What you can expect
A mastectomy is an umbrella term used for several techniques to remove one or both breasts. In addition, the surgeon may also remove nearby lymph nodes to determine whether the cancer has spread.
During an axillary node dissection, the surgeon removes a number of lymph nodes from your armpit on the side of the tumor.
In a sentinel lymph node biopsy, your surgeon removes only the first few nodes into which a tumor drains (sentinel nodes).
Lymph nodes removed during a mastectomy are then tested for cancer. If no cancer is present, no further lymph nodes need be removed. If cancer is present, the surgeon will discuss options, such as radiation to your armpit. If this is what you decide to do, no further lymph nodes will need to be removed.
Removing all of the breast tissue and most of the lymph nodes is called a modified radical mastectomy. Newer mastectomy techniques remove less tissue and fewer lymph nodes.
Other types of mastectomy include:
- Total mastectomy. A total mastectomy, also known as a simple mastectomy, involves removal of the entire breast, including the breast tissue, areola and nipple. A sentinel lymph node biopsy may be done at the time of a total mastectomy.
Skin-sparing mastectomy. A skin-sparing mastectomy involves removal of all the breast tissue, nipple and areola, but not the breast skin. A sentinel lymph node biopsy also may be done. Breast reconstruction can be performed immediately after the mastectomy.
A skin-sparing mastectomy may not be suitable for larger tumors.
- Nipple-sparing mastectomy. A nipple- or areola-sparing mastectomy involves removal of only breast tissue, sparing the skin, nipple and areola. A sentinel lymph node biopsy also may be done. Breast reconstruction is performed immediately afterward.
Before the procedure
Your doctor or nurse will tell you when to arrive at the hospital. A mastectomy without reconstruction usually takes one to three hours. The surgery is often done as an outpatient procedure, and most people go home on the same day of the operation.
If you're having both breasts removed (a double mastectomy), expect to spend more time in surgery and possibly an additional day in the hospital. If you're having breast reconstruction following a mastectomy, the procedure also takes longer and you may stay in the hospital for a few additional days.
If you're having a sentinel node biopsy, before your surgery a radioactive tracer and a blue dye are injected into the area around the tumor or the skin above the tumor. The tracer and the dye travel to the sentinel node or nodes, allowing your doctor to see where they are and remove them during surgery.
During the procedure
A mastectomy is usually performed under general anesthesia, so you're not aware during the surgery. Your surgeon starts by making an elliptical incision around your breast. The breast tissue is removed and, depending on your procedure, other parts of the breast also may be removed.
Regardless of the type of mastectomy you have, the breast tissue and lymph nodes that are removed will be sent to a laboratory for analysis.
If you're having breast reconstruction at the same time as a mastectomy, the plastic surgeon will coordinate with the breast surgeon to be available at the time of surgery.
One option for breast reconstruction involves placing temporary tissue expanders in the chest. These temporary expanders will form the new breast mound.
For women who will have radiation therapy after surgery, one option is to place temporary tissue expanders in the chest to hold the breast skin in place. This allows you to delay final breast reconstruction until after radiation therapy.
If you're planning to have radiation therapy after surgery, meet with a radiation oncologist before surgery to discuss benefits and risks, as well as how radiation will impact your breast reconstruction options.
As the surgery is completed, the incision is closed with stitches (sutures), which either dissolve or are removed later. You might also have one or two small plastic tubes placed where your breast was removed. The tubes will drain any fluids that accumulate after surgery. The tubes are sewn into place, and the ends are attached to a small drainage bag.
After the procedure
After your surgery, you can expect to:
- Be taken to a recovery room where your blood pressure, pulse and breathing are monitored
- Have a dressing (bandage) over the surgery site
- Feel some pain, numbness and a pinching sensation in your underarm area
- Receive instructions on how to care for yourself at home, including taking care of your incision and drains, recognizing signs of infection, and understanding activity restrictions
- Talk with your health care team about when to resume wearing a bra or wearing a breast prosthesis
- Be given prescriptions for pain medication and possibly an antibiotic