What Is a Mastectomy?

Everything to know about this common surgery for breast cancer treatment including types of mastectomies, recovery time, and more

Most women diagnosed with breast cancer will undergo some type of surgery as part of their treatment plan. One of the main options is a mastectomy, a procedure that surgeons have been performing for hundreds of years to remove one or both breasts. Choosing to have a mastectomy isn’t easy, of course: You and your doctor will need to discuss many factors to help you decide if a mastectomy is the right option for your situation.

Read on to learn when the procedure is and isn’t recommended, the various types of mastectomies performed, and what you can expect during the recovery process.

What is a mastectomy?

The term mastectomy comes from the Greek word for breast: “mastos.” It’s a surgical procedure to remove all the tissue from one or both breasts. The operation traditionally included removal of the nipple, areola, and breast skin, but you may be a candidate for newer types of mastectomies that allow you to keep them.

A mastectomy may also involve more than removal of the breast and may be combined with other procedures. For example, if your cancer has spread from the breast to the lymph nodes under your arm, your surgeon may remove them during your mastectomy. In rare cases, the pectoral (chest wall) muscles are also excised in what’s called a radical mastectomy, detailed below. And if you opt for breast reconstruction, your surgeon can perform the procedure at the same time as your mastectomy.

Why are mastectomies performed?

A mastectomy is performed as a treatment for breast cancer since the procedure is a physical removal of cancer cells and tumors from breast tissue; this can also help prevent breast cancer from spreading (metastasizing) to other sites in the body. This is particularly important since once the cancer has spread from the breasts and nearby lymph nodes—a.k.a. stage 4 or metastatic breast cancer—it may be treated but it is no longer curable. Mastectomy may also be recommended to prevent breast cancer in women who are at high risk of developing the disease.

What stage of breast cancer requires a mastectomy? It’s an option for nearly every stage and type of the disease, including:

• Stage 0, noninvasive breast cancer: ductal carcinoma in situ (DCIS)
• Early-stage breast cancer (stages 1 and 2)
• Locally advanced breast cancer (stage 3)
• Locally recurrent breast cancer
• Inflammatory breast cancer following chemotherapy
• Paget’s disease

Disease stage isn’t the only factor doctors consider when recommending a mastectomy versus a lumpectomy, the other main type of breast cancer surgery in which only a portion of the breast tissue is removed. Lumpectomies are considered breast-conserving surgery since a small lump is generally removed, preserving most of the breast tissue. A lumpectomy or mastectomy is almost always followed by radiation and so avoiding them may be preferable if you’re pregnant and don’t want to expose the fetus to radiation or if you’ve previously been treated with radiation and the cancer has recurred.

Your doctor may also recommend a mastectomy if:

• Your tumor is larger than two inches across or is large compared to the overall size of your breast.
• There are two or more tumors located in different areas of your breast that aren’t close enough to each other to be removed together.
• You have malignant microcalcifications throughout your breast.
• You have undergone a lumpectomy, but there is still cancerous tissue at the edge (margins) of the removal site.
• You have a connective tissue disease such as lupus or scleroderma that can make you particularly sensitive to the side effects of radiation.

Mastectomies are not recommended for some women, such as those with metastatic breast cancer, since it has already spread beyond the breast. Your doctor may also advise against a mastectomy if you’re older, have other major medical conditions, are at a high risk of dying from surgery or anesthesia, or if the procedure is extremely difficult to perform due to the size of the cancer.

What’s a unilateral mastectomy?

A unilateral mastectomy refers to the removal of tissue from one breast. Your surgeon may recommend this procedure if your cancer is only in one breast and you don’t have a high risk of cancer occurring in both breasts.

What’s a bilateral mastectomy?

During a bilateral mastectomy—also called a double mastectomy—the surgeon removes both of your breasts. Most breast cancer patients won’t need a double mastectomy, but it may be necessary in certain circumstances, including if you have cancer in both breasts and/or you have previously received radiation to your chest.

Genetics and family history are also a consideration when choosing between bilateral mastectomy or unilateral mastectomy. You may benefit from a prophylactic/preventive bilateral mastectomy if you have genetic mutations that increase your risk of breast cancer (BRCA1, BCRA2, etc.) and/or you have several close family members who have been diagnosed with breast cancer at a young age. (See “What’s a prophylactic mastectomy?” below.)

Some women with cancer in one breast opt for a double mastectomy to make their breasts more symmetrical. Others may remove both breasts out of concern the cancer will occur in the other breast. But unless you’re at high risk of developing cancer in the healthy breast, there’s no overall survival benefit in removing both breasts.

What are the main types of mastectomy?

