Complications Uncommon After Single or Double Mastectomy

• TOPIC: Diagnosis, Surgery, and Planning Your Treatment
• TAGS: Early-stage: Stage 0 -- DCIS (Ductal Carcinoma in Situ), Early-stage: Stage IA, Early-stage: Stage IB, Early-stage: Stage IIA, Early-stage: Stage IIB, Early-stage: Stage IIIA, Ductal Carcinoma In Situ, Invasive or Infiltrating Ductal Carcinoma, Invasive or Infiltrating Lobular Carcinoma, Planning/Considering Surgery, Mastectomy, Planning/Considering Surgery, and Prophylactic Mastectomy

Some women who’ve been diagnosed with early-stage breast cancer in one breast choose to have that breast and the other healthy breast removed. Removing the other healthy breast is called contralateral prophylactic mastectomy. So while a woman has cancer in just one breast, she has a double mastectomy.

The healthy breast is usually removed because of an understandable fear that a new, second breast cancer might develop in that breast. Statistics show that more and more women diagnosed with early-stage breast cancer in one breast are choosing to have the breast affected by cancer as well as the other healthy breast removed.

Because more women are opting to have both breasts removed, researchers wanted to see if women who had double mastectomy had more complications or different types of complications than women who had single mastectomy.

A study suggests that complications are uncommon after single or double mastectomy and immediate reconstruction, though women who had double mastectomy did have more complications than women who had single mastectomy. The research was presented on Sept. 4, 2014 at the 2014 ASCO Breast Conference in San Francisco. Read the abstract of “A NSQIP analysis of 30-day complications after bilateral versus unilateral mastectomy with immediate reconstruction.”

In the study, the researchers looked at information from the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database. The NSQIP database includes information from 400 hospitals on outcomes of surgeries.

The researchers looked at the records of 11,727 women who had single mastectomy and 6,502 women who had double mastectomy from 2005 to 2012. All the women had immediate reconstruction. This means that breast reconstruction was done during the same operation right after surgery to remove one or both breasts.

About 80% of women who had single mastectomy had reconstruction using an implant and about 90% of the women who had double mastectomy had implant reconstruction.

Overall, the women had few complications.

Certain complications happened more often in women who had double mastectomy, including:

• needing to have the implant removed or replaced
• needing to have another operation
• needing to have a transfusion after reconstruction with an implant
• needing to have a transfusion after reconstruction with tissue from someplace else in the body (autologous reconstruction)

The rate of severe complications was about the same in both groups (less than 1%). Severe complications included:

• heart attack
• pneumonia
• kidney failure
• stroke
• urinary tract infection
• blood clots

“Complications after mastectomy with reconstruction are infrequent,” said Mark Sisco, M.D., of NorthShore University HealthSystem, at a briefing discussing the study. “Double mastectomy results in more surgical complications than single mastectomy. Women with breast cancer should consider these factors when deciding whether to undergo double mastectomy.”

Still, if you are at a higher-than-average risk of breast cancer because:

• you know you have an abnormal gene linked to breast cancer, including BRCA1, BRCA2, or PALB2
• you have a strong family history of breast cancer among more than one first-degree relative, such as a mother, sister, or daughter

then a double mastectomy might make sense for you.

Women who don’t have either of these factors that increase risk are very unlikely to develop a second breast cancer in the other healthy breast. (Their risk is 1% or less per year.)

Some doctors are concerned that too many women are choosing to have contralateral prophylactic mastectomy during or shortly after breast cancer surgery because they overestimate their risk of future breast cancer. Double mastectomy is a bigger operation. It’s associated with a more difficult recovery and more complications.

