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MastectomyThis factsheet is for women who would like information about having a mastectomy operation. Mastectomy is an operation to remove a breast, usually because of breast cancer. For more information about breast cancer, please see the separate BUPA factsheet, Breast cancer. What's involved?Mastectomy is an operation to remove cancer. In a "simple mastectomy" the breast tissue, some skin, and the nipple are removed as well as the cancer. If the cancer has spread into the underlying muscle, it may have to be removed as well, but this is rare. This operation is called a radical mastectomy Some lymph nodes (lymph glands) may also be removed from your armpit. Lymph nodes are small bean-shaped organs that are part of your immune system. Lymph nodes are usually taken out because cancer tends to spread into them. A sample of nodes is examined under a microscope and, if cancer is present, all of the lymph nodes in the armpit may need to be removed - this is called axillary clearance. What are the alternatives to mastectomy?Depending on the size and position of the lump in your breast, and the type of cancer found, there may be alternatives to mastectomy. For more information about different treatment options, please see the separate BUPA factsheet, Breast cancer. Your doctor will advise you on which treatment is best for you. What happens before mastectomy?You will be able to see a specialist breast care nurse before you are admitted to hospital. The nurse will provide advice and support on the practical and emotional aspects of having a mastectomy, and offer information on bras and prostheses (bra inserts). Your surgeon will discuss how to prepare for your operation and your options for breast reconstruction (see below), taking your personal preferences into account. What should I expect in hospital?Your exact length of stay in hospital will depend on the extent of your surgery and how you feel afterwards. It is likely to be several days. Before surgery, you will talk to your surgeon about the operation and you will be asked to sign a consent form. This confirms that you understand the risks, benefits and possible alternatives to the procedure and have given your permission for it to go ahead. This is a good time to ask any unanswered questions about the operation. You will be asked to follow fasting instructions as your operation will be carried out under general anaesthesia. This means that you will be asleep throughout the procedure and will feel no pain. Typically, you must not eat or drink for about six hours before a general anaesthetic. However, some anaesthetists allow occasional sips of water until two hours beforehand. The operationMastectomy usually takes between one and two hours. The technique your surgeon will use will depend on the type of mastectomy you are having. In a simple mastectomy, once the anaesthetic has taken effect, your surgeon will make a diagonal or horizontal cut across the skin of your breast. He or she will then remove breast tissue and, usually, some of your lymph nodes. Your skin is then reshaped and the cut is closed up with fine stitches. Breast reconstructionIt's often possible to restore the shape of the breast with a breast reconstruction. Breast reconstruction can be done in the same operation as the mastectomy. However, some women decide to have it done months or years after their mastectomy, or not at all. It is entirely your decision. Reconstruction can take many forms. The tissue that is removed in mastectomy can be replaced by a silicone implant or skin and muscles can be taken from other parts of your body such as your back or abdomen (tummy). Your surgeon or breast care nurse will give you more information and advise you on which type of reconstruction is best for you. After the operationWhen you wake up after the operation you will find a drip in your arm. This is to give you fluid while you can't eat and drink. There will also be tubes running out from under your skin in the area of the operation. These drain fluid out of the operation site into a bottle or bag beside your bed. These are usually removed around two to five days after your operation. You will be given painkillers to help relieve any discomfort as the anaesthetic wears off. A physiotherapist will visit you to discuss a programme of exercises to do in hospital and at home. These will help restore your strength and movement in your arm and speed up your recovery. Before discharge, your breast care nurse will give you advice about caring for your stitches, hygiene and bathing. You will also be given an appointment to have your stitches removed if necessary, which will be about seven to 10 days after surgery. If you have not had a breast reconstruction, you will be offered a lightweight bra-insert called a cumfie. You will be given a more substantial prosthesis at a follow-up appointment with your specialist breast care nurse, usually four to six weeks after your operation. Recovering from mastectomyYou may feel some discomfort around the operation site for a few weeks. Once home, you may take more painkillers if needed, as advised by your surgeon or nurse. Your surgeon will give you advice about resuming your normal activities. How soon you are able to return to work will largely depend on your job. You should expect to tire easily to begin with, and it is important to take it easy. For several weeks you should not:
However, it's important to use your arm on the side of the operation to prevent it getting stiff. If you have questions about what you can and can't do, call your breast care nurse for guidance. At your follow-up appointment, your surgeon will advise you when you can resume other normal activities, including sports. Your surgeon will also discuss any further treatment that you may need, such as radiotherapy, chemotherapy or hormone treatment. Deciding on treatmentMastectomy is a commonly performed and generally safe surgical procedure. For most women the benefits are much greater than any disadvantages. However, in order to make a well-informed decision and give your consent, you need to be aware of the possible side-effects and the risk of complications. Side-effects are the unwanted but mostly temporary effects of a successful procedure. For example, feeling sick as a result of the general anaesthetic. Anyone having mastectomy can also expect:
Complications are unexpected problems that can occur during or after the procedure. Most women are not affected. The main complications of any operation are bleeding during or soon after the procedure, infection and an abnormal reaction to the anaesthetic. It's also possible for a blood clot to develop in a vein in the legs - a deep vein thrombosis or DVT. Specific complications of mastectomy are rare but can include:
The chance of complications depends on the type of procedure that you are having and other factors such as your general health. Your surgeon will explain how the risks apply to you. Your surgeon will be very experienced at this procedure but sometimes the cosmetic result can be disappointing. Ask your surgeon to show you some photographs so that you know what to expect. Contact with other women who have had mastectomy can also be helpful before and after the procedure. Information about this kind of support is provided by breast care nurses and from organisations such as Breast Cancer Care (see below). Further information
References
Published by BUPA's health information team, healthinfo@bupa.com, February 2006.
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