Mastectomy is an umbrella term used for several different procedures. In addition to removing one or both breasts, mastectomy may also include removing lymph nodes in the armpit area to determine whether the cancer has spread. For an axillary node dissection, the surgeon removes a number of nodes from your armpit on the side of the tumor. In a sentinel lymph node biopsy, your surgeon removes only the first one or two nodes into which a tumor drains (sentinel nodes). These are then tested for cancer. If no cancer is present, no further lymph nodes need be removed. If cancer is present, the surgeon will remove more lymph nodes in the armpit.
The different types of mastectomy are:
- Modified radical mastectomy. A modified radical mastectomy involves removal of the entire breast, including the breast tissue, skin, areola and nipple. The lining over the chest muscles and sometimes part of the chest wall is also removed, as well as most of the underarm lymph nodes (complete axillary node dissection). This procedure may be recommended for large tumors or if the cancer has spread to the lymph nodes.
- Simple (total) mastectomy. A simple mastectomy involves removal of the entire breast, including the breast tissue, skin, areola and nipple. A sentinel lymph node biopsy may be done at the time of a simple mastectomy.
- Skin-sparing mastectomy. A skin-sparing mastectomy involves removal of all the breast tissue, nipple and areola, but not the breast skin. Breast reconstruction is performed immediately after the mastectomy. Skin-sparing mastectomy may not be suitable for larger tumors.
- Nipple-sparing (subcutaneous) mastectomy. A nipple-sparing mastectomy involves removal of only breast tissue, sparing the skin, nipple, areola and chest wall muscles. 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. Mastectomy without reconstruction usually takes one to three hours. It usually requires a one- to two-day hospital stay, although more and more people are going home on the same day as the operation. If you're having both breasts removed (double mastectomy), expect to spend more time in surgery and possibly more time in the hospital. If you're having breast reconstruction following mastectomy, the procedure also takes longer.
If you're having sentinel node biopsy, before your surgery a radioactive substance or blue dye or both will be injected into the area around the tumor or the skin above the tumor. The dye will travel to the sentinel node or nodes, allowing your doctor to see where they are and remove them during surgery.
During the procedure
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 may also be removed. Regardless of the type of mastectomy you have, some breast tissue and lymph nodes will be sent to a laboratory for analysis.
If you're having breast reconstruction at the same time as 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 behind the chest wall muscle. 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 sutures (stitches), 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:
Oct. 26, 2011
- 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
- Breast cancer treatment (PDQ). National Cancer Institute. http://www.cancer.gov/cancertopics/pdq/treatment/breast/healthprofessional/AllPages. Accessed Aug. 18, 2011.
- Breast cancer risk reduction. Fort Washington, Pa.: National Comprehensive Cancer Network. http://www.nccn.org/professionals/physician_gls/f_guidelines.asp. Accessed Aug. 18, 2011.
- Modified radical and total mastectomy. In: Khatri VP, et al. Operative Surgery Manual. Philadelphia, Pa.: Saunders Elsevier; 2003. http://www.mdconsult.com/books/about.do?about=true&eid=4-u1.0-B0-7216-7864-5..X5001-9&isbn=0-7216-7864-5&uniqId=273959611-3. Accessed Aug. 18, 2011.
- Iglehart JD, et al. Diseases of the breast. In: Townsend CM Jr., et al. Sabiston Textbook of Surgery: The Biological Basis of Modern Surgical Practice. 18th ed. Philadelphia, Pa.: Saunders Elsevier; 2008. http://www.mdconsult.com/das/book/body/208746819-6/0/1565/0.html. Accessed Aug. 18, 2011.
- Surgery for breast cancer. American Cancer Society. http://www.cancer.org/Cancer/BreastCancer/DetailedGuide/breast-cancer-treating-surgery. Accessed Aug. 18, 2011.