A mastectomy is an operation to remove the breast.
It's used to treat breast cancer in women or breast cancer in men. It can also be used to reduce the risk of cancer developing in the breast.
If your GP refers you urgently because they think you have cancer, you have the right to be seen by a specialist within two weeks.
In 2012-13, just under 23,200 mastectomies were carried out in England.
Preparing for a mastectomy
Before having a mastectomy, you'll have the opportunity to discuss the operation with a specialist nurse or surgeon. You can discuss how the procedure might affect you both physically and emotionally.
A specialist nurse can give you practical advice about bras and prostheses (bra inserts), if you need them. Your surgeon will discuss the type of mastectomy you'll have, possible complications and the option of breast reconstruction (see below).
If you're currently taking any medicines, find out whether you should continue taking them before your operation. However, don't stop taking a prescribed medication unless advised to do so by a qualified healthcare professional responsible for your care.
If you smoke, you may be advised to stop smoking before your operation. Smoking can increase the risk of complications during and after your operation, which may increase your recovery time.
There are several different types of mastectomy. The type recommended for you will depend on factors such as how much the cancer has spread. All types of mastectomy use general anaestheticand involve making a cut (incision) either diagonally or horizontally across your breast so that the breast tissue can be removed.
Before the operation, you may need to have chemotherapy or hormone therapy to reduce the size of any tumours.
After your breast has been removed, you may choose to have a breast reconstruction. This involves creating an artificial breast to replace the breast or breasts that have been removed.
It's sometimes possible for a breast reconstruction to be carried out at the same time as a mastectomy, although it can be delayed until a later date if necessary
Mastectomies are very safe procedures, with minimal complications. Most people make a good recovery and only need to stay in hospital for one night. However, some people will need to spend a few days in hospital. Generally, it takes three and six weeks to fully recover.
During the early stages of recovery, you may have tubes coming from the wound. These are used to drain away blood and fluids to help prevent swelling or infection. Your scar and stitches will be covered with a dressing.
It's common to experience pain, numbness, tingling and swelling after a mastectomy, but painkillers should provide some relief.
In rare cases, more serious complications can develop following a mastectomy, including infection of the wound and delayed healing.
Why a mastectomy may be necessary
A mastectomy is mainly used as a treatment for breast cancer or to reduce the risk of breast cancer developing.
Although breast cancer in men is much rarer than female breast cancer, it can also be treated with a mastectomy.
Treating breast cancer
The aim of a mastectomy operation is to remove all cancerous tissue from the breast. This is very important because if any cancerous cells are left behind, there's a risk that the cancer will grow back and spread to other parts of the body.
A mastectomy isn't always the most suitable treatment for breast cancer, although in many cases it's very effective. The specialist responsible for your care will be able to advise you on this.
A mastectomy may be recommended when:
the tumour is large in proportion to the breast
the cancer is present in more than one area of the breast
pre-cancerous cells, called ductal carcinoma in situ (DCIS), have affected most of the breast
Once a diagnosis of breast cancer has been confirmed, it should be treated as soon as possible. Early detection and treatment of breast cancer improves the chances of a successful outcome and a full recovery.
Preventing breast cancer
Risk-reducing (prophylactic) mastectomies are sometimes carried out on non-cancerous, healthy breasts to reduce the risk of breast cancer developing.
The procedure may be considered if a woman has a very high risk of developing breast cancer. This might be because she has a family history of breast cancer and carries a mutated (altered) version of the BRCA1, BRCA2 or TP53 gene. Having one of these altered genes greatly increases a woman's risk of developing breast cancer.
Prophylactic mastectomies can reduce the risk of breast cancer by up to 90% in people at a high risk of developing the condition. In some cases, a lumpectomy (removing a lump from the breast) may be all that's required, rather than removing the whole breast.
If you're concerned about your risk of developing breast cancer in a healthy breast, you should discuss the risks and benefits of surgery with your doctor or surgeon before making a decision. Prophylactic mastectomies aren't usually recommended if there's no evidence of an increased risk of breast cancer.
If you're at an increased risk of breast cancer, it may be possible to reduce your chances of developing the condition using medication rather than surgery.