If you've been diagnosed with early-stage breast cancer in one breast, ask your doctor about ALL of your treatment and risk reduction options. Double mastectomy is only one of these options and is an aggressive step. While that may be the right decision for you, give yourself the time you need to consider your decision carefully. Talk to your doctor to make sure that your decisions are based on your actual risk. Ask your doctor about how the cancer details in your pathology report may affect your future risk. Together, you and your doctor can make the decisions that are best for you and your unique situation.  Read more details

Source: breascancer.org

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Mastectomy Risks

Like all surgeries, mastectomy has some risks:

• Numbness of the skin along the incision site and mild to moderate tenderness of the adjacent area: Numbness and tenderness can happen because the nerves were cut during surgery. Find out more about numbness.
• Extra sensitivity to touch within the area of surgery: Touch sensitivity is also due to irritated nerve endings. The sensation usually improves as the nerves grow back. Read more about managing breast area sensitivity.
• Fluid collecting under the scar: Fluid collection under the scar may be the result of hematoma — an accumulation of blood in the wound — or seroma, an accumulation of clear fluid in the wound. Both usually resolve on their own or after being drained with a needle by your doctor. Learn more about hematoma and seroma.
• Delayed wound healing: During mastectomy, the blood vessels that supply your breast tissue are cut. Occasionally that can present problems when your body tries to heal the incision site. If there isn't enough blood flow to the flaps of your incision, small areas of skin may wither and scab or need to be trimmed by your surgeon. This is uncommon and is usually not a serious complication. Read more about managing delayed healing.
• Increased risk of infection in the surgical area: If infection happens, it can usually be discovered early and responds well to treatment. Talk to your doctor about the warning signs of infection.
• Scar tissue formation: With mastectomy alone and mastectomy plus reconstruction, there is a risk for scar tissue to form and build up over time. Sometimes the scar tissue can be lumpy or painful. Your surgeon can tell you about ways to manage any discomfort. Find out more about managing scar tissue formation.

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More about Mastectomy

Mastectomy Surgery and Recovery 

What To Expect What to expect on the day of, during, and after mastectomy surgery as well as the recovery period in the weeks after surgery.

Getting your pathology report after mastectomy Surgery can be a stressful experience. Having as clear a picture as possible about how things go the day of the procedure — and immediately afterward — can help. It’s a good idea to ask someone on your cancer care team any questions you may have about the pre-surgery and post-surgery instructions so you can follow them accurately. Here’s what you can expect before, during, and after mastectomy surgery and recovery.    

Before mastectomy surgery 

In the hospital on the day of surgery, you change into a hospital gown and wait in a preoperative holding area. Some hospitals allow you to have one or two friends or family members in the room. Before surgery, you typically meet the anesthesiologist to talk about your medical history, any allergies you may have, and the plan for administering anesthesia during your surgery.  Your surgeon or the surgeon assistant may draw markings with a felt-tip marker on your breast that shows where the incision is going to be. You sit up while this happens so they can mark the natural crease of your breast. A nurse inserts an intravenous infusion (IV) line into your hand or arm and tapes it into place so you can receive relaxing medication through the IV line. Once you are wheeled into the operating room, you are given general anesthesia. After you’re asleep, a breathing tube is placed through your mouth and into your windpipe to help you breathe.   

During mastectomy surgery 

A mastectomy without immediate breast reconstruction can take one to three hours. If you are having breast reconstruction during the mastectomy, the surgery takes longer. Reconstruction with tissue expanders or breast implants takes about three to four hours, reconstruction with tissue flaps takes about six to eight hours. During the mastectomy, the surgeon separates the breast tissue from the skin and muscle. All of the breast tissue that the surgeon can see — which lies between the collarbone and ribs, from the side of the body to the breastbone in the center — is removed. Depending on the type of mastectomy you are having, your surgeon may remove other parts of the breast. 

Lymph node dissection 

In most cases, your breast surgeon also performs either a sentinel lymph node dissection (in which one to five underarm lymph nodes are removed) or an axillary lymph node dissection (in which about 10 or more underarm lymph nodes are removed). This is done to see if the cancer has spread to the lymph nodes. Your surgeon may send the lymph nodes that were removed to the pathology department to be checked for cancer cells during the surgery. If the pathologist finds cancer cells, your surgeon may remove more lymph nodes during the surgery. 

If you’re having a sentinel lymph node dissection, your surgeon uses a lymphatic mapping procedure to find the sentinel lymph nodes. This is done either on the day before the mastectomy, the morning of the mastectomy, or during the mastectomy. The procedure involves injecting a radioactive liquid, a blue dye, or both, underneath the nipple or near the tumor site. The liquid and/or dye travel to the sentinel node or nodes, allowing the surgeon to see where they are and remove them. The surgeon may also use a small handheld device to measure the radioactivity from the liquid and check how much of it was absorbed. 