There are four main types of mastectomies, and the best approach for you is determined by factors such as your age, overall health, tumor size and stage, lymph node involvement, and more. Options include the following:

Simple (or total) mastectomy: This is the most common type of mastectomy. The surgeon removes the breast tissue and possibly the breast skin, nipple, and areola as well. A total mastectomy is most likely to be recommended if the cancer has not spread beyond your breast or you’re removing your breasts to lower your risk of developing breast cancer.

Skin-sparing mastectomy: This type of mastectomy is a modified version of a simple mastectomy that preserves as much of the breast skin as possible. Most women are candidates for this procedure, but it’s not recommended for those who aren’t getting immediate breast reconstruction because the remaining skin may fold and contract. It may also be unadvisable if your tumors are large or close to the surface of the skin.

Nipple-sparing mastectomy: If there is no cancer in your nipple or the tissue just beneath it, you may be able to have a nipple-sparing mastectomy. However, it is only recommended if you’re undergoing immediate breast reconstruction.

Modified radical mastectomy: This procedure is usually performed in women whose breast cancer has spread to the lymph nodes, as both breast tissue and lymph nodes are removed during a modified radical mastectomy.

What about radical mastectomy?

Rarely, a woman may need to undergo a radical mastectomy, meaning the entire breast, axillary (underarm) lymph nodes, and the pectoral (chest wall) muscles are removed.

The procedure, first performed in 1882, was the standard of care for treating breast cancer for close to a century. While effective, the procedure was aggressive and highly disfiguring, and it was virtually abandoned by the 1970s.

Thanks to major advances in our understanding of breast cancer biology, chemotherapy, radiation therapy, etc., more conservative procedures like simple mastectomies and lumpectomies with radiation have largely replaced radical mastectomies. The only reason they may be recommended now is if breast tumor is growing into the chest muscles.

What’s a prophylactic mastectomy​?

While mastectomies are most often performed to treat breast cancer, some women at high risk of breast cancer choose to have a prophylactic mastectomy, also called a preventive mastectomy, to lower their chance of developing the disease.

If genetic testing reveals that you carry a genetic mutation associated with a high risk of breast cancer (BRCA1, BCRA2, TP53, PTEN), undergoing a prophylactic mastectomy can decrease your risk dramatically. Research shows that a bilateral prophylactic mastectomy reduces the risk of breast cancer by 95 percent in patients with a BRCA1 or BRCA2 mutation, and by 90 percent in those with a strong family history of breast cancer.

Other reasons you may choose to undergo a prophylactic mastectomy include:

• Having an immediate family member (parent, sibling, child) who had breast cancer, particularly if they developed the disease before age 50
• A personal history of breast cancer. If you already had the disease and underwent a unilateral mastectomy to treat it, you may choose to remove the other breast.
• Have previously undergone radiation therapy to your chest (particularly between the ages of 10 and 30), which increases your risk of breast cancer

What’s the mastectomy recovery process like?

It typically takes three to four weeks to recover from a mastectomy, regardless of the type of mastectomy you have. Mastectomy recovery mostly occurs at home, since many patients can go home the same day of their surgery or the following day. However, you may need to stay in the hospital for up to four or five days if you had a mastectomy with immediate autologous reconstruction (breast reconstruction using your own tissue).

When you wake after surgery, you may not feel much pain because the surgeon has injected a lot of numbing medication into your tissues. If you had immediate breast reconstruction, you may notice tightness and pressure in your chest. As the numbing medication wears off, your doctor may prescribe painkillers, though many women can get relief from over-the-counter pain medication such as ibuprofen and acetaminophen.

When you’re ready to leave the hospital, your doctor will provide you with a list of instructions for home recovery. It includes information about:

• Caring for your dressings and surgical site. You’ll be given instructions on how to change your bandages and identify signs of infection (swelling, redness, pus, etc.)
• Emptying your surgical drains. In most cases, drains are placed following a mastectomy in areas where fluid may accumulate, typically at the surgical site and in your armpit if you had lymph nodes removed. A nurse will show you how to empty the drains, keep them in place, ensure the insertion site stays clean and dry, etc. Drains typically stay in place for up to three weeks.
• Performing exercises to reduce side effects. This includes movements to help keep your arm and shoulder flexible since these areas can stiffen following a mastectomy. You may be able to do them yourself or your doctor might have you work with a physical therapist, occupational therapist, or cancer exercise specialist.
• Following temporary restrictions. These include no heavy lifting or lifting your arm above your head and refraining from bathing/swimming and driving. Your doctor will let you know when you can safely resume these activities.
• Wearing mastectomy bras. These are designed to have drains pinned to them and keep you more comfortable as you recover. Many insurance companies cover the cost of mastectomy bras.
• Knowing when to call your doctor. Signs you may need medical attention include pain that doesn’t respond to medication, fever more than 100 °F or chills, excessive bleeding or swelling, redness outside the dressing, and discharge or bad odor from the surgical site.