Mastectomy

Mastectomy is an operation to remove the entire breast, sometimes with other tissues.  A modified radical mastectomy involves removing the whole breast and most or all of the axillary (underarm) lymph nodes draining the breast. This is the most common surgery for women with breast cancer who are having the whole breast removed.  In a simple or total mastectomy the surgeon removes the whole breast, including the nipple, but does not remove muscle tissue from beneath the breast. A few lymph nodes may be removed during the procedure.  Sometimes this is done for both breasts (a bilateral mastectomy), especially when it is done as preventive surgery in women at very high risk for breast cancer.  A skin-sparing mastectomy  may be an option for some women with smaller tumors   Most of the skin over the breast (other than the nipple and areola) is left intact to facilitate reconstructive procedures.  A radical mastectomy is an extensive operation where the surgeon removes the whole breast, axillary lymph nodes, and the pectoral (chest wall) muscles under the breast. Since a modified radical mastectomy has been proven to be as effective as a radical mastectomy, it is rarely done today. After a mastectomy, most women, if they are hospitalized, can go home the next day.

Choosing lumpectomy or mastectomy

Many women with early stage cancers are candidates for either breast-conserving surgery or mastectomy.  The main advantage of a lumpectomy is that the patient does not lose her breast. The disadvantage is the usual need for radiation therapy  and that treatment continues for a number of weeks after surgery. The advantage of a mastectomy is that usually radiation therapy is not needed and there is no remaining breast for risk of developing a new cancer in that breast.  A small number of women having breast-conserving surgery may not need radiation,  while a small percentage of women who have a mastectomy will still need radiation therapy to the mastectomy area.  The cure rate after breast conserving therapy and mastectomy in appropriately chosen patients is equal.  When deciding between a lumpectomy and mastectomy, be sure to get all the facts. This is a very personal decision and we are here to support you in your decision.  Your choice will depend on a number of factors, such as:

• Feelings about losing your breast
• Feelings about radiation therapy
• Time and distance to have radiation therapy treatments
• Desire for reconstruction after having a mastectomy
• Preference for mastectomy to treat your cancer as quickly as possible
• Fear of cancer recurrence
• Avoid long term follow up of the involved breast

For some women, mastectomy is the best option. Breast conservation therapy is usually not recommended or is contraindicated for:

• Patients with prior radiation therapy to the affected breast
• Mulriple areas of cancer in the same breast
• Patients where breast conserving attempts have failed to completely remove the cancer
• Patients with certain serious connective tissue diseases such as scleroderma or lupus, where radiation therapy is contrindicated
• Pregnant women who would require radiation while still pregnant (risking harm to the fetus)
• Tumors larger than 5 cm (2 inches) that don't shrink with neoadjuvant chemotherapy
• Large cancers in a small breast
• Patients testing positive for BRCA1 and/or BRCA2 mutations
• Male breast cancer patients

WHAT TO DO BEFORE SURGERY

• Preoperative preparation includes blood work, medical evaluation, chest x-ray and an EKG depending on your age and medical condition.
• After your surgeon reviews with you the potential risks and benefits of the operation, you will need to provide written consent for surgery.
• Blood transfusion and/or blood products may rarely be needed depending on your condition.
• It is recommended that you shower with an antibacterial soap the night before or morning of the operation.
• After midnight the night before the operation, you should not eat or drink anything except medications that your surgeon and/or anesthesiologist has told you to take with a sip of water the morning of surgery.
• Drugs such as aspirin, blood thinners, anti-inflammatory medications (arthritis medications) and large doses of Vitamin E will need to be stopped temporarily for several days to a week prior to surgery.
• Diet medication or St. John’s Wort should not be used for the two weeks prior to surgery.
• Quit smoking and arrange for any help you may need at home.

HOW IS A MASTECTOMY PERFORMED?

You will most likely be asked to check into the hospital the morning of your surgery.

• Mastectomy surgery is usually performed under a general anesthesia.  It usually takes about an hour and a half.
• A sentinel lymph node biopsy is sometimes done with a mastectomy.
• An elliptical incision is made around the breast.
• The breast tissue is removed from the underlying chest wall muscles.
• Usually two drains are placed beneath the skin flaps.
• The incision is closed across the chest wall.

WHAT SHOULD I EXPECT AFTER SURGERY?

Our goal is for your surgery and recovery to be as comfortable and convenient as possible.  After breast conserving surgery, you may experience temporary pain and swelling at the excision site.

• Most Patients are able to engage in light activity while at home after surgery. Patients should not shower or tub bathe until the drains are removed.
• Post-operative pain is generally not severe although some patients may require a pain medication.
• You may have numbness and tingling in your chest, underarm, shoulder, and upper arm. These feelings usually go away within a few weeks or months. But for some women, numbness does not go away.
• Most patients can resume normal activities within a week or two, including driving, light lifting, and work.
• A volunteer from the American Cancer Society Reach to Recovery program may contact you after surgery.  Please refrain from beginning the exercise program until after your drains have been removed.
• You should call the office each weekday in the morning to report your drain output.  The nurse will tell you when to come into the office for drain removal.
• You will need to protect your arm and hand on the treated side:
  • Avoid wearing tight clothing or jewelry on your affected arm
  • Carry your purse or luggage with the other arm
  • Use an electric razor to avoid cuts when shaving under your arm
  • Have shots, blood tests and blood pressure measurements on the other arm
  • Wear gloves to protect your hands when gardening and when using strong detergents
  • Have careful manicures and avoid cutting your cuticles
  • Avoid burns or sunburns to your affected arm and hand

WHAT COMPLICATIONS CAN OCCUR?

Mastectomy is generally considered extremely safe. As with any operation, there is a risk of a complication. Complications during the operation may include:

• Bleeding or hematoma
• Seroma formation beneath the skin flaps
• Swelling of the arm on the side of the surgery
• Weakness of chest wall muscles
• Rarely infection of the wound
• Skin wound separation
• Adverse reaction to general anesthesia

WHEN TO CALL YOUR DOCTOR

Be sure to call your physician or surgeon if you develop any of the following symptoms after surgery:

• Persistent fever over 101 degrees F (39 C)
• Chills
• Bleeding
• Swelling of the skin flaps
• Swelling of the arm
• Pain that is not relieved by your medications
• Persistent nausea or vomiting
• You are unable to eat or drink liquids
• Persistent cough or shortness of breath
• Purulent drainage (pus) from the incision
• Redness surrounding the incision that is worsening or getting bigger

Related Links and Resources

• UT Health Encyclopedia – Mastectomy
• UT Health Encyclopedia – Breast Cancer
• UT Health Encyclopedia – Breast Mass
• National Cancer Institute – Breast Cancer
• American Cancer Society – Breast Cancer