The National Institute for Health and Care Excellence (NICE)recommends two medications called tamoxifen and raloxifene for this purpose. These medications aren't suitable for everyone, but they should be considered before making a decision about having a mastectomy.
How a mastectomy is performed
There are several different types of mastectomy, depending on the areas that are removed.
Some of the main types of mastectomy include:
standard mastectomy – all the breast tissue and most of the skin covering is removed
skin-sparing mastectomy – all of the breast tissue is removed, including the nipple, but most of the skin covering the breast is left
subcutaneous mastectomy – a skin-sparing mastectomy where the nipple isn't removed
radical mastectomy –all of the breast tissue is removed, plus the skin covering it, the two muscles behind the breast and the lymph nodes in the armpit; this procedure is now rarely carried out
modified radical mastectomy – a radical mastectomy, where the large muscle behind the breast (the larger of the two pectoral muscles) is left in place
Removing the breast tissue
All mastectomies are carried out under general anaesthetic, which means you'll be asleep during the operation and won't feel any pain or discomfort. However, you will feel sore when you wake up after the operation, which usually takes between one and two hours.
During the operation, a diagonal or horizontal cut is made across your breast so the breast tissue can be removed. The amount of skin removed will depend on the type of mastectomy you're having. The surgeon will usually leave one or two drainage tubes in place to stop fluid building up in the breast space.
In some cases, surgery may be carried out on the lymph nodes at the same time as the mastectomy. Lymph nodes are small, oval-shaped tissues that remove unwanted bacteria and particles from the body. They're part of the immune system (the body's natural defence against infection and illness).
It's possible for breast cancer to spread to the lymph nodes under your arm. If this is the case, most or all of your lymph nodes may be removed at the same time as your mastectomy.
It's standard practice for all removed tissue to be sent to a laboratory to be examined. Your surgeon will explain the reasons for this before your operation, as well as any further treatment you may need if your lymph nodes are affected.
Once the procedure is complete, stitches will be used to close the wound
Breast reconstruction is surgery to make a new breast to replace the tissue removed during a mastectomy. The new breast can be created using:
a silicone implant
tissue from another part of your body, such as your abdomen (tummy) or back
a combination of both
The aim is to create a shape that matches the removed breast or breasts.
Breast reconstruction can often be carried out at the same time as a mastectomy, or it can be performed at a later date. Some people decide not to have breast reconstruction at all. It's your decision and your specialist will discuss the options with you.
Lipomodelling is a procedure recommended by the National Institute for Health and Care Excellence (NICE). It uses a person's own fat cells after breast reconstruction or breast-conserving surgery. The aim is to restore the size and shape of the breast.
Fat is collected using a needle and syringe, usually from the abdomen, outer thigh or from the side of the body. The fat cells are separated and cleaned before being injected into the breast. Several treatment sessions are usually needed.
Following lipomodelling, some of the repositioned fat is often re-absorbed during the first six months. There's also some concern that it may make mammogram images more difficult to interpret in the future.
Lipomodelling is a safe and, in many cases, effective procedure. Out of 820 people who had the procedure after mastectomy and breast reconstruction, just 34 people (4%) reported long-term breast asymmetry (unequal breast size and shape).
Endoscopic mastectomy is surgery to remove the breast using a small cut in the armpit or around the edge of the nipple. An endoscope (a long, thin, flexible tube with a light and camera at one end) is used, along with special tools to remove the breast tissue.
This type of surgery isn't routinely used, because there's not enough evidence to confirm its safety and effectiveness. Endoscopic mastectomies may be carried out as part of medical research (clinical trials), but only in units that specialise in breast cancer management and by surgeons trained in both breast cancer surgery and endoscopy.
cancer (PDF, 92.5kb).
Recovering from a mastectomy
Most people who have a mastectomy recover well after the procedure and don't develop complications.
In most cases, it takes three to six weeks to fully recover.
After the operation
When you wake up after the operation, you will probably feel sore. This pain can be controlled with painkillers. It's very important to tell your doctor or nurse when you're in pain, because they can adapt your medication accordingly.
After the operation, you may have a drip in your arm so that you can be given fluids until you're able to eat and drink again.
