes, reconstruction can begin right after the breast tissue is removed. In other cases, some steps may happen immediately, while others take place months later. There are different methods for breast reconstruction:

Breast expanders with saline or silicone implants.
Autologous tissue reconstruction (using tissue from another part of the person’s body).
A mix of implants and body tissue.

A person’s ability to have immediate reconstruction can depend on factors like medical history, personal preferences, and overall treatment plan. Another key point is if radiation therapy will be needed. Radiation can affect both the timing and method of reconstruction. Some patients will know about their need for radiation before surgery, but others may not find out until after the procedure.

A meeting with a radiation specialist, called a radiation oncologist, might also be suggested to help review the benefits or risks. During these conversations, making a plan that involves both the breast surgeon and plastic surgeon ensures better coordination and support.

Getting Ready for the Surgery Day

Patients should follow all directions from the healthcare team to get the best results and recover well. Here are some common steps to prepare:

Tell the healthcare team about any medications, vitamins, or supplements. Some may need to be stopped before surgery, as they could interfere with recovery or bleeding.
Stop blood-thinning medicines, like aspirin, if directed by a doctor. Alternative blood thinners might be given around the time of the procedure if needed.
Follow eating and drinking rules. Instructions will be given on when to stop eating before surgery. Sometimes, drinking clear fluids is allowed until a certain point. It is necessary to stay hydrated but follow all guidance from the team.
Pack a small bag for the hospital. Even if most patients go home the same day, having comfortable clothes that are easy to put on, like a zip-up top or loose robe, can help. Bringing toiletries, reading material, a mastectomy bra (if recommended), slippers, and a robe can increase comfort during the stay.

A quick table can help organize what to bring:

Item	Purpose
Robe & Slippers	Comfort in the hospital
Easy-on Clothing	Ease of changing after surgery
Mastectomy Bra	Support after operation
Toiletries	Basic hygiene
Book or Tablet	Entertainment, passing time

Arranging a ride home is important, as driving after anesthesia is not allowed. Those who stay overnight should set up a recovery area at home, keeping things like a phone, TV remote, water, and snacks within easy reach.

What You Can Expect

Getting Ready for Surgery

Before surgery, staff give patients clear instructions about where to go and what to do when they arrive. Sometimes, a person may need to visit one area first and then go to the surgical area. For those having a sentinel lymph node biopsy, a special dye and sometimes a radioactive tracer are injected near the breast cancer. These substances travel to the sentinel lymph nodes, helping the surgeon find and remove them during surgery.

Mastectomy procedures without immediate breast reconstruction generally take between one and three hours. Most surgeries happen as outpatient procedures, so people usually return home the same day. Occasionally, patients stay overnight, especially if recovery is slow or if the surgery is extensive.

The medical team reviews medications with the patient ahead of time and gives information about fasting, showering, and wearing comfortable clothing. Patients should not eat or drink anything after midnight before the operation unless directed otherwise. These preparations help reduce the risk of problems during and after surgery.

Preparation Step	Timing	Notes
Stop eating and drinking	Night before	Fasting instructions provided
Medication review	Days before	Adjust or stop as advised
Remove nail polish and jewelry	Day of surgery	Keep area clean
Arrange transportation	In advance	You will need a ride home

Step-by-Step Walkthrough of the Operation

The surgical team places the patient under general anesthesia, so the patient sleeps and does not feel discomfort. The surgeon makes an incision on the chest. The specific type of incision and surgical approach depend on the type of mastectomy:

Total Mastectomy: Removes all breast tissue, the nipple, and the areola.
Skin-Sparing <astectomy: Keeps most of the breast skin while removing the breast tissue and nipple.
Nipple-Sparing Mastectomy: Removes breast tissue only, preserving the nipple, areola, and breast skin.

If cancer may have spread, the surgeon often performs a sentinel lymph node biopsy or removes more lymph nodes from under the arm (called axillary lymph node dissection). A sentinel lymph node biopsy checks only a few specific lymph nodes, while an axillary dissection removes more.

The surgical team sends all nodes and tissue removed in surgery to a laboratory for analysis and shares results in a pathology report. These reports help doctors decide if more treatment is needed later.

When breast reconstruction is planned, a plastic surgeon joins the team once the breast tissue has been removed. Reconstruction may use implants or body tissue, depending on the patient’s wishes and needs. Skin-sparing and nipple-sparing mastectomies are especially common when immediate reconstruction is desired.

Before finishing, the surgeon places dissolvable stitches or stitches that may need removal later. The team may place soft plastic drainage tubes to collect fluid and help reduce swelling. These tubes attach to a small bag outside the body, and patients receive instructions on how to care for them at home.

What Happens After Surgery

After the operation, nurses monitor breathing, blood pressure, and the incision in a recovery room. A large bandage or dressing covers the chest area. Many patients feel pain, numbness, or tightness around the chest or underarm, especially if lymph nodes were removed.

Staff provide medications to manage pain and prevent infection. Most people go home the same day, but some may stay overnight. Before leaving, the health team provides detailed instructions about:

How to take care of the surgical area and drainage tubes.
Cleaning and changing dressings.
Watching for signs of infection, like redness, swelling, or fever.

Patients should be careful with arm movement, especially if lymph nodes were removed. The care team usually recommends gentle arm exercises after a few days to help with flexibility and less stiffness in the shoulder. Here’s a summary of what patients might experience at home:

Limited range of motion on the surgery side for the first week.
Soreness or a pinching sensation in the underarm area.
Detailed instructions for showering and when to start regular activities.
Guidelines on when bras or breast forms (prosthesis) can be worn.

A follow-up appointment is scheduled to check healing and remove any stitches if needed. Patients also receive updates on the pathology report, which explains if any cancer was found in the breast tissue or lymph nodes. This helps decide if more treatment is needed.

Findings After Surgery

After surgery, lab technicians examine removed tissue and lymph nodes. Lab tests help determine if any cancer cells remain and if the lymph nodes contain cancer. This information usually becomes available in about 1–2 weeks. Results guide the care team’s next steps. If they find more cancer cells, the care team may refer the patient to other specialists:

Radiation Oncologist: Evaluates the need for radiation, especially if cancer appears in the skin, muscle, or lymph nodes.
Medical Oncologist: Recommends chemotherapy or hormone therapy.
Plastic Surgeon: Discusses breast reconstruction options, such as immediate reconstruction, delayed reconstruction, implants, or breast prosthesis.
Support: Offers counseling or support groups.

Treatment options after mastectomy can include:

Option	When Considered
Immediate Reconstruction	Done during the same