Why might I need a mastectomy?
A mastectomy may be done as part of treatment for breast cancer. Your physician will likely advise you to have a mastectomy if:
- The tumor is large
- The tumor involves more than one area of your breast
- Using radiation therapy is not advised
The size of your breast may also help determine the type of mastectomy that is done.
In some cases, women with a high risk of breast cancer may want to have a mastectomy before cancer develops; this includes women with genes linked to breast cancer, as the BRCA1 or BRCA2 genes. In these cases, a mastectomy is done to try to keep breast cancer from occurring.
Types of mastectomy procedures
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Total (simple) mastectomy
This procedure removes the whole breast, including the nipple, the areola and most of the overlying skin.
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Modified radical mastectomy
This procedure removes the entire breast which includes the nipple, areola, the overlying skin and the lining over the chest muscles. Some of the lymph nodes under the arm are also removed. Breast cancer often spreads to these lymph nodes and can then spread to other parts of the body. In some cases, part of the chest wall muscle is also removed.
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Radical mastectomy
This procedure removes the entire breast, including the nipple, the areola, the overlying skin, the lymph nodes under the arm and the chest muscles under the breast. For many years, this was the standard surgery, but today it is rarely done. It may be advised when breast cancer has spread to the chest muscles.
Breast reconstruction surgery after mastectomy
You may worry about how your breast will look after a mastectomy. In most cases, breast reconstruction surgery can be done to rebuild the breast so it is the size and shape of your other breast. Many women have breast reconstruction done at the same time as the mastectomy; some wait and have it done as a second surgery later. Always talk with your physician about reconstructive surgery options.
What are the risks of a mastectomy?
Possible complications of mastectomy include:
- Short-term (temporary) breast swelling
- Breast soreness
- Hardness due to scar tissue that can form at the site of the cut
- Wound infection or bleeding
- Swelling of the arm, if lymph nodes were removed
- Pain in the breast that has been removed, this is called phantom breast pain and can be helped with medications, exercise or massage
A clear fluid (seroma) is often found in the breast after a mastectomy. If this bothers you, it can be drained in the surgeon’s office. If needed, it can be treated with compression, or you may get an injection that helps to harden the space in the breast to help keep fluid from collecting there.
You will likely have a scar at the mastectomy site and may also have a pulling feeling near or under your arm after surgery.
Depression and feelings of loss of sexual identity may occur after a mastectomy.
It is rare that breast reconstruction surgery causes complications, but problems may happen as you are healing which may interfere with radiation or chemotherapy treatment.
There may be other risks depending on your specific medical condition. Be sure to discuss any concerns with your physician before the surgery.
How do I get ready for a mastectomy?
- Your physician will explain the procedure to you, and give you an opportunity to ask any questions you may have.
- You will be asked to sign a consent form giving the physician permission to do the procedure; read the form carefully and ask questions if something is not clear to you.
- Your physician will take your medical history and give you a physical exam; this is to be sure you are in good health before the surgery. Blood tests and other labs may also be taken.
- You will be asked not to eat or drink anything for some time before the surgery; specific instructions will be given by your surgeon.
- Tell your physician if you are pregnant or think you may be pregnant.
- Tell your physician if you are sensitive or allergic to any medications, latex, tape and anesthesia medicines (local and general).
- Tell your physician about all the medications you currently take; including over-the-counter and prescription medicines, vitamins, herbs and other supplements.
- You may be given a sedative to help you relax before the procedure.
- Your physician may have other instructions for you based on your medical condition.
What happens after a mastectomy?
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In the hospital
After the procedure, you will be taken to the recovery room and monitored closely. Your recovery process will vary depending on the mastectomy you had done and the type of anesthesia you are given. Once your blood pressure, pulse and breathing are stable and you are alert, you will be taken to your hospital room.
You will likely stay in the hospital for one to three days after your procedure; this will depend on the extent of your surgery and if you also had breast reconstruction done.
Radiation therapy or chemotherapy may be needed after a mastectomy; your physician will advise you about this depending on your particular situation.
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At home
Once you’re home, keep the surgical area clean and dry; your physician will give you specific bathing instructions. Unless otherwise instructed, the narrow strips of tape across the incision can get wet during the shower. You may be directed to replace a wet dressing with a clean, dry one.
You will be instructed about how to take care of the drainage tube; this should be removed after about two weeks at the first follow-up exam.
The amount of pain you have will vary depending on the amount and location of tissue removed during surgery; most soreness may last a few days. Take a pain reliever as advised by your physician. Aspirin and some other pain medicines may increase your chance of bleeding; be sure to only take recommended medicines.
If lymph node removal was done with your mastectomy, your physician may want you to do certain exercises which will help limber up your shoulder and arm area and help prevent swelling. Soreness after lymph node removal can cause you to keep your arm and shoulder very still making your arm and shoulder stiffness, but overdoing the exercises can also hurt you. So start the exercises slowly; do them regularly and progress a little each day. You may be advised to do these exercises even if you didn’t have lymph node removal.
Tell your physician
Tell your physician if you have any of the following:
- Fever or chills
- Redness, swelling or bleeding or other drainages from the incision site
- Increased pain around the incision site
- Swelling, numbness or tingling of the affected arm
If you have problems dealing with your recovery, your physician may refer you to a volunteer agency or group for support.
Your physician may give you other instructions depending on your situation.