Following a mastectomy, you may have one or more drainage tubes coming from the wound site. The purpose of these tubes is to drain blood and tissue fluid away from the wound to prevent it collecting and causing swelling or infection. Your surgeon will decide how long the tubes need to stay in for. It may be as short as 24 hours, or up to a few days.
The dressing over your wound will need to stay in place for at least a couple of days. During this time, it may need to be replaced and the wound cleaned. In some cases, the same dressing will need to stay on for a week or so.
You may have dissolvable stitches that don't need to be removed. However, some people have stitches or metal clips that need to be removed after 7 to 10 days. Your wound should have healed during this time.
Preparing for home
The length of your hospital stay will depend on the type of surgery you have, but you'll usually need to stay in hospital for about two or three days. However, it isn't unusual to only stay in hospital for one night.
Before you leave hospital, your specialist or nurse will talk to you about what to do when you get home. You will probably need a lot of rest. Gentle exercises may be recommended to overcome the stiffness of your arm and to encourage healthy circulation in the area that's been operated on.
Your specialist or nurse will discuss suitable bras and prostheses (bra inserts) if you haven't had breast reconstruction. If this is the case, you'll be given a lightweight artificial breast shape that you can put inside your bra. This is usually temporary, until your wound has completely healed. You'll eventually be given a permanent prosthesis.
After having a mastectomy, you'll have a scar going across your chest and under your arm, although the shape may be different if you had an immediate breast reconstruction.
Your specialist or nurse will advise you on how to look after your scar. If you're uncomfortable about how your scar looks, there are a number of possible treatments, such as further corrective surgery and using make-up, to cover the scar.
Recovering at home
Avoid the following activities during the first three to four weeks after surgery:
driving – don't drive until you're confident you can handle the car
lifting anything heavy or doing repetitive movements – such as vacuuming or ironing
swimming or playing sports
Your specialist can advise you on when you can return to work.
Talking to others
Recovering from a mastectomy can be emotionally difficult. Some people find it helpful to talk to others who have had the operation, both before and after the mastectomy.
You can get information on contacting others who have had a mastectomy from your specialist breast cancer care nurse and from organisations such as:
Macmillan Cancer Support – has information on groups you can join and a support line you can call for free 0808 808 0000 (Monday to Friday, 9am-8pm)
Cancer Research UK – provides advice on coping emotionallyand a helpline you can call free of charge on 0808 800 4040 (Monday to Friday, 9am-5pm)
You can also find cancer support services in your area.
Complications of a mastectomy
In most cases, recovery from a mastectomy is straightforward and without complications.
It's normal to experience certain side effects, such as short-term pain and swelling of the tissue over your chest wall. You'll also have a scar.
You may have swelling at the site of your operation due to body fluid collecting underneath the skin. This is called seroma. It often disappears without treatment, although it may need to be drained with a needle and syringe. Speak to your surgeon or breast care nurse if you think you're developing seroma.
If you've had the lymph nodes removed under your arm, you may experience numbness and tingling around this area. This often goes away as the area heals, but in some cases it's permanent. There's also a small chance that any pain you experience after having a mastectomy will be long-lasting.
Other complications include infection and a condition called lymphoedema (a side effect of mastectomies, that involve the armpit). Speak to your specialist or breast care nurse immediately if you think that you may be experiencing any of the symptoms described below.
Your wound may be infected if the wound site:
becomes more painful and swollen
is leaking fluid (discharge)
This can be treated with antibiotics.
If you've had some lymph nodes removed, you're more at risk of developing a condition called lymphoedema. This usually starts some time after surgery, but it can also develop many months or years later.
Lymphoedema is a build-up of fluid in the arm that causes swelling, pain and tenderness in your arm and hand.
Your nurse will tell you how to prevent lymphoedema using skincare techniques and exercises. If it occurs, lymphoedema can be controlled with early treatment in a specialised lymphoedema clinic.
Risks of breast reconstruction
If a breast implant was put in after your mastectomy, there's a slight risk of it becoming infected. If this happens, the implant may need to be removed.
The implant may also be removed if your skin fails to heal properly. The risk of this happening is higher in people who have diabetes or smoke.