Breast reconstruction during mastectomy 

If you’re having immediate breast reconstruction with tissue expanders, breast implants, or tissue flaps, your plastic surgeon performs the reconstruction during the same procedure. If you’re not having immediate reconstruction, the breast surgeon or plastic surgeon performs a flat closure, so the chest appears flat.

The last steps of mastectomy surgery 

When the procedure is nearly over, your breast surgeon checks the surgery areas for bleeding and may insert one or more thin, flexible tubes called surgical drains in your breast area, armpit, or both. The drains collect the excess fluid that can otherwise build up in those areas after surgery. Each tube carries the fluid outside your body and is attached to a soft plastic bulb that collects the fluid, and that must be periodically emptied. After the drains are inserted, your surgeon stitches the incision closed. The surgery site is covered with a bandage that wraps closely around your chest. In most cases, your breathing tube is taken out while you’re still in the operating room.   

Post-mastectomy surgery 

You are moved to the recovery room after mastectomy surgery, where staff monitors your heart rate, body temperature, blood pressure, breathing, and oxygen levels. If you are in pain or feel nauseous from the anesthesia, let a nurse know so that you can be given medication. After that, you may be admitted to a hospital room. You may be able to go home on the same day as the operation, especially if you had no lymph nodes removed, only sentinel lymph nodes removed, no reconstruction, or immediate reconstruction with a tissue expander or breast implant. Otherwise, you can expect to stay in the hospital for an average of three days or less. If you had immediate reconstruction with tissue flaps, you can expect to stay an average of two to five days because your surgical team needs to monitor the blood flow to the flap. Before you leave the hospital, your surgeon or nurse talks with you and gives you written instructions about the following: 

Taking pain medication 

Your surgeon is probably going to give you a prescription for pain medication to take with you when you leave the hospital. You might want to get it filled on your way home or have a friend or family member get it filled for you right away.

Your surgical team may use a new approach to pain management called ERAS (enhanced recovery after surgery). These protocols can control your pain for up to 3 or 4 days after surgery without the use of opioids and can help you have a shorter hospital stay. Some medications that may be used as part of an ERAS protocol during surgery include lidocaine and liposomal bupivacaine (brand name: Exparel). Gabapentin (a nerve medication) and Tylenol may be used after surgery. You may want to ask your surgical team before your mastectomy if they can use an ERAS pain management protocol.

Side effects from a lymphatic mapping procedure 

If you had a lymphatic mapping procedure before a sentinel lymph node dissection and blue dye was used, your skin, pee, and poop may be bluish-green for one to two days after the surgery. The blue dye can stain the skin at the injection site for months and sometimes permanently.

Caring for the bandage (dressing) over your mastectomy incision 

Ask your surgeon or nurse how to take care of the mastectomy bandage. The surgeon may ask that you not try to remove the bandage and instead wait until your first follow-up visit so that he or she can remove the bandage. 

Caring for a surgical drain after mastectomy surgery 

If you have one or more surgical drains in your breast area or armpit, they might be removed before you leave the hospital. Sometimes, a drain should stay inserted until the first follow-up visit with your doctor, usually one to two weeks after surgery. If you’re going home with a drain inserted, you need to empty the fluid from the detachable drain bulb a few times a day. Make sure your surgeon gives you instructions on caring for the drain before you leave the hospital.

Mastectomy stitches 

Most surgeons use sutures (stitches) that dissolve over time, so there’s no longer any need to have them removed. Occasionally, you see the end of the suture poking out of the incision like a whisker. If this happens, your surgeon can easily remove it.

Recognizing signs of infection post-mastectomy 

Your surgeon should explain how to tell if you have an infection in your incision and when to call your doctor’s office. Some signs of infection to look out for include fever, increased redness around the incision, and pus draining from the incision.

Exercising your arm after mastectomy 

Your surgeon or nurse shows you an exercise routine you can do to prevent arm and shoulder stiffness and to help prevent the formation of significant scar tissue. Usually, you start the exercises the morning after surgery. Your surgeon should also give you written, illustrated instructions on how to do the exercises. Ask your surgeon any questions you may have to make sure the exercise routine is right for you. Some exercises should be avoided until the drains are removed.

