Mastectomy (breast removal)

About breast removal surgery

There are two main types of breast removal surgery.

  • Simple breast removal – all of your breast tissue will be removed.
  • Radical breast removal – your breast tissue and the underlying muscle in your chest will be removed (this is usually only done if the cancer has spread into your chest wall muscles).

Your surgeon will advise you which type of breast removal surgery is best for you.

What are the alternatives to breast removal surgery?

Depending on the size, position and the type of cancer you have, your surgeon may suggest alternative treatment options to breast removal surgery. These may include:

  • breast lump removal (and some surrounding tissue), not your whole breast
  • breast reduction-type surgery to remove a larger cancer
  • radiotherapy – a treatment to destroy cancer cells with radiation
  • chemotherapy – a treatment to destroy cancer cells with medicines
  • hormonal therapy – a treatment that can lower the levels of oestrogen in your body, or block the effects of this hormone, which can cause the cancer to shrink

However, many women still usually need some sort of surgery at some stage to treat breast cancer.

Ask your surgeon for advice about the best treatment option for you.

Preparing for breast removal surgery

Your surgeon may advise you to have chemotherapy or hormone therapy before your breast removal operation. These treatments can help to reduce the size of the cancer, which will make it easier to remove.

Your surgeon will explain how to prepare for your operation. For example, if you smoke you will be asked to stop, as smoking increases your risk of getting a chest and wound infection, which can slow your recovery.

Breast removal surgery usually requires a hospital stay of one to two days and it’s usually done under general anaesthesia. This means you will be asleep during the operation.

You will be asked to follow fasting instructions. This means not eating or drinking, typically for about six hours beforehand. However, it’s important to follow your surgeon or anaesthetist’s advice.

At the hospital, your nurse may check your heart rate and blood pressure and test your urine.

Your surgeon will discuss with you what will happen before, during and after your procedure, and any pain you might have. This is your opportunity to understand what will happen, and you can help yourself by preparing questions to ask about the risks, benefits and any alternatives to the procedure. This will help you to be informed, so you can give your consent for the procedure to go ahead, which you may be asked to do by signing a consent form.

What happens during breast removal surgery?

Depending on the type of operation you have, your operation may take up to two hours, or longer if you’re having breast reconstruction surgery at the same time.

The technique your surgeon will use depends on the type of breast removal you're having. If you're having a simple breast removal, your surgeon will make a diagonal or horizontal cut across your breast, and remove the breast tissue.

Lymph nodes are glands throughout your body that are part of your immune system. Sometimes breast cancer can spread to the lymph nodes under your armpit. If cancer has spread to your lymph nodes, your surgeon will recommend that you have all your lymph nodes removed from that armpit. This is called an axillary clearance or axillary dissection. If your armpit is normal, your surgeon will advise you to have a procedure called a sentinel lymph node biopsy. In this procedure, your surgeon will identify a type of lymph nodes called the sentinel lymph nodes and remove these. He or she will send them to a laboratory for testing to determine the type of cells and if these are benign (not cancerous) or cancerous.

It’s possible to have breast reconstruction surgery at the same time as having your breast removed, or you can have this at a later date, or not at all. In breast reconstruction surgery, a new breast shape can be formed using tissue from your back or abdomen (tummy), or by using a silicone implant or a combination of these techniques.

When the operation is complete, your surgeon will close the cuts with stitches. These may be dissolvable. Your surgeon may also use tissue glue and/or paper strips.

What to expect afterwards

You will need to rest until the effects of the anaesthetic have passed. You may need pain relief to help with any discomfort as the anaesthetic wears off.

Occasionally, you may have a catheter (a fine tube) to drain urine from your bladder into a bag. This will usually be removed when you’re ready to get out of bed and walk around. You may also have fine plastic tubes running out from the wound. These drain fluid into another bag and are usually removed after two to five days – you may be sent home with the drains still in place.

Your nurse will give you advice about getting out of bed, bathing, diet and gentle exercises. Try to avoid getting shower gel, soap, cream or ointment on your wound, although it’s fine to wash with water after 48 hours if you don’t have dressings on. A physiotherapist (a health professional who specialises in maintaining and improving movement and mobility) will visit you to discuss a programme of exercises for you. These will help restore strength and movement in your arm and speed up your recovery.

Your nurse will give you some advice about caring for your healing wound before you go home. You may be given a date for a follow-up appointment.

If you haven't had breast reconstruction surgery, you may be offered a lightweight foam bra-insert, called a cumfie or softie. At your follow-up, you may be fitted for a permanent, soft plastic (silicone) false breast to wear inside your bra. This will closely match the size and shape of your other breast.

You will need to arrange for someone to drive you home. Try to have a friend or relative stay with you for the first 24 hours after your operation.

The length of time your dissolvable stitches will take to disappear depends on what type you have. However, for this type of procedure, they should usually disappear in about two weeks. Non-dissolvable stitches will be removed seven to 10 days after your operation.

Recovering from breast removal surgery

It usually takes at least three weeks to make a full recovery from breast removal surgery, but this varies between individuals, so it’s important to follow your surgeon’s advice.

At home, you will tire easily to begin with, so it's important to take it easy and eat a balanced diet. To improve your recovery, continue to do the exercises recommended by your physiotherapist.

If you need pain relief, you can take over-the-counter painkillers such as paracetamol or ibuprofen. Always read the patient information leaflet that comes with your medicine and if you have any questions, ask your pharmacist for advice.

