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Breast removal (mastectomy) Q&As

Published by Bupa's health information team, June 2009.

Answers to questions about breast removal (mastectomy)

This section contains answers to common questions about this topic. Questions have been suggested by health professionals, website feedback and requests via email.

 

My surgeon has recommended I have a mastectomy. What are the alternatives?

Your surgeon may recommend a mastectomy if you have been diagnosed with breast cancer. This decision will be based on the type of cancer you have, the size of the lump and its exact position, and how much surrounding tissue needs to be removed. A mastectomy may also be recommended if you have a strong family history of breast cancer. There are possible alternatives to mastectomy, for example, a lumpectomy - the removal of a lump.

Explanation

A mastectomy is a surgical procedure to remove the whole breast, including the nipple. It's usually performed to treat breast cancer. However, if you're at a very high risk of developing breast cancer because of an inherited gene, your surgeon may recommend a mastectomy to reduce your risk. This is known as prophylactic mastectomy.

There are different types of mastectomy ranging from simple mastectomy, where only the breast tissue is removed, to radical mastectomy, which removes all the breast tissue, the lymph nodes (lymph glands) in your armpit and the underlying muscle. Lymph nodes are glands throughout your body that are part of your immune system.

There are possible alternatives to mastectomy. For example, a lumpectomy is the removal of the breast lump (tumour) and some surrounding tissue, rather than the whole breast, and is usually followed by treatment with radiotherapy. This type of surgery is also referred to as breast conserving therapy. However, it may not be the most effective surgery for you. Your surgeon will discuss which surgery is best for you and the decision will depend on a number of factors including the size and position of the lump in your breast, the type of cancer found, whether any surrounding tissue needs to be removed and the size of your breast. He or she may recommend a mastectomy if the breast lump is large in proportion to the size of your breast, if the lump is in the centre of your breast or directly behind your nipple, or if there are multiple areas of cancer cells in your breast.

Mastectomy may also be necessary if you have several pre-cancerous areas (ductal carcinoma in situ, or DCIS). DCIS is a non-invasive form of breast cancer where the abnormal cell growth is limited to inside the breast ducts.

Having a mastectomy can be a difficult decision to make. Before you have your operation, you should make sure you have fully discussed with your surgeon why they have recommended a mastectomy for you and what the surgery involves.

Further information

Sources

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What is breast reconstruction and who can have it?

Breast reconstruction is surgery to make a new breast after a mastectomy. Most women who have had an entire breast removed can have breast reconstruction.

Explanation

If you have a mastectomy, your surgeon will remove all of your breast tissue. It's often possible to restore the shape of your breast with a breast reconstruction. You can have breast reconstruction in the same operation as the mastectomy (immediate reconstruction) depending upon other treatment you may need, or at a later date (delayed reconstruction).

Reconstruction can take many forms. The tissue that's removed in a mastectomy can be replaced by a silicone implant under the skin and muscle that covers your chest. Alternatively, a new breast shape can be made from tissue from other parts of your body, such as your back or abdomen (tummy). Most women who have had an entire breast removed can have breast reconstruction. If you're well enough, you can have breast reconstruction at any age, even if you have large breasts, have had a radical mastectomy or have had radiotherapy.

There are benefits and drawbacks of immediate versus delayed reconstruction. For example, if you have immediate reconstruction, this will give you a new breast straight away and may help you cope better with losing your breast. However, by delaying the reconstruction, you will have more time to consider your options. Also, if you are having radiotherapy after your surgery you won't be able to have any type of implant reconstruction during your mastectomy as this can be damaged by the radiotherapy. Ask your surgeon or breast care nurse for more information. He or she will advise you on which type of reconstruction is best for you and when this can take place, taking into account your personal preferences.

Further information

Sources

  • Management of breast cancer in women: A national clinical guideline. Scottish Intercollegiate Guidelines Network, December 2005. www.sign.ac.uk
  • Breast reconstruction. Cancer Research UK. www.cancerhelp.org.uk, accessed 6 February 2008
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Will having a mastectomy mean I don't need to have radiotherapy?

Radiotherapy isn't usually necessary following your mastectomy. However, this will depend on the type of mastectomy you have had, the size of the lump and whether the cancer cells have spread to the surrounding lymph nodes (lymph glands). Lymph nodes are glands throughout your body that are part of your immune system.

Explanation

Radiotherapy is a cancer treatment that uses radiation to kill the cancer cells and may be used to reduce the risk of the cancer coming back (recurrence) following breast cancer surgery. It's not usually necessary to have radiotherapy if you have had a mastectomy. However, after a mastectomy, you might be given radiotherapy to your chest area if the lump is large or the cancer cells have spread to the lymph glands under your arm. You might also be given radiotherapy to the lymph glands above your collarbone.

Your surgeon will discuss your treatment with a radiotherapist (a doctor specialising in radiation therapy) after your operation and will advise you if radiotherapy is necessary for you.

Further information

Sources

  • Radiotherapy. Breast Cancer Care. www.breastcancercare.org.uk, accessed 12 February 2008
  • Management of breast cancer in women: A national clinical guideline. Scottish Intercollegiate Guidelines Network, December 2005. www.sign.ac.uk
  • Treating breast cancer with surgery. Macmillan Cancer Support. www.macmillan.org.uk, accessed 5 February 2008
  • Types of breast cancer surgery. Cancer Research UK. www.cancerhelp.org.uk, accessed 12 February 2008
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This information was published by Bupa's health information team and is based on reputable sources of medical evidence. It has been peer reviewed by Bupa doctors. The content is intended for general information only and does not replace the need for personal advice from a qualified health professional.

Publication date: June 2009

Breast removal (mastectomy) factsheet

 

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