- How is it performed
- Why is it necessary
- Real stories
- Pauline's story
- Getting ready
A mastectomy is an operation to remove 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.
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.
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.
How is it 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.
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 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.
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.
Why is it 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.
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.
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.
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.
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.
Emma Duncan was diagnosed with breast cancer twice in four years, once in each breast.
Her first treatment was a lumpectomy with chemotherapy and radiotherapy. Her second treatment included a full mastectomy, removing both breasts, followed by reconstructive plastic surgery.
"I asked my doctor if there was any screening programme that they could put me into when I was 25, because my mother had died from breast cancer when she was 32. They referred me to the Royal Victoria Infirmary and I used to come once a year just for a check-up.
"A few years later I was in the bath and I noticed a lump under my left armpit. I didn’t quite know what to make of it; I was quite worried at first. I went to see my doctor the next day and he suspected that it might just be a cyst because I was only 28 at the time, but because of my family history, they did a referral anyway.
"At the hospital I had an ultrasound, a mammogram and a needle biopsy. When I returned a week later for the results, they confirmed that I did have breast cancer and that I would need to come in for lumpectomy surgery 10 days later.
"I had chemotherapy for six months after my first diagnosis, followed by five weeks of radiotherapy. It was really, really hard. All my hair fell out and it made me feel so ill.
"My husband Graham was great, he tried to support me as best he could throughout it, my sister-in-law was never off the phone, and my best friend Claire was lovely.
"My sister handled it in a very different way; she had watched my mum become very, very poorly and then her older sister was diagnosed. She found it hard to deal with and she just couldn’t handle coming to see me. She later admitted being terrified that it might be her next.
"The second time I was diagnosed, I had a bigger operation, a double mastectomy. The decision to have a mastectomy was quite easy to make, for me the only decision when you’ve had cancer twice.
"The reality after the event was much different. With the reconstructive surgery as well, I knew it would be a long recovery, but I don’t think anything prepared me for just how long. I cried every single day because I was so uncomfortable.
"I was referred to a psychologist who told me I wasn’t going mad. Anybody who had been through what I had would be expected to have a few tearful days. Things settled down, then it was just a case of trying to get back to normal.
"Looking back at everything I wouldn’t have changed my decision at all, it was definitely for the best.
"I now have check-ups every six months, I see my oncologist, my breast surgeons and the family clinic. I’m seen quite regularly. I see my plastic surgeon, my geneticist and have an ultrasound once a year, plus a blood test every four months as part of the ovarian screening programme. The Macmillan Breast Care nurses ring me up every once in a while to keep me up to date, and to check that I’m alright. I’m very well looked after!
"Now I just want to stay cancer-free. I’ve done as much as I possibly can to prevent it from coming back or getting a new cancer. I didn’t quite make it after my first diagnosis, but I’d like to hit my five-year point.
"My advice to other women would be to speak to your breast care nurse or go on the Cancer Research UK or Cancer Care websites, there are so many recognised sources of information. The internet is full of horror stories, so make sure you get as much information but from reputable sources."
Pauline Polley, from Dorset, had a mastectomy after she was diagnosed with breast cancer. She had a breast reconstruction 18 months later.
“I found out I had breast cancer when I was 38. I’d noticed my nipple was slightly raised. My doctor referred me to the specialist breast clinic where I was diagnosed with a tumour deep within the breast. My husband and I were dumbstruck.
"I had a lumpectomy 10 days later, but the tumour was big (33mm) and there was cancer in my lymph nodes. So 10 days after the lumpectomy, I had a mastectomy on my left side.
“Washing my breast in the shower for the last time was awful. I put my gown on and thought, ‘I’m not going to look at it again’, but I couldn't help it.
"When I woke after the surgery, it hit me what had happened. I looked down and one side was dead flat.The other was my normal D-cup. I couldn’t have a reconstruction at that stage as I had to have intensive radiotherapy to the breast area.
“I had chemotherapy for eight months, and then radiotherapy for five weeks. I also started therapy with Herceptin, as part of a drugs trial.
“I had a prosthesis (false breast), which goes inside your bra, but I didn’t like using it. You need a lightweight, synthetic one during radiotherapy so it doesn’t irritate the skin. It doesn’t have the weight of a normal breast and I looked lopsided, which was annoying.
“Once, I was walking from my car to the hospital when I realised the prosthesis was all the way up my neck and I hadn’t realised. What must people have thought! I also play a lot of golf, and it used to get in the way.
"After the mastectomy I thought I never wanted surgery again, but my friend Sarah had a reconstruction and it looked good. I decided to go for a consultation with the surgeon.
"Because of the surgery and radiotherapy I’d had, there was only one option available to me. The surgeon would take a section of my back muscle, keep it attached to all the nerves and blood supply, put it over a silicone implant on my front, and stitch it all back up again. He’d build me a C-cup, and reduce my right breast to a C-cup later. I decided then and there to go for it.
"In June 2003 I had the reconstruction. I was really looking forward to it: I woke up after the surgery and it was brilliant and exciting to see a breast there again.
"The cut in my back was about 12 inches long, from the spine to my side. It felt weird, a little tight, and the breast seemed very high. They do that so the weight gradually stretches the skin. I didn’t have much pain, and didn’t take the painkillers I was given.
"It was such a relief to put a bra on and not have to worry about stuffing a prosthesis in. A few weeks later, they reduced my right breast to a C-cup, and took part of my right nipple to make a new nipple on my left breast. It’s very clever and the stitching is tiny. I had the nipple centre tattooed in and it looks brilliant. I have sensation in about half of the new breast and the rest of it is numb and if you touch my back I feel it in my front, which is a strange sensation.
"At first the breast felt alien, but now it’s become part of me. After the mastectomy, it was difficult to go into a lingerie shop and see all the bras and tops that I couldn’t wear. Now, I can wear anything.
“Having the reconstruction has helped my confidence, and my husband has been brilliant. He doesn’t treat my breasts any differently. He said, ‘Whatever you decide to do, you know I’ll still love you because it’s the way you are’.
"In September 2006 I was diagnosed with secondary breast cancer in my liver. With chemotherapy and hormone treatment the tumour has shrunk and stabilised. I have scans every three months, and I’m on Herceptin and hormone treatment.
"If a woman is considering a breast reconstruction, I’d say talk to a surgeon to find out about all your options. Try to see some women in the flesh who have had it done; I’m always happy to show women mine. If it’s possible to have a reconstruction done at the same time as your surgery, I think that’s a good idea. That way you won’t have the feeling of nothing being there for a while.”
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.
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.
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.
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.
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.