Mastectomy is the removal of the breast, and possibly other tissues surrounding the breast if the cancer has involved them, with the goal of removing as much of the cancerous tissue as possible and removing as many cancer cells as possible. All mastectomies are total mastectomies, and given the different size and location of the tumor and the site of metastasis, the amount of other tissue removed by the surgery will vary.
What are the mastectomies?
- Total mastectomy or simple mastectomy, which is the removal of the entire breast.
- Modified radical mastectomy for breast cancer, which is the removal of the entire breast and the axillary lymph nodes (axillary lymph nodes).
- Radical breast cancer surgery, which involves removal of the entire breast, pectoral muscle, and all lymph nodes in the axilla (axillary lymph node dissection), is rarely used.
Male breast cancer patients usually undergo modified radical surgery. Depending on the location of the tumor in the breast or other factors, some women may undergo skin-preserving or nipple-preserving mastectomy. Skin-preserving mastectomy will preserve most of the skin on the surface of the breast except for the nipple and areola, and nipple-preserving mastectomy will preserve the skin of the breast as well as the nipple and areola.
Some women choose to have breast reconstruction after mastectomy, and reconstruction can be performed at the same time as the mastectomy or as a separate procedure at a later date.
In addition to surgery, patients may receive radiation therapy, chemotherapy, endocrine therapy, or a combination of these therapies.
What options might patients face?
For tumors of some sizes or where two or more tumors are present too far apart, mastectomy may be more appropriate than breast-conserving surgery. Radiation therapy is not always needed after mastectomy, so mastectomy is a better option if radiation therapy is not desired or not available.
Some women choose to undergo breast reconstruction at the same time as or after a mastectomy. Patients should consult with their physician about the suitability of breast reconstruction before undergoing a mastectomy.
What should I expect after surgery?
Mastectomy requires general anesthesia. After surgery, the patient will be taken to a recovery room. If you experience nausea, pain, or anxiety, seek help from a nurse.
Patients will be awake to find the surgical site bandaged and may also have one or two drains to collect fluid to prevent fluid from accumulating at the surgical site. If the drain is still in place at discharge, the nurse will advise how to care for it.
The provider will instruct the patient on how to control pain and care for the incision. Bandages are usually removed and showers are taken on the second day after surgery. Most patients are discharged home within 24 hours of the mastectomy, but if they also have a breast reconstruction, they will need to stay in the hospital for several more days.
During the hospital stay, the provider may teach some exercises to avoid shoulder stiffness. Patients should not engage in strenuous activity for several weeks after surgery, and the surgeon will advise how soon to increase activity.
What are the risks of surgery?
Surgical complications include infection, bleeding, poor healing of the incision, or a reaction to anesthesia. There may be fluid collection at the incision site, which is an accumulation of blood or clear fluid that needs to be drained. There may be pain in the chest with stretching, tightness, tingling, or numbness.
If axillary lymph nodes are removed, lymphedema (swelling of the arm) may occur because the ability of fluid in the tissue to drain through the lymphatic system is reduced after removal of the lymph nodes. If you feel swelling or pain in the arm on the side of surgery, tell your doctor or nurse immediately. The nerves responsible for skin sensation on the inside of the upper arm are also in the area where these lymph nodes are located, and if the nerves are damaged during surgery, the corresponding location may feel numb.
How does the surgery work?
For early-stage breast cancer, the survival rate for removal of the mass or part of the breast (breast-conserving surgery) combined with radiation therapy is the same as for mastectomy. Although mastectomy is more extensive, many patients still choose mastectomy because they may not want or be able to receive radiation therapy after breast-conserving surgery, or may believe that mastectomy will prevent the cancer from coming back as much as possible.
Metastatic breast cancer is not always surgically treatable. However, some studies have shown that even if breast cancer is found after it has already metastasized to other organs, total removal of the primary tumor in the breast may still increase survival.