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Mastectomy: Surgery to treat or prevent breast cancer

Learn about mastectomy, including when it's necessary, what's involved and what you can expect after the surgery.

By Mayo Clinic staff

Surgery of any kind can be a challenging experience, but mastectomy — the surgical removal of one or both breasts — may raise special concerns. You may wonder if this surgery is your best option for treating or preventing breast cancer. You also may be concerned about how you'll feel and look after the mastectomy.

Take your time to gather information on the mastectomy procedure and what you can expect before and after the surgery. Researching your options and talking with your doctor can give you the information you need to decide whether mastectomy is right for you.

Who is mastectomy for?

Mastectomy is an effective treatment for breast cancer. Your doctor may recommended mastectomy over other treatment options — such as surgery to remove the tumor only (lumpectomy) plus radiation therapy — if:

  • You're in the first or second trimester of pregnancy, when radiation creates an unacceptable risk to your unborn child.
  • You have two or more tumors in separate areas of the breast.
  • You have widespread or malignant-appearing microcalcifications throughout the breast.
  • You've previously had radiation treatment to the breast region.
  • You have a strong family history of breast cancer.
  • You carry a gene mutation that confers a high risk of developing another breast cancer.

You might also choose mastectomy if:

  • You have a large tumor relative to the overall size of your breast. You may not have enough healthy tissue left after lumpectomy to achieve an acceptable cosmetic result.
  • You have a history of connective tissue disease, such as systemic lupus erythematosus, and may not tolerate the side effects of radiation, particularly to the skin.
  • The tumor is located beneath the nipple and may involve the nipple, making it more difficult to preserve the nipple and areola.
  • You live a long distance from a radiation facility and being there every day for five to six weeks would be too large a hardship.

You may also consider mastectomy may if you don't have breast cancer but are at high risk of developing the disease. This procedure, called preventive (prophylactic) or risk-reducing mastectomy, removes one or both of your breasts in hopes of preventing or reducing your risk of developing breast cancer in the future.

How do you prepare?

Before your surgery, you'll meet with a surgeon and perhaps an anesthesiologist to discuss your operation, review your medical history and determine the plan for your anesthesia. This is a good time to ask questions and to make sure you understand the procedure, including the reasons for and risks of the surgery.

You'll be asked questions about allergies or other chronic problems you may have and medications you're taking. Some medications — such as aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs) and blood-thinning medications (anticoagulants) — can cause excessive bleeding during surgery. Other medications and herbal supplements may interact with the anesthetics and cause problems. Your doctor may ask you to stop using these medications and supplements for a period of time before and after surgery.

Follow your doctor's directions in preparing for the surgery. This includes restrictions on eating, drinking, and limiting or stopping the use of nicotine products.

How is mastectomy done?

CLICK TO ENLARGE

Images of simple and modified radical mastectomy Simple mastectomy and modified radical mastectomy

The surgeon usually makes a single incision across half your chest, allowing for removal of the breast and, if necessary, adjacent underarm (axillary) lymph nodes. The extent of the surgery depends on many factors, such as your diagnosis and whether reconstruction is done immediately after the mastectomy. Types of mastectomies include:

  • Radical mastectomy — removal of the entire breast, chest wall (pectoral) muscles, all of the lymph nodes under the arm, and some additional fat and skin. Except to treat advanced stages of breast cancer, this type of mastectomy is rarely used.
  • Modified radical mastectomy — removal of the entire breast, including the breast tissue, skin, areola and nipple, and 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 — removal of the entire breast, including the breast tissue, skin, areola and nipple, but not all the lymph nodes. A sentinel lymph node biopsy maybe done at the time of the simple mastectomy. Simple mastectomy is also appropriate when the cancer is in multiple sites within the breast but is confined to the ducts (carcinoma in situ).
  • Skin-sparing mastectomy — removal of all the breast tissue, nipple and areola but not the breast skin. This procedure may be used when breast reconstruction is performed immediately following the mastectomy.
  • Subcutaneous (nipple-sparing) mastectomy — removal of only breast tissue, sparing the skin, nipple, areola, chest wall muscles and lymph nodes. This is one of several surgical procedures plastic surgeons may perform as a preventive measure for people at high-risk of breast cancer.
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WO00113

Nov. 30, 2007

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