Recognizing signs of lymphedema after lymph node dissection 

If you have had any underarm lymph nodes removed, you are going to receive information on taking care of your arm and being alert to signs of lymphedema. Lymphedema is abnormal swelling in the arm, hand, breast area, underarm, or torso. It occurs when the normal flow of lymph — a thin, clear fluid that circulates throughout the body to remove wastes from tissues — is disrupted. Lymph fluid normally drains from body tissues through the lymph nodes and lymph channels. When some lymph nodes and channels are removed or damaged during surgery, lymph fluid may not drain properly and can collect in the tissues on the side of the body where the lymph nodes were removed. Symptoms of lymphedema include swelling, achiness, tingling, heaviness, tightness, or a feeling of fullness in the hand, arm, chest, or armpit area. Detecting lymphedema early increases the likelihood of successful treatment. There are also things you can do to reduce your risk of it or reduce the severity. (Learn about Lymphedema)

Scheduling your follow-up appointments  

Your surgeon may arrange for a home health care provider to evaluate you at home within the first day or two after you return home from the hospital. Your follow-up appointment with your surgeon should usually be scheduled for within one to two weeks after you leave the hospital.

How long to avoid certain activities after mastectomy 

Your doctor may instruct you not to lift objects heavier than 5 pounds for four to six weeks. Ask your doctor how long you need to avoid more strenuous activities (like jogging, tennis, or weightlifting) and about exercises and movements you can do while you are healing.

When you can start wearing a prosthetic breast form or resume wearing a bra 

The site of mastectomy surgery, and especially mastectomy with reconstruction, needs time to heal before you can wear a breast prosthesis or bra. Follow your post-surgical instructions or ask your doctor to let you know how long you need to wait after your mastectomy surgery.   

At-home mastectomy recovery 

Mastectomy recovery time can last a few weeks after surgery, and longer if you have had reconstruction. It’s important to take the time you need to heal. Here are some general mastectomy recovery guidelines to follow at home: 

• Rest. When you get home from the hospital, you probably are going to feel fatigued from the experience. Allow yourself to get extra rest in the first few weeks after surgery. Read more about managing fatigue. 
• Take pain medication as needed. You probably are going to feel a mixture of numbness and pain around the breast incision, the chest wall, and the armpit incision (if you had lymph nodes removed). If you feel the need, take pain medication according to your doctor’s instructions. Learn more about managing chest pain, armpit discomfort, and general pain.  
• Follow your doctor’s instructions on when you can take a shower. You may be instructed to take sponge baths until your doctor has removed your drains or sutures. 
• Continue doing arm exercises each day. It’s important to continue doing arm exercises on a regular basis to prevent stiffness and to keep your arm flexible. 
• Have friends and family pitch in around the house. Recovery from mastectomy can take time. Ask friends and family to help with meals, laundry, shopping, and childcare. As your body heals, try not to take on more than you can handle. 
• Be aware that your body continues to adjust to the effects of the surgery over a period of months. You may have sensations such as tingling, burning, pins and needles, numbness, unbearable itching, pressure, and tenderness in the chest, arm, and/or armpit in the first few months after surgery. Your discomfort may go away by itself, or it may persist. The sensations are typically caused by the damage to the sensory nerves in the chest and armpit that occurred during the surgery. Talk with your doctor about treatments to manage these symptoms if they are bothering you.  

For tips on preparing for mastectomy and recovery, read Before Mastectomy: 10 Tips to Get Ready for Your Hospital Stay and Recovery.

Getting your pathology report after mastectomy 

Your surgeon sends the breast tissue and any removed lymph nodes to a laboratory for testing. The tests provide information about the cancer’s characteristics. Just like the pathology report you received after your biopsy, you receive a pathology report about a week after a mastectomy. Once all the results are in, your doctor reviews the pathology report with you and discusses the next steps, including the need for additional therapy such as chemotherapy, radiation therapy, hormonal therapy, or targeted therapy. The treatment plan your medical team discussed with you before the mastectomy might change based on the test results in the pathology report from the surgery.    If you had a prophylactic mastectomy, the pathology report tells you whether or not any cancer is present. 

