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Mastectomy

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What is a mastectomy?

A mastectomy is an operation to remove the breast.

It is usually used as a treatment for breast cancer in women or breast cancer in men. It may also be used as a way to reduce the risk of cancer developing in the breast.

If your doctor refers you urgently because they think you have cancer, you have the right to be seen by a specialist within two weeks.

How are mastectomies carried out?

Before having a mastectomy you will have the opportunity to discuss the operation with a specialist nurse or surgeon. This may include things like possible complications, the option of breast reconstruction or the type of mastectomy you will have.

You may also need to have chemotherapy or hormone therapy to reduce the size of any tumours before the operation.

There are several different types of mastectomy. The type of surgery recommended for you will depend on things 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.

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

Read more about getting ready for a mastectomy and how a mastectomy is performed.

After surgery

Mastectomies are very safe procedures with minimal complications. Most people recover well and it's common to only stay in hospital for one night, although some people will need to spend a few days in hospital. Generally, it takes between 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 by a dressing.

It is common to experience pain, numbness, tingling and swelling after a mastectomy, but painkillers should offer some relief.

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

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

How is a mastectomy 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 it 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 is not removed
  • radical mastectomy – when 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, but this is now only carried out rarely
  • 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 performed under general anaesthetic, which means you will be asleep during the operation and will not 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 are 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 your body. They are part of the immune system (the body's natural defence against infection and illness).

It is 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 is 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 a procedure that involves making 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 or back
  • a combination of both of these

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. Alternatively, the surgery can be performed at a later date. Some people decide not to have breast reconstruction at all. It is your decision and your specialist will discuss the options with you.

Endoscopic mastectomy

This 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 source and camera at one end) is used along with special tools to remove the breast tissue.

NICE found there is currently not enough evidence to confirm the safety and effectiveness of endoscopic mastectomies. Therefore, this type of surgery is not routinely used.

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 more about endoscopies and clinical trials.

Preparing for a mastectomy

Before having a mastectomy, you can discuss the procedure with a nurse or surgeon. You may also receive treatment beforehand to reduce the size of any tumours.

A nurse can talk to you about how the procedure might affect you physically and emotionally. They can also give you practical advice about bras and prostheses (bra inserts), if you need them.

If you want to know what your scar will look like after your surgery, you may be able to see photographs of other people who have had the procedure.

Breast reconstruction

Most women are offered breast reconstruction if they are going to have a mastectomy. This is surgery to create an artificial breast.

It may be possible for you to have breast reconstruction at the same time as a mastectomy, or you may be advised to wait.

If you choose to have breast reconstruction surgery, talk to your surgeon about when you would like it done and the specific type of surgery you will need.

Chemotherapy and hormone therapy

Before your operation you may be advised to have treatment to reduce the size of any breast tumours. These treatments include:

  • anti-cancer (cytotoxic) medication to kill the cancer cells (chemotherapy)
  • medication to stop hormones in your body that encourage breast cancer (hormone therapy)

If successful, these treatments can reduce the amount of breast tissue that needs to be removed, which may improve the appearance of your breast after surgery.

Preparing for surgery

Before having surgery, you may have some tests to check the cancer has not spread, plus a general check-up to make sure you are fit for the operation.

If you are currently taking any medicines, find out whether you should continue taking them before your operation. Never stop taking a prescribed medication, unless advised to do so by your doctor or another qualified healthcare professional responsible for your care.

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

It is common to be admitted to hospital on the same day of your operation, but you may be admitted the night before. You will be asked not to eat or drink for a few hours before the operation. A nurse will check your temperature, blood pressure and heartbeat.

See how a mastectomy is performed for more information about how the operation is carried out.

Recovery

Most people who have a mastectomy recover well after the procedure and do not develop complications.

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

After the operation

When you wake up after the operation, it is likely that you will feel sore. This pain can be controlled with painkillers. It is very important to tell your doctor or nurse when you are 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 are able to eat and drink again.

Wound care

Following the 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 do not need to be removed. However, some people have stitches or metal clips that need to be removed after seven to 10 days. Your wound should have healed during this period of time.

Preparing for home

The length of your stay in hospital will depend on the type of surgery you have, but you will usually need to stay in hospital for about two or three days. However, it is not 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 are likely to 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 has been operated on.

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

Scars

After a mastectomy, you will 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 also advise you about how to look after your scar. If you are uncomfortable about how your scar looks, there are a number of possible treatments, such as:

  • correcting the scar with further surgery
  • using make-up to cover up the scar

Read more about treating scars.

Talking to others

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

You can get information about contacting others who have had a mastectomy from your specialist breast cancer care nurse.

When is a mastectomy necessary?

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

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 is a risk that the cancer will grow back and spread to other parts of the body.

A mastectomy is not always the most suitable treatment for breast cancer, although in many cases it is very effective. The specialist responsible for your care will be able to advise you about 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, the condition 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.

Read more about female breast cancer.

Preventing breast cancer

Risk-reducing (prophylactic) mastectomies are 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 is required, rather than removing the whole breast.

If you are 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 are not usually recommended if there is 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.

These medications aren't suitable for everyone, but they should be considered before making a decision about having a mastectomy.

Complications of a mastectomy

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

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

You may have swelling at the site of your operation as a result of body fluid collecting underneath the skin. This is called seroma. It often goes away without treatment, although it may sometimes need to be drained with a needle and syringe. You should speak to your surgeon or breast care nurse if you think that you are developing seroma.

If you have 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 it is permanent in some cases. There is also a small chance that any pain you experience after 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 (inflamed)
  • is leaking fluid (discharge)

This can be treated with antibiotics.

Lymphoedema

If you have some lymph nodes removed, you are 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 appropriate skincare techniques and exercises. If it occurs, lymphoedema can be controlled with early treatment in a specialised lymphoedema clinic.

Read more about lymphoedema, including the symptoms, and how it is diagnosed and treated.

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