About Mastectomy

Definition: A mastectomy is a surgical procedure in which most or all of the breast tissue is removed, in order to treat breast cancer.

• a simple, or total mastectomy is the removal of all of the breast tissue, but none of the underlying muscle nor the lymph nodes are removed

• a modified radical mastectomy is the removal of all of the breast tissue, as well as the lymph nodes on the same side of the body as the breast

• a radical mastectomy, also called a Halsted mastectomy is the removal of all of the breast tissue, the underlying muscle, as well as the lymph nodes on the same side of the body as the breast (this is rarely done now)

• a skin-sparing mastectomy is one in which the breast tissue is removed, but the breast skin is kept, so that in the case of immediate breast reconstruction (plastic surgery) no skin grafts will be needed, to cover the breast implant.

Pronunciation: mas-TEK-tu-mee

Also Known As: breast removal surgery

Common Misspellings: masectomy, massectumy

Examples: A mastectomy is used to treat any breast cancer that has spread, or invaded, breast tissues beyond the original tumor site. It is important that the surgeon be experienced in breast surgery, and that the surgical margins of the tissue that is removed are clear of cancer cells. A well-done mastectomy helps to prevent breast cancer recurrence.

Mastectomy: Overview

By Jennifer Whitlock, RN, MSN, FN

Updated on June 04, 2020

Medically reviewed by Doru Paul, MD

A mastectomy is the surgical removal of a breast, either to treat or to prevent breast cancer.

What Is a Mastectomy?

A mastectomy is performed in a hospital under general anesthesia and typically lasts 2 to 3 hours. The operation may take longer if a procedure to remove the lymph nodes is planned or reconstructive surgery is being performed immediately after the mastectomy.

During a mastectomy, the following steps are generally taken:

1. An elliptical incision 6 to 8 inches in length is made that begins on the inside of the breast, near the breastbone, and extends upward and outward toward the armpit.
2. Once the breast tissue (and sometimes the lymph nodes underneath the arm) is removed, the incision is closed with either staples or absorbable ​sutures
3. A drain may also be placed, which helps remove excess fluid from the body to promote healing and decrease swelling. The drain will be under a bandage to protect the surgical site and the drain placement.

Both the staples and the drain will be removed during an office visit after the patient is discharged from the hospital.

After a mastectomy, a woman has the choice of rebuilding the breast that was removed. This is called breast reconstruction.[1] It may be performed at the time of the mastectomy (called immediate reconstruction), or it can be delayed (often after the mastectomy incisions have healed and a woman has completed all of her breast cancer treatments.

Various Surgical Techniques

Depending on various factors, most notably the stage of breast cancer, a surgeon will perform one of these types of mastectomies:

• Simple (Total) Mastectomy: All of the breast tissue is removed from the affected breast. The surrounding lymph nodes and muscles under the breast tissue are left intact.
• Modified Radical Mastectomy: All of the breast tissue is removed along with the lymph nodes from the armpit (axilla) on the affected side of the body.
• Double (Bilateral) Mastectomy: Both breasts are removed (this surgery is usually performed as a simple mastectomy, just on both breasts). It's usually performed preventively in women who are at high risk for developing breast cancer (e.g., women who have tested positive for the BRCA mutation).
• Radical Mastectomy: All of the breast tissue from the affected breast is removed along with the underarm lymph nodes and the chest muscle that lies underneath the breast. Only the skin required to close the incision is left in place. This is not a common surgery and is reserved for patients who have advanced breast cancer that has invaded the muscle wall under the breast tissue.[2]

During a simple or modified radical mastectomy, if a woman is undergoing immediate breast reconstruction, the surgeon may consider performing one of the two surgical techniques below:

• Skin-Sparing Mastectomy: This technique preserves the skin of the breast, but not the nipple and areola, which are removed. The breast tissue is then removed through that area. For women with large breasts, an additional incision may be made to allow the breast tissue to be removed, but the vast majority of skin is left behind after surgery.
• Nipple-Sparing Mastectomy: With this technique, the incision to remove the breast tissue is made around the areola, thus preserving both the nipple and areola. This procedure, like the skin-sparing procedure, may result in a larger incision than is necessary in the traditional procedure, especially if the breast is large in size.

