Mastectomy
Mastectomy is an operation to remove the whole breast. It is usually performed to treat breast cancer and sometimes because of a high risk of cancer.
Mastectomy can be combined with breast reconstruction. Most women are suitable for some form of reconstruction, but many women choose to "go flat" or would rather not worry about reconstruction for now - something can always be done later.
Key points
- Operation to remove the whole breast
- Usually an overnight stay
- Less likely to need radiotherapy
- Low (but not zero) risk
- Can be combined with breast reconstruction
Alternatives
If chemotherapy is needed, it can sometimes be given before surgery. This can shrink down the tumour and allow breast conservation surgery instead of mastectomy.
Modern breast surgery techniques can be used to remove larger cancers than previously possible without needing a mastectomy. These include therapeutic mammoplasty and local flap reconstruction such as LICAP.
Potential problems
- Bleeding, including a pocket of blood under the skin (haematoma) (5%)
- Seroma
- Wound infection (<5%)
- Skin necrosis (<1%)
- Breast cancer recurrence (1% per year)
- Risk of anaesthesia (low)
Associated treatment
Most women having mastectomy will also require surgery to the lymph glands in the arm pit. Most women have a sentinel node biopsy at the same time as the mastectomy, but if cancer is found in the lymph glands before surgery, you may need an axillary dissection.
You may choose to have a breast reconstruction at the same time.
Some women having mastectomy will be advised to have radiotherapy. This reduces the risk of any breast cancer recurring in the chest wall area.
Many women with breast cancer are recommended to take hormonal therapy for several years. This depends on the biology of your cancer and will be discussed with you in detail if needed.
Some women are recommended to have chemotherapy or targeted therapy for several months. Again this depends on the biology of your tumour and you will discuss this in detail with your medical oncologist if needed.
On the day of surgery
You will need to fast for 6 hours before surgery. You can take any medications as normal and continue to drink water until 2 hours before surgery.
You should shower and wash well in the morning. Bring something to do as there will be a lot of waiting.
When you arrive you will be checked in by the nurses and change into a gown and stockings ready for the operation.
In the holding bay
You will see your surgeon and anaesthetist, have a drip put in and have the operative site marked. You might also be given premedication.
In recovery
After surgery you will go to recovery. You will be watched closely until you are alert and well enough to return to the ward. You might be given medication for any sickness or pain.
After surgery
Swelling or bruising is common and usually settles on its own.
You will probably have a drain (plastic tube) to prevent fluid building up in the wound. This is usually removed after about a week. You can shower carefully straight away. Try not to soak your dressings and pat them dry afterwards.
Pain and discomfort can usually be managed with simple painkiller tablets.
Eat healthily and try to exercise a little every day. You will probably find your movement restricted for several weeks. The exercises given to you by your breast care nurse will help to minimise stiffness.
If you have any concerns call the team - we would rather know about it and you are never wasting our time! We can always arrange for you to come to the clinic if needed and if you are unwell out of hours you can always attend the emergency department.
Driving
You need to be able to concentrate properly and perform an emergency stop without any distracting pain. You will probably need to avoid driving for 1-2 weeks, but check with your insurance company.
Work
Getting back to work can be necessary or helpful for many women, but you will probably need to wait at least until you get your results and can plan any further surgery or treatment.
EDI: mybreast