If you were recently diagnosed with breast cancer, you may find yourself thinking about a mastectomy and breast reconstruction. A mastectomy involves removing the entire breast with surgery. Removing all of the breast tissue can lower the chances that any cancer cells are left behind after surgery.
In the body, there are many lymph nodes located in and around the breasts, mainly in the underarm area (armpit). Lymph nodes are an important part of the immune system that carry white blood cells around the body.
When breast cancer begins to spread, the cancer will first move into nearby lymph nodes. The first lymph node (or nodes) that the cancer cells move into are the sentinel nodes. During a mastectomy, the breast surgeon will remove these affected lymph nodes to stop cancer from spreading further. This procedure is called sentinel node mapping.
A simple mastectomy (also known as a total mastectomy) removes all of the breast tissue but does not remove any lymph nodes from the underarm area. In some cases, lymph nodes can still be taken out with a simple mastectomy if the nodes are in the breast tissue that is removed during surgery.
People with breast cancer will have a simple mastectomy if they have a certain type of breast cancer known as ductal carcinoma in situ or if they want a prophylactic mastectomy.
In some cases, people who are more likely to develop breast cancer at some point in their lives may choose to have their breasts removed before cancer has a chance to form. Removing the breast tissue before cancer develops is called a prophylactic mastectomy. This mastectomy is often done when there is a strong family history of breast cancer or if a person carries a genetic mutation in the BRCA1 or BRCA2 genes.
According to the National Cancer Institute, prophylactic surgery can reduce the risk of breast cancer by at least 95 percent in women with BRCA mutations and up to 90 percent in those with a family history of the condition.
Surgery, especially a mastectomy, is a serious choice and can affect your life in many ways. If you are considering a prophylactic mastectomy to lower your chances of developing breast cancer, your doctor will be able to help guide you.
A partial mastectomy removes all of the cancerous breast tissue and some normal tissue surrounding it while leaving the breast. This surgery is similar to a lumpectomy, which only removes part of the breast. However, more tissue is typically removed during the partial mastectomy.
A modified radical mastectomy combines a simple mastectomy with removal of axillary lymph nodes or axillary lymph node dissection (ALND). The surgeon will remove the entire breast and the nearby lymph nodes. The muscles underneath the breast are not removed.
This procedure is done in most people with invasive breast cancer so that the lymph nodes can be tested for cancer. Cancer found in the nodes may suggest that cancer has spread elsewhere in the body.
A radical mastectomy is an extensive surgery that removes the entire breast, all surrounding lymph nodes, and the chest wall muscles underneath the breast.
The procedure is recommended only for people who have cancer in the chest muscles underneath the breast. Radical mastectomy used to be a common surgery for treating breast cancer, but it is rarely done now because the modified radical mastectomy is just as effective.
During a nipple-sparing mastectomy, the entire breast is removed, but the nipple and areola are left intact.
When thinking about your treatment for breast cancer, surgery is likely to be an option. Before you and your doctor make a decision, it’s important to weigh your options and think about the impact your choices will have on your health and emotional well-being.
A mastectomy is different from other breast-conserving surgeries (such as a lumpectomy, which saves most of the breast). Many people choose a specific surgery for personal reasons in addition to medical reasons. For example, those who are at a higher risk of developing breast cancer may choose to have a double mastectomy (removal of both breasts).
According to the American Cancer Society, your doctor may recommend a mastectomy if you:
Many people who have had a mastectomy recommend bringing comfortable clothing that is easy to put on and take off. Button-up shirts, zip-up sweatshirts, and similar clothing is ideal because you will likely not be able to lift your arms or move much.
During the surgery, you will be under general anesthesia. A mastectomy with an ALND takes between two to three hours. Once the procedure is done, you will wake up in a recovery room where you are closely monitored by nurses and doctors. You will then be moved to another room for the rest of your hospital stay.
A mastectomy is major surgery, and you should expect to be in the hospital for several days to recover. You will have physical limitations after surgery — for example, you will not be able to lift heavy objects. Be sure to make a plan for your recovery with these limitations in mind.
The day after surgery, a member of your health care team will show you different arm exercises that will help prevent arm and shoulder stiffness. These exercises also help prevent scar tissue from forming. You can expect your chest muscles and arms to be sore after the surgery, and you will typically receive medication to alleviate the pain.
After you are discharged from the hospital, you can expect to spend a few weeks at home recovering. It will be important to:
During a mastectomy, lymph nodes can also be removed to prevent the spread of cancer. When the nodes are removed, however, there is no place for the lymph fluid to drain, and the fluid begins to build up. This fluid buildup creates swelling in the affected area known as lymphedema. The more lymph nodes that are removed during surgery, the more likely lymphedema is to develop.
After a mastectomy, you may consider having reconstructive surgery to rebuild and restore the chest’s appearance. Everyone undergoing a mastectomy will have different thoughts on reconstruction, and it is important to choose the best option for yourself.
Breast reconstruction can be done during the mastectomy or at a later time. If you are considering reconstruction, be sure to talk to your breast surgeon and a plastic surgeon before your mastectomy. Knowing your plans and expectations in advance helps your surgical team make the best treatment plan for you.
If you would like to have the appearance of a breast without surgery, you can also wear a breast prosthesis (also known as a breast form). Prostheses are typically gel or foam inserts that fit into a bra or bathing suit that mimic the look of breast tissue. There are many types of breast prostheses, giving you plenty of options to find something comfortable and flattering.
Taking care of your mental health and well-being is an important part of recovery and cancer survivorship. It is common to experience symptoms of depression and anxiety with cancer and surgery. If you begin feeling down, speak with your doctor. They will be able to refer you to mental health professionals who can help.
A mastectomy is major surgery, and you are not alone in going through the procedure. Support groups such as MyBCTeam can provide a community for you to share your emotions and experiences with others who have also had mastectomies or other surgeries.
MyBCTeam is the social network for people with breast cancer. More than 53,000 members come together to ask questions, give advice, and share their stories with others who understand life with breast cancer.
Have you had a mastectomy to treat your breast cancer? Share your experience in the comments below, or start a conversation by posting on MyBCTeam.