The skin or nipple-sparing mastectomies are reserved for patients whose area of cancer is a minimum of two centimeters away from the tissue that is to be saved. [3] Therefore, a patient whose cancer is affecting the skin or nipple would not be a candidate.

Contraindications

Although there are no set in stone guidelines, a mastectomy may be contraindicated in the following cases:[4]

• A patient with distant metastatic breast cancer (e.g., breast cancer has spread to the brain, for example)
• An elderly or frail patient with other significant medical conditions and/or a patient with a high risk of death from the surgery or from anesthesia
• Certain aspects of the cancer may make surgery technically difficult—for example, if the cancer is too large or has invaded the skin or chest wall, a treatment like chemotherapy or radiation to shrink to first may be indicated before surgery

Mastectomy or Breast-Conserving Surgery?

Patients with early-stage breast cancer often have the option of choosing between a lumpectomy/breast-conserving surgery (removing a "lump" of breast tissue that contains the cancer) and a mastectomy (removing the whole breast). If a woman chooses breast-conserving surgery (BCS), she will most likely also need radiation.

Research shows that a mastectomy does not improve a person's chance of long-term survival when compared to BCS with radiation. As a result, most women choose BCS with radiation.

However, according to the American Cancer Society, a mastectomy may be advised in these cases:[5]

• The patient cannot undergo radiation, possibly because of an underlying medical condition (e.g., systemic lupus erythematosus) that makes them sensitive to the side effects of radiation
• The patient has inflammatory breast cancer
• The breast was treated with radiation in the past
• The patient already had BCS and not all of the cancer was removed
• There are two areas of cancer within the same breast that are too far apart
• A breast cancer that is larger than 5 centimeters (cm) across, or is larger relative to the patient's breast size
• Pregnancy and would require the radiation to occur during pregnancy (based on timing)
• The patient has a genetic mutation (e.g., BRCA mutation) that increases their risk more for a second breast cancer

Purpose of Mastectomy

The main purpose of a mastectomy is to treat breast cancer, of which there are different types, including:

1. Ductal carcinoma in situ (DCIS) (non-invasive breast cancer)
2. Invasive breast cancers (e.g., invasive ductal carcinoma or invasive lobular carcinoma
3. Difficult to treat cancers, such as triple-negative breast cancer and inflammatory breast cancer
4. Less common breast cancers, including Paget disease of the breast, angiosarcoma, and Phyllodes tumor

Callout: While a mastectomy is most commonly performed in women, men can get breast cancer too and therefore, require a mastectomy for treatment.[6] Less commonly, a man with gynecomastia may undergo a subcutaneous mastectomy combined with liposuction.[7]

Surgical Management of Gynecomastia: Subcutaneous Mastectomy and Liposuction

A mastectomy may also be done to prevent breast cancer. This is called a prophylactic mastectomy and may be performed if:

• A patient has a genetic mutation that increases their risk for developing breast cancer (e.g., the BRCA mutation gene)
• A patient has a strong family history of breast cancer
• A patient underwent chest radiation before the age of 30
• A patient has or had cancer in one breast

Less commonly,

Related: Purpose of Mastectomy Surgery

How to Prepare

What to Expect on the Day of Surgery

Recovery

The recovery from mastectomy surgery begins in the PACU, or post-anesthesia care unit, where the patient is monitored while the anesthesia drugs wear off.

After that, the patient is taken to a hospital room, where they will stay for one or two nights before being discharged home.

Your healthcare team will provide you with specific instructions on the recovery process, such as:[5]

• Caring for your surgical site and drain (if you have one)
• Restricting or avoiding certain activities and the duration (e.g., driving or running)
• Taking medications (e.g., pain medications or possibly an antibiotic)
• Attending follow-up appointments

You may also be given instructions on performing arm exercises on your own or under the guidance of a physical therapist.

