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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 is an approach to lower the chances that cancer cells are left behind after surgery. Every year in the United States, more than 100,000 women have a mastectomy, according to Brigham and Women’s Hospital. On MyBCTeam, more than 12,000 members have reported undergoing a mastectomy to remove one or both breasts.
Many people are given the choice between a mastectomy or a lumpectomy. The choice of surgery is ultimately up to you and your surgeon. With the advice of their physician, some choose a mastectomy over a lumpectomy based on the other treatments needed. Studies show that both types of breast cancer surgery are equally effective, and which procedure is used does not affect long-term survival.
There are many lymph nodes located in and around the breasts, mainly in the 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, 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. The procedure to identify the first nodes that the breast drains to is called sentinel node mapping.
When thinking about your treatment for breast cancer, surgery is likely to be an option. Before you and your doctor make a decision, weigh your options and think about the impact your choices will have on your health and emotional well-being.
A mastectomy is different from breast-conserving surgery (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:
Breast cancer treatment options depend on the stage of your cancer. For those with stage 1 breast cancer, surgery is typically used as a first-line treatment. A mastectomy may be done along with a sentinel lymph node biopsy (SLNB) to confirm that cancer has not spread to the lymph nodes. After your mastectomy, your oncologist may recommend radiation therapy, although this is significantly less common than after a lumpectomy. The decision will be based on the type of cancer you have and previous treatment you’ve received.
Stage 2 breast cancer can also be treated with a mastectomy. Radiation therapy at this stage after surgery is more common, especially if cancer cells are found in the SLNB. If you were treated with hormone therapy or chemotherapy before surgery, you may also be a candidate for radiation therapy after surgery.
Stage 3 breast cancer is diagnosed when the tumor is larger than two inches, or if cancer has spread to nearby tissues or lymph nodes. In this case, oncologists typically recommend shrinking the tumor with chemotherapy before surgery (known as neoadjuvant chemotherapy). When the tumor does not shrink, the surgeon performs a mastectomy to try to remove most of the cancer cells. Afterward, radiation therapy and/or chemotherapy are typically given to help eliminate any remaining cancer cells.
There are six types of mastectomy. The type used depends on the kind of breast cancer and if any nearby lymph nodes are affected.
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 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 gene.
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 the 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 cases of 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 decades ago, but it is rarely done today 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.
In a skin-sparing mastectomy, all of the breast tissue is removed. The nipple and areola complex are also removed. However, the goal is to preserve the overlying skin of the breast, to allow for a more cosmetic reconstruction with an implant.
Many people who have had a mastectomy recommend packing comfortable clothing that is easy to put on and take off. Button-up shirts, zip-up sweatshirts, and similar clothing are ideal because you will likely not be able to lift your arms or move much after the procedure.
During 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 will be 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 overnight or for several days to recover. You will have physical limitations after surgery — for example, you will not be able to lift heavy objects or be able to drive a car. 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 lessen 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 do the following:
Post-mastectomy recovery can be uncomfortable, but many MyBCTeam members offer suggestions for helpful things you need after a mastectomy. Mastectomy pillows are specially designed to go under the arm on your surgical side and protect the incision, making it easier to lie down. Others recommend comfortable shirts and bras that support your surgical site without squeezing too much.
If you need help around the house with daily tasks, ask a family member or friend for extra support. You may have some activity restrictions after your mastectomy. Knowing your limits after surgery is important, and letting your body heal is the priority.
During a mastectomy, lymph nodes can also be removed to keep cancer from spreading. 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.
Taking care of your mental health and well-being is an important part of recovery and cancer survivorship. It is common to experience 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’re not alone when 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 58,000 members come together to ask questions, give advice, and share their stories with others who understand life with breast cancer.
Have you undergone a mastectomy to treat your breast cancer? Share your experience in the comments below, or start a conversation by posting on MyBCTeam.
Jonas DeMuro, M.D. is a critical care surgeon on Long Island, NY. Learn more about him here.
Emily Wagner, M.S. holds a Master of Science in biomedical sciences with a focus in pharmacology. She is passionate about immunology, cancer biology, and molecular biology. Learn more about her here.
