Mastectomy

A mastectomy is a surgical procedure in which part, or all, of the breast is removed. Healthy tissue around the breast, including lymph nodes in the armpit, may also be removed.

Following are the most common types of mastectomy:

Some breast lumps are removed with breast-sparing surgeries, such as a lumpectomy.

Who is a candidate for the procedure?

A mastectomy is generally done in women with a diagnosis of breast cancer. It may also be done to prevent breast cancer. Women with a personal family history of breast cancer may choose to have a mastectomy. Women who are positive for a breast cancer gene, such as BRCA 1 and BRCA 2, may also make this choice.

How is the procedure performed?

The woman is put to sleep under general anesthesia. The skin over the affected breast, the chest, and the upper arm is cleansed with an antiseptic. An incision is made to include the nipple and the pigmented skin around the nipple, called the areola. The incision may be horizontal from the breastbone to the underarm. Occasionally, if the tumor is higher up, the incision is diagonal from the upper part of the armpit down to the breastbone. The surgeon may be able to include any previous biopsy incision, for cosmetic reasons.

The chest wall incision is closed with sutures or staples. Small tubes are placed through the skin to drain any fluid that might build up in the area. A large bandage is placed over the incision and taped firmly in place. This pressure dressing keeps the skin against the chest wall muscles. This lessens the fluid buildup and promotes drainage. However, most women lose sensation in the surgical area.

What happens right after the procedure?

The woman will be kept in the surgery recovery room for a short period of time. She will have an intravenous line, or IV, and oxygen tube. The throat may be sore from the breathing tube used during the surgery. She will be asked to cough and breathe deeply to clean out the lungs and prevent pneumonia. Pain medication will be given as needed. The woman may be thirsty and nauseated, and she will have a bulky bandage and drains.

Back in the hospital room, the woman will usually need help getting up the first time. After that, she will be encouraged to get up and move about. Most women can go home the next day. The bandages and drains remain in place until they are removed by the surgeon. Home care instructions are given.

What happens later at home?

The woman may need to periodically empty a reservoir attached to the drains. Care must be taken to keep all items clean to prevent infection. Proper hand-washing is very important before and after emptying the drains or changing dressings. The color and amount of drainage should be noted and reported to the surgeon.

Pain medications are given, but the pain is not usually severe. The surgeon will let the woman know what activities are allowed in the first few days after surgery.

After healing, the woman will have a flat, normally shaped chest wall. The scar runs diagonally or horizontally from near the breastbone to the edge where the breast tissue was. Reconstructive surgery can be done at any time to improve the cosmetic results.

Many women feel sad or depressed after mastectomy. They may have concerns about body image and sexuality. Any diagnosis of cancer brings with it the fear of death. A healthcare provider can provide support with these issues and can recommend other resources for support.

What are the potential complications after the procedure?

Surgery can cause bleeding, infection, or allergic reaction to anesthesia. Other complications of mastectomy include the following:

The following steps can help prevent lymphedema.

Any new or worsening symptoms should be reported to the healthcare provider.

Author:Susan Woods, MD
Date Written:
Editor:Ballenberg, Sally, BS
Edit Date:05/30/01
Reviewer:Fern Carness, RN, MPH
Date Reviewed:05/13/01