Learn more about Understanding Your Pathology Report.

Source: Breast Cancer. Org

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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.

1. National Cancer Institute. Breast Reconstruction After Mastectomy.
2. Plesca M, Bordea C, El Houcheimi B, Ichim E, Blidaru A. Evolution of radical mastectomy for breast cancer. J Med Life.
3. Galimberti V, Vicini E, Corso G, et al. Nipple-sparing and skin-sparing mastectomy: Review of aims, oncological safety and contraindications. Breast. 2017;34 Suppl 1(Suppl 1):S82–S84. doi:10.1016/j.breast.2017.06.034
4. Goethals A, Rose J. Mastectomy. StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing.
5. American Cancer Society. Mastectomy.
6. American Cancer Society. What Is Breast Cancer in Men?
7. Dae Hwa Kim 1, Il Hwan Byun 1, Won Jai Lee 1, Dong Kyun Rah 1, Ji Ye Kim 2, Dong Won Lee 3 Aesthetic Plast Surg. 2016 Dec;40(6):877-884. doi: 10.1007/s00266-016-0705-y. Epub 2016 Sep 27.
8. Burgess C, Cornelius V, Love S, Graham J, Richards M, Ramirez A. Depression and anxiety in women with early breast cancer: five year observational cohort study. BMJ. 2005;330(7493):702. doi:10.1136/bmj.38343.670868.D3
9. Kim CS, Algan O. Radiation therapy for early stage breast cancer. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing.
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
11. Robertson SA, Jeevaratnam JA, Agrawal A, Cutress RI. Mastectomy skin flap necrosis: challenges and solutions. Breast Cancer (Dove Med Press). 2017; 9: 141–152. doi:10.2147/BCTT.S81712
12. Tait RC et al. Persistent Post-Mastectomy Pain: Risk Factors and Current Approaches to Treatment. J Pain. 2018 Dec; 19(12): 1367–1383. doi:10.1016/j.jpain.2018.06.002

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How mastectomy bras can regain your well-being and your confidence

By Cassandra Haley

Women who have a mastectomy may find the next few days and months very difficult. Not only do they have to deal with the physical discomfort - women who had breast surgery after being diagnosed with breast cancer may feel the loss of confidence they once had.

That's why during these times, you need something that will help make the physical and emotional healing process easier and lighter for you.When you don't undergo an immediate surgical reconstruction, wearing a mastectomy bra will help you during this period of your life.

A mastectomy bra is a wire-free undergarment that will keep your body comfortable. It has pockets in its cups which hold the breast prosthesis in place. A mastectomy bra is made with soft fabric that does not irritate your skin and yet supports your chest area. And because they are especially made for women who just had a breast operation, it is crafted in such a way that it is easier to wear even with limited mobility.Wearing a mastectomy bra with a breast form has its advantages.

First, it protects your sensitive breasts from experiencing further pain after the operation by covering the wounds and scars. Second, compared to a regular bra, a mastectomy bra is made to be breathable and soft to the skin so you feel more comfortable. Third, the mastectomy bra's unique construction aids in improving your posture and lessens neck, back and shoulder pain. And fourth, it gives you a sense of balance that you lost when you had your mastectomy.Your doctor or surgeon may recommend places where you can buy a mastectomy bra - at a store near you, in a hospital or even online. But before buying one, consult a professional mastectomy fitter first.

Wear a comfortable, close-fitting top so you can get a proper fit. It's not as stressful and embarrassing as you think; you can be assured of a private and pleasant experience during your fitting. After your fitting, you can buy a couple of mastectomy bras that fit right, feel comfortable and look great under your clothes.Undergoing mastectomy is not the end of your womanhood. Having breast surgery should not affect your self-esteem. With the right mastectomy bra, plus the love and support of your family and friends, you can regain your confidence sooner and speed up your physical and emotional healing.

Get back on track with mastectomy bras from Lauren Silva. We also have bra inserts, other bras and lingerie available for regular and plus sized women.

Article Source: EzineArticles.com

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