Mastectomy is the surgical removal of the breast that is performed to treat or prevent breast cancer. In early stages of breast cancer, women may choose breast-conserving surgery called as lumpectomy, which involves removal of the cancerous tumor only. Lumpectomy is not an option for some women with early or with advanced stages of breast cancer. Recent surgical advances preserve breast skin allowing for a more natural appearance of the breast. Breast reconstruction or surgical restoration of the breast can be done at the same time as mastectomy or later.
Mastectomy may be a treatment options for various types of breast cancer including:
- Ductal carcinoma in situ
- Stages 1 and 2 breast cancer
- Stage 3 breast cancer
- Inflammatory breast cancer
- Paget’s disease
- Locally recurrent breast cancer
Sometimes mastectomy is recommended instead of lumpectomy and radiation if you have two or more tumors in different areas of the breast or you have received radiation treatment to the breast region. Mastectomy is also an option if the tumor size is large relative to the breast size. Some women consider mastectomy as an option if they are at high risk for developing breast cancer. Prophylactic mastectomy, i.e. reducing risk by mastectomy, involves removal of one or both breasts to reduce developing breast cancer. In some cases, chemotherapy may be recommended before mastectomy to shrink the tumor.
Types of Mastectomy
- Modified radical mastectomy – involves removal of the entire breast including the nipple, areola, breast tissue, and skin. Most of the lymph nodes are removed along with the lining over the chest muscles. This procedure is usually performed for large tumors or if the lymph nodes are affected by breast cancer.
- Simple (total) mastectomy – involves removal of the entire breast along with the breast tissue, skin, nipple, and areola but does not remove the underlying chest muscle. At the time of surgery, a sentinel lymph node biopsy may be performed.
- Skin-sparing mastectomy – is performed when immediate reconstruction is planned. It involves removal of breast tissue, nipple, areola, but not the majority of the breast skin.
- Nipple-sparing mastectomy – involves sparing the skin, nipple, areola, chest wall muscles, and lymph nodes while removing only breast tissue.
Risks of Mastectomy
Some of the risks of mastectomy are:
- Bleeding and infection at the surgery site
- Post-mastectomy pain syndrome
- Swelling of arm
- Scar tissue formation
- Should pain and stiffness
- Emotional distress with physical appearance
What to expect during mastectomy
Mastectomy usually involves one or two-day hospital stay, and if you are opting for breast reconstruction, the stay may be longer. The procedure is performed under general anesthesia. Irrespective of the type of mastectomy, some breast tissue will be removed and sent to the laboratory for analysis. Lymph nodes may also be removed. If you are having immediate breast reconstruction surgery, tissue expanders or implants may be placed, or a muscle or fat-flap procedure may be performed. The incision is closed with sutures, which may dissolve or can be removed later.
At your visit to the doctor, your mastectomy test results will be explained to you and you may be referred to consult with a radiation oncologist, medical oncologist, plastic surgeon, or a support group.
Content reviewed by Deanna Jean Attai, MD, FACS