While the precise recovery varies from patient to patient—depending on various factors, like the patient's underlying health and the type of mastectomy performed—most patients can resume normal activities, including work, within about four weeks.[5] If breast reconstruction is performed, in addition to the mastectomy, return to regular activities usually takes longer.

Related: Mastectomy Surgery: Recovery

Long-Term Care

If a woman has breast cancer, the benefit of a mastec

Depression after the diagnosis of breast cancer, with or without surgery, is a problem for many patients.[8] Depression can make it difficult for a patient to recover from surgery or take part in related decision making. It can also heighten the fatigue that patients feel after surgery as well as chemotherapy and radiation. It is easy to confuse the symptoms of a normal recovery from surgery, so it is important to be familiar with the symptoms of depression.

Patients who opt not to have reconstruction may need prosthetics that create a balance between a natural breast and a breast that has been removed. There are many mastectomy products available, primarily online, including bras, breast forms, and swimsuits.

In addition to surgery, most patients have radiation therapy, chemotherapy or a combination of both. The decision is based on the severity of the cancer, the wishes of the patient and the oncologist’s opinion.[9]

Potential Risks

As with any surgery, a mastectomy comes with potential risks and complications.

Immediate or short-term complications that may occur after a mastectomy include:

1. Hematoma: A hematoma is a collection of blood within the wound site. It may lead to pain, swelling, and bruising underneath the breast.
2. Seroma: A seroma is a collection of serous (pale yellow) fluid that collects in the dead space of the post-mastectomy skin flap, axilla, or breast after a modified radical mastectomy or breast-conserving surgery.[10] A seroma may cause pain and swelling.
3. Wound Infection: This complication is rare and usually due to staphylococcal bacteria, which is found normally on the skin. It may cause symptoms like fever, tenderness, warmth, redness, and/or swelling around the surgical site.
4. Skin Flap Necrosis: Necrosis or death of the tissue that comprises the skin flap occurs when the blood supply to the skin flap is insufficient.[11] This necrosis may be partial or full-thickness (more severe) and is more likely to occur in patients who smoke, are obese, or who have diabetes.

Potentially long-term complications of a mastectomy include:

1. Persistent Post-Mastectomy Pain (PPMP): Pain described as a shooting, stabbing, pulling, tightness, burning, or aching sensation that persists over time may occur in the armpit, breast/chest wall, and upper arm after a mastectomy.[12] This chronic post-mastectomy pain may be worsened by cold weather and certain movements, especially overhead activity.
2. Lymphedema: Swelling of the arm may occur if you had lymph nodes removed from your axilla. This occurs because fluid cannot adequately drain through the lymph system. Lymphedema can lead to arm numbness, swelling, stiffness, and pain.

Related: A Step-By-Step Guide to Arm Lymphedema Exercises

A Word From Verywell

The vast majority of mastectomies are performed on women as a breast cancer treatment, although men may develop breast cancer and require the procedure, too. In some cases, a lumpectomy may be another surgical treatment option for these patients. Those with more extensive breast cancer may require a bilateral mastectomy, which is the removal of some or all of the tissue in both breasts.

Simple Mastectomy (Total Mastectomy)

A simple mastectomy, also known as a total mastectomy, is a procedure that removes all of the breast tissue of the affected breast. The most common form of the surgery, referred to as traditional total mastectomy, includes the removal of the areola and nipple. However, the surgery can be performed using skin and nipple sparing techniques. It also leaves the muscle under the breast left intact.

The procedure is performed using an elliptical incision 6 to 8 inches in length that begins on the inside of the breast, near the breastbone, and extends upward and outward toward the armpit. The incision can also be altered to remove scar tissue from previous procedures, which can improve the cosmetic outcome if reconstruction is desired.

