Patient education: Mastectomy (The Basics)

What is a mastectomy? — This is surgery to remove the whole breast. The doctor might also remove 1 or more lymph nodes (glands) under the arm. Mastectomy is a way to treat breast cancer.

There are different types of mastectomies:

●Simple mastectomy – This involves removing the entire breast without removing lymph nodes in the armpit. It is also called a "total" mastectomy.

●Modified radical mastectomy – This involves removing the entire breast and lymph nodes in the armpit.

●Double mastectomy – This involves removing both breasts. It is also called a "bilateral" mastectomy.

●Skin-sparing or nipple-sparing mastectomy – In this type, the doctor removes the breast tissue, but "spares" or keeps the skin and/or nipple. This can then be used to help reconstruct the breast.

People who have a mastectomy can also have surgery to rebuild or "reconstruct" the breast that is removed (figure 1). Sometimes, this can be done at the same time as the mastectomy. Other people might choose not to have reconstruction.

How do I prepare for surgery? — The doctor or nurse will tell you if you need to do anything special to prepare. Before your procedure, your doctor will do an exam. They might send you to get tests, such as:

●Lab tests

●Mammogram or other imaging tests – Imagining tests create pictures of the inside of the body.

●Biopsy – This is a procedure to remove a small sample of tissue for testing.

Your doctor will also ask you about your "health history." This involves asking you questions about any health problems you have or had in the past, past surgeries, and any medicines you take. Tell them about:

●Any medicines you are taking – This includes any prescription or "over-the-counter" medicines you use, plus any herbal supplements you take. It helps to write down and bring a list of any medicines you take, or bring a bag with all of your medicines with you.

●Any allergies you have

●Any bleeding problems you have – Certain medicines, including some herbs and supplements, can increase the risk of bleeding. Some health conditions also increase this risk.

You will also get information about:

●Eating and drinking before your procedure – In some cases, you might need to "fast" before surgery. This means not eating or drinking anything for a period of time. In other cases, you might be allowed to have liquids until a short time before the procedure. Whether you need to fast, and for how long, depends on the procedure you are having.

●Lowering the risk of infection – In some cases, you might need to wash the area with a special soap.

●What help you will need when you go home – For example, you might need to have someone else bring you home or stay with you for some time while you recover.

Ask the doctor or nurse if you have questions or if there is anything you do not understand.

What happens during surgery? — When it is time for the procedure:

●You will get an "IV," which is a thin tube that goes into a vein. This can be used to give you fluids and medicines.

●You will get anesthesia medicines. This is to make sure that you do not feel pain during the procedure. Most people who have a mastectomy get general anesthesia. This type of anesthesia makes you unconscious so you can't feel, see, or hear anything during the procedure. If you have general anesthesia, you might get a breathing tube to help you breathe.

●You might get medicines to help control pain after the procedure.

●The doctors and nurses will monitor your breathing, blood pressure, and heart rate during the procedure.

●The doctor will make a cut in the skin over the breast. Then, they will remove the breast tissue. Unless you are having a nipple- or skin-sparing procedure, the doctor will also remove the nipple and some of the skin as well. They might also remove lymph nodes under the arm and around the breast.

If you have chosen to have your breast reconstructed, the doctor might insert something called an "expander" after your breast is removed. This is a device that gradually stretches your skin and muscle so that you can have an implant put in later.

●At the end of the surgery, the doctor will place a thin drain tube under the skin. This is used to drain any blood or fluid build-up from the area as you heal. The drain is connected to a closed container to collect the fluid.

●The doctor will close your cuts (incisions) and cover them with clean bandages.

●This procedure takes between 1 and 3 hours.

What happens after surgery? — After your procedure, you will be taken to a recovery room. The staff will watch you closely as your anesthesia wears off. Some people stay in the hospital overnight, and others go home the same day.

As you recover:

●You might feel groggy or confused for a short time. You might also feel nauseous or vomit. The doctor or nurse can give you medicine to help with this.

●If you had a breathing tube, you might have a sore throat. This usually gets better quickly.

●The staff will help you get out of bed and start moving around when you are ready.

●You will get medicine if needed to help with pain. You might need other medicines, too.

●When you are ready to eat, you will start with clear liquids. Then, you can start eating as you are able. You might feel better if you start with bland foods.

What are the risks of a mastectomy? — Your doctor will talk to you about all of the possible risks, and answer your questions. Possible risks include:

●Collection of fluid under the skin

●Infection

●Nipple or skin flap tissue death

●Pain

●Arm or shoulder stiffness

●Nerve injury

●Fluid buildup in your arm or hand if lymph nodes were removed

●Depression or sadness

What else should I know? — Before you go home from the hospital, make sure that you know what problems to look for and when you should call the doctor. Make sure that you understand your doctor or nurse's instructions and how to care for your drain if you have one. Ask questions about anything you do not understand.

More on this topic

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Patient education: Sentinel lymph node biopsy for breast cancer (The Basics)
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