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Mastectomy

Breast removal surgery; Subcutaneous mastectomy; Nipple sparing mastectomy; Total mastectomy; Skin sparing mastectomy; Simple mastectomy; Modified radical mastectomy; Breast cancer - mastectomy

A mastectomy is surgery to remove the breast tissue. Some of the skin and the nipple may also be removed. However, surgery that spares the nipple and skin can now be done more often. The surgery is most often done to treat breast cancer.

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Female Breast

Presentation

Mastectomy - series - Normal anatomy
Breast reconstruction - series - Indication, part 1

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Description

Before surgery begins, you will be given general anesthesia. This means you will be asleep and pain-free during surgery.

There are different types of mastectomies. Which one your surgeon performs depends on the type of breast problem you have. Most of the time, mastectomy is done to treat cancer. However, it is sometimes done to prevent cancer (prophylactic mastectomy).

The surgeon will make a cut in your breast and perform one of these operations:

One or two small plastic drains or tubes are very often left in your chest to remove extra fluid from where the breast tissue used to be.

A plastic surgeon may be able to begin reconstruction of the breast during the same operation. You may also choose to have breast reconstruction at a later time. If you have reconstruction, a skin- or nipple-sparing mastectomy may be an option.

Mastectomy will take about 2 to 3 hours.

Why the Procedure Is Performed

WOMAN DIAGNOSED WITH BREAST CANCER

The most common reason for a mastectomy is breast cancer.

If you are diagnosed with breast cancer, talk to your health care provider about your choices:

You and your provider should consider:

The choice of what is best for you can be difficult. You and the providers who are treating your breast cancer will decide together what is best.

WOMEN AT HIGH RISK FOR BREAST CANCER

Women who have a very high risk of developing breast cancer may choose to have a preventive (or prophylactic) mastectomy to reduce the risk of breast cancer.

You may be more likely to get breast cancer if one or more close family relatives has had the disease, especially at an early age. Genetic tests (such as BRCA1 or BRCA2) may help show that you have a high risk. However, even with a normal genetic test, you may still be at high risk of breast cancer, depending on other factors. It may be useful to meet with a genetic counselor to assess your level of risk.

Prophylactic mastectomy should be done only after very careful thought and discussion with your doctor, a genetic counselor, your family, and loved ones.

Mastectomy greatly reduces the risk of breast cancer, but does not eliminate it.

Risks

Scabbing, blistering, wound opening, seroma, or skin loss along the edge of the surgical cut or within the skin flaps may occur.

Risks:

Before the Procedure

You may have blood and imaging tests (such as CT scans, bone scans, and chest x-ray) after your provider finds breast cancer. This is done to determine if the cancer has spread outside of the breast and lymph nodes under the arm.

Always tell your provider if:

During the week before the surgery:

On the day of the surgery:

You will be told when to arrive at the hospital. Be sure to arrive on time.

After the Procedure

Most women stay in the hospital for 24 to 48 hours after a mastectomy. Your length of stay will depend on the type of surgery you had. Many women go home with drainage tubes still in their chest after mastectomy. The doctor will remove them later during an office visit. A nurse will teach you how to look after the drain, or you might be able to have a home care nurse help you.

You may have pain around the site of your cut after surgery. The pain is moderate after the first day and then goes away over a period of a few weeks. You will receive pain medicines before you are released from the hospital.

Fluid may collect in the area of your mastectomy after all the drains are removed. This is called a seroma. It most often goes away on its own, but it may need to be drained using a needle (aspiration).

Outlook (Prognosis)

Most women recover well after mastectomy.

In addition to surgery, you may need other treatments for breast cancer. These treatments may include hormonal therapy, radiation therapy, and chemotherapy. All have side effects, so you should talk to your provider about the choices.

Related Information

Breast cancer
Breast lump removal
Radiation therapy
Breast reconstruction - implants
Breast reconstruction - natural tissue
Lymphedema - self-care
Breast radiation - discharge
After chemotherapy - discharge
Dry mouth during cancer treatment
Eating extra calories when sick - adults
Surgical wound care - open
Oral mucositis - self-care
Chest radiation - discharge
Drinking water safely during cancer treatment
Safe eating during cancer treatment
Mastectomy - discharge
Mastectomy and breast reconstruction - what to ask your doctor
Cosmetic breast surgery - discharge

References

Davidson NE. Breast cancer and benign breast disorders. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 26th ed. Philadelphia, PA: Elsevier; 2020:chap 188.

Henry NL, Shah PD, Haider I, Freer PE, Jagsi R, Sabel MS. Cancer of the breast. In: Niederhuber JE, Armitage JO, Kastan MB, Doroshow JH, Tepper JE, eds. Abeloff's Clinical Oncology. 6th ed. Philadelphia, PA: Elsevier; 2020:chap 88.

Hunt KK, Mittendorf EA. Diseases of the breast. In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 20th ed. Philadelphia, PA: Elsevier; 2017:chap 34.

Macmillan RD. Mastectomy. In: Dixon JM, Barber MD, eds. Breast Surgery: A Companion to Specialist Surgical Practice. 6th ed. Philadelphia, PA: Elsevier; 2019:122-133.

National Comprehensive Cancer Network website. NCCN clinical practice guidelines in oncology: breast cancer. Version 2.2020. www.nccn.org/professionals/physician_gls/pdf/breast.pdf. Updated February 5, 2020. Accessed February 25, 2020.

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Review Date: 2/11/2020  

Reviewed By: Todd Campbell, MD, FACS, Clinical Assistant Professor Department of Surgery, Volunteer Faculty, Rowan University School of Osteopathic Medicine, Stratford, NJ; Medical Director, Independence Blue Cross. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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