Once the breast tissue is removed, the incision is closed with either absorbable ​sutures, which the body slowly absorbs over time, or staples that are removed during an office visit 10 to 14 days after surgery. There may also be a drain, a device that helps remove excess fluid from the body to promote healing and decrease swelling, in place. The drain will be under a bandage to protect the surgical site and the drain placement. In most cases, the drain will be removed during an office visit after discharge from the hospital.

When this type of mastectomy is combined with an additional procedure to remove lymph nodes from under the arm it is called a modified radical mastectomy. It, too, can be paired with a breast reconstruction procedure.

Modified Radical Mastectomy

A modified radical mastectomy is a type of mastectomy that combines the removal of all breast tissue from the affected breast with lymph node removal from the armpit on the affected side of the body. This surgery typically includes the removal of both the nipple and areola, but the surgery can be performed using skin and nipple sparing techniques.

Like a simple mastectomy, the procedure is performed using an elliptical incision 6 to 8 inches in length that begins on the inside of the breast, near the breastbone, and extends upward and outward toward the armpit.

Once the breast tissue is removed, the incision is closed with either absorbable sutures or staples that are removed during an office visit 10 to 14 days after surgery. There may also be drains in place to decrease the amount of swelling in the area. These drains are covered with bandages to protect the incision site and the drain placement. The drains are typically removed after discharge from the hospital by the surgeon during a routine office visit after surgery.

Radical Mastectomy (Halsted Mastectomy)

A radical mastectomy, also known as a Halsted mastectomy, is not a commonly performed procedure.[2] While this surgery was the standard of care in the past, it is now only performed on patients who have advanced breast cancer that has invaded the muscle wall under the breast tissue.

Like other types of mastectomy, a radical mastectomy removes all of the breast tissue of the affected breast. It also removes all of the lymph nodes under the arm on the affected side and the muscle that lies under the breast. Only the skin required to close the incision is left in place.

This procedure is not considered necessary for patients whose cancer has not invaded the muscle.

This surgery is considered the most disfiguring of the mastectomy procedures, leaving very little tissue other than skin over the rib bones. The scar left after this surgery is 6 to 8 inches long, with enough skin left to close the incision with sutures or staples.

The surgeon may also place drains in the areas of surgery which, as in the other procedures, will be covered for protection and then later removed by the surgeon during a routine office visit.

Nipple- and Skin-Sparing Mastectomy Techniques

Nipple and skin sparing techniques can be used in combination with most mastectomy surgeries to retain more skin than is done in a traditional mastectomy. A general guideline for retaining the nipple, areola, and additional skin is this: The area of cancer should be a minimum of two centimeters away from the tissue that is to be saved.3 Therefore, a patient whose cancer is affecting the skin or nipple would not be a candidate for having those tissues retained after surgery.

Skin Sparing Mastectomy

This technique preserves the skin of the breast, but not the nipple and areola, which are removed. The breast tissue is then removed through that area. For women with large breasts, an additional incision may be made to allow the breast tissue to be removed, but the vast majority of skin is left behind after surgery.

Nipple Sparing Mastectomy

The incision to remove the breast tissue is made around the areola, thus preserving both the nipple and areola. This procedure, like the skin-sparing procedure, may result in a larger incision than is necessary in the traditional procedure, especially if the breast is large in size.

Total Skin-Sparing Mastectomy

This procedure, also known as a subcutaneous mastectomy, not only preserves the skin of the breast but the nipple and areola, too. The incision to remove the breast tissue can be placed in the fold under the breast where it cannot be easily seen once healed, or the incision may be made around the areola.

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

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4. Goethals A, Rose J. Mastectomy. StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing.
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6. American Cancer Society. What Is Breast Cancer in Men?
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10. Sampathraju S, Rodrigues G. Seroma Formation after Mastectomy: Pathogenesis and Prevention. Indian J Surg Oncol. 2010 Dec; 1(4): 328–333. doi:10.1007/s13193-011-0067-5
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