At your follow-up appointment, your surgeon will give advice about when you can resume your usual activities and return to work. Your surgeon will also discuss any further treatment that you may need.

Follow your surgeon's advice about driving but it’s best not to drive for a few weeks. Also contact your motor insurer so that you’re aware of their recommendations.

What are the risks?

As with every procedure, there are some risks associated with breast removal surgery. We have not included the chance of these happening as they are specific to you and differ for every person. Ask your surgeon to explain how these risks apply to you.

Side-effects

Side-effects are the unwanted but mostly temporary effects you may get after having the procedure.

Side-effects of a mastectomy include:

  • soreness, swelling, bruising and tightness in your breast area and in your arm and shoulder
  • scarring – you will have a permanent scar but this usually fades over time
  • numbness or tingling in your upper arm and on your chest
  • a build up of fluid around your healing wound (seroma) – this may need to be drained with a needle and syringe

Complications

Complications are when problems occur during or after the operation. The possible complications of any operation include an unexpected reaction to the anaesthetic, excessive bleeding or developing a blood clot, usually in a vein in your leg (deep vein thrombosis, DVT).

Complications of breast removal surgery can include:

  • an infection – you may need antibiotics to treat it

If your surgeon removes lymph nodes from under your arm in the same procedure, there is a risk of having a build up of fluid in your arm (lymphoedema), particularly if you have all your lymph nodes removed. This causes swelling, pain and tenderness in your arm and hand and may require further treatment. Your nurse or physiotherapist may give you advice about exercises you can do to help prevent this.

My surgeon has recommended I have breast removal surgery. What are the alternatives?

Answer

Your surgeon may recommend breast removal surgery to treat breast cancer. This decision will be based on the type of cancer you have, its exact location in your breast and how much of your breast tissue is affected. There are possible alternatives to breast removal, for example chemotherapy or radiotherapy first to shrink the cancer and then just removing the remaining breast lump.

Explanation

There are possible alternatives to having your breast removed. For example, a lumpectomy is the removal of the breast lump (tumour) and some surrounding tissue, rather than your whole breast (mastectomy), and is followed by treatment with radiotherapy. This type of surgery is also referred to as breast conserving therapy. However, it may not be the most effective surgery for you. Your surgeon will discuss which surgery is best for you and the decision will depend on a number of factors including the type of cancer you have, its exact location in your breast and how much of your breast tissue is affected.

Having your breast removed can be a difficult decision to make. Before you have your operation, make sure you fully discuss with your surgeon why he or she has recommended breast removal for you, what the surgery will involve, and if there are any alternatives.

Will having breast removal surgery mean I don't need to have radiotherapy?

Answer

Radiotherapy is the use of radiation to kill cancer cells. Whether you need radiotherapy or not will depend on the type of cancer you have, its size and whether or not your lymph nodes are involved. Having radiotherapy after breast removal surgery is occasionally still needed to reduce the risk of the cancer coming back.

Explanation

If you have breast removal surgery, you may need radiotherapy to get rid of any:

  • remaining cancer cells in your breast area
  • cancer cells in your lymph glands

Your surgeon will discuss your treatment with you and advise if radiotherapy is necessary. If it’s needed, you will see an oncologist (a doctor who specialises diagnosing and treating cancer using non-surgical treatments) to discuss this further.

What is breast reconstruction?

Answer

Breast reconstruction surgery is an operation to restore the shape of your breast after you have surgery to remove your breast or breasts.

Explanation

If you're having breast removal surgery, you may wish to have breast reconstruction to restore the shape and appearance of your breast to match your remaining natural breast. This can be done with an implant, your own body tissue, or a combination of these techniques.

Breast reconstruction surgery can be done immediately after breast removal (immediate reconstruction), or at a later date (delayed reconstruction).

Your surgeon or nurse will advise you on the type of reconstruction that is best for you and when this can take place, taking into account your personal preferences.

My mother had breast cancer and my doctor said a prophylactic mastectomy is an option for me - what is this?

Answer

If your mother had breast cancer, particularly before the age of 40, it’s possible that you may be more at risk of getting it too. You may wish to discuss your risk with a clinical geneticist to decide if you need additional breast screening or a genetic test to assess your risk of carrying a genetic abnormality that pre-disposes you to breast cancer.

Explanation

Breast cancer can run in some families, which is called familial breast cancer or hereditary breast cancer. It’s more likely if more than one woman in your family has had had breast cancer at a young age, if there is a history of both breasts being affected, or another cancer that is related to breast cancer, such as ovarian cancer. If this is the case, you may have a higher risk of developing breast cancer than other women in the general population.

If breast cancer does run in your family, it could be caused by a fault in one of the genes that are known to be associated to breast cancer. Examples of these genes include BRCA1, BRCA2 and TP53. However, being born with a faulty gene doesn't mean you will definitely get cancer, but you’re more at risk.

Speak to your GP about getting referred to a clinical geneticist (a doctor who specialises in diagnosing inherited conditions) or a breast surgeon to discuss your level of risk. If tests confirm that you have inherited a faulty gene, you may decide to take measures to lower your risk of getting breast cancer, such as having your breasts removed. However, this is a big decision and it’s important that you discuss your options fully with your doctor. You may decide to have regular checks instead so if you do develop cancer, you can get treatment at an early stage.