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Breast removal (mastectomy)

Published by Bupa's health information team, August 2008.

This factsheet is for women who are planning to have a mastectomy, or who would like information about it.

A mastectomy is an operation to remove a breast, usually because of breast cancer or occasionally because there is a strong family history of breast cancer.

Your care will be adapted to meet your individual needs and may differ from what is described here. So it's important that you follow your surgeon's advice.

About mastectomy
What are the alternatives to mastectomy?
Preparing for your operation
About the operation
What to expect afterwards
Recovering from mastectomy
What are the risks?
Help and support
Questions and answers
Related topics
Further information
Sources

About mastectomy

In a simple mastectomy the breast tissue, some skin, and the nipple are removed as well as the cancer.

Lymph nodes (lymph glands) may also be removed from your armpit. Lymph nodes are glands throughout your body that are part of your immune system. A sample from the lymph nodes is examined to see if cancer has spread into them. If cancer is present your surgeon may recommend removing them. This is a modified radical mastectomy (also known as total mastectomy and axillary clearance).

If the cancer has spread into the underlying muscle, this may have to be removed as well. This is called a radical mastectomy, but it's rarely done.

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. Your surgeon will advise you which treatment is best for you.

Preparing for your operation

You will be able to see a specialist breast care nurse before you are admitted to hospital. Your 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. For example, if you smoke you will be asked to stop, as smoking increases your risk of getting a wound infection and slows your recovery.

You will need to stay in hospital for up to 10 days depending on the type of surgery you have.

A mastectomy is done under general anaesthesia. This means you will be asleep during the operation.

You will be asked to follow fasting instructions. 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.

At the hospital your nurse will explain how you will be cared for during your stay. Your nurse may check your heart rate and blood pressure, and test your urine.

Your surgeon will usually ask you 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.

You may be asked to wear compression stockings to help prevent blood clots forming in the veins in your legs. You may need to have an injection of an anti-clotting medicine called heparin as well as, or instead of, stockings.

About the operation

Mastectomy 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 reconstruction

It's often possible to restore the shape of your breast with a breast reconstruction. This can be done at the same time as the mastectomy or at a later date. Your surgeon will advise you which type of reconstruction is best for you.

What to expect afterwards

When you wake up after your operation you will find a drip in your arm. There will also be tubes running out from under your skin around the operation site, which drain excess fluid from the area. These are usually removed within a few days of your operation.

You will need to rest until the effects of the anaesthetic have passed. Your nurse will give you painkillers to help relieve any discomfort as the anaesthetic wears off.

A physiotherapist (a specialist in movement and mobility) will visit you to discuss a programme of exercises for you. These will help restore strength and movement in your arm and speed up your recovery.

If you haven't had a breast reconstruction, you will be offered a lightweight foam bra-insert, called a cumfie or softie. Once your wound has healed (after about four to six weeks), you will be fitted for a permanent, soft plastic (silicone) false breast to wear inside your bra. This will closely match the size and shape of your other breast.

Your nurse will give you some advice about caring for your healing wounds before you go home. You may be given a date for a follow-up appointment.

Dissolvable stitches will disappear on their own in seven to 10 days. Non-dissolvable stitches are removed a week after surgery.

Recovering from mastectomy

If you need pain relief, you can take over-the-counter painkillers such as paracetamol or ibuprofen. Follow the instructions in the patient information leaflet that comes with the medicine and ask your pharmacist for advice.

General anaesthesia temporarily affects your co-ordination and reasoning skills, so you must not drive, drink alcohol, operate machinery or sign legal documents for 48 hours afterwards. If you are in any doubt about driving always follow your surgeon's advice and please contact your motor insurer so that you are aware of their recommendations.

Your surgeon will advise you about resuming your normal activities. You will tire easily to begin with, so it's important to take it easy and eat a balanced diet.

While your wound is healing you shouldn't:

do strenuous exercise
lift heavy weights or make repetitive movements (eg ironing) with the arm on your affected side
drive

It's important to use your arm on the side of the operation to prevent it getting stiff, so you should continue to do the exercises recommended by your physiotherapist.

Your surgeon will also discuss any further treatment that you may need, such as radiotherapy, chemotherapy or hormone treatment.

What are the risks?

Mastectomy is commonly performed and generally safe. However, in order to make an informed decision and give your consent, you need to be aware of the possible side-effects and the risk of complications of this procedure.

Side-effects

These are the unwanted, but mostly temporary effects of a successful treatment, for example feeling sick as a result of the general anaesthetic and swelling around your wound.

Side-effects of a mastectomy include:

pain or tightness in your breast area and in your arm and shoulder, especially if you have had all your lymph glands removed
numbness and tingling in your upper arm - this usually goes away within a few months of your operation, but you should contact your breast care nurse if it doesn't
a scar - the appearance will depend on the type of surgery. Ask your surgeon what to expect
fluid collection (seroma) around your operation site - this is usually absorbed within a few weeks but may need to be drained if it's large or uncomfortable
infection of the operation site - you may need antibiotics to treat an infection

Complications

This is when problems occur during or after the operation. Most women aren't affected. The possible complications of any operation include an unexpected reaction to the anaesthetic, excessive bleeding or developing a blood clot, usually in a vein in the leg (deep vein thrombosis, DVT).

Specific complications of mastectomy are rare but can include:

pain from your armpit to your hand (cording). It can be treated with physiotherapy and antibiotics, but may last months and may re-occur
a build up of fluid (lymphoedema) in your arm making it swollen and painful - it can occur months or years after surgery
pain and sensations (such as numbness or "pins and needles") around the operation site, which can last for years after surgery (post-mastectomy pain syndrome)

The exact risks are specific to you and will differ for every person, so we have not included statistics here. Ask your surgeon to explain how these risks apply to you.

Help and support

Contact with other women who have had a mastectomy can be helpful before and after the procedure. Ask your breast care nurse for information. You may also find it helpful to talk to someone from a support organisation such as Breast Cancer Care.