A mastectomy is surgery to remove the breast tissue. Some of the skin and the nipple may also be removed. However, surgery that spares the nipple and skin can now be done more often. The surgery is most often done to treat breast cancer.
Before surgery begins, you will be given general anesthesia. This means you will be asleep and pain-free during surgery.
There are different types of mastectomies. Which one your surgeon performs depends on the type of breast problem you have. Most of the time, mastectomy is done to treat cancer. However, it is sometimes done to prevent cancer (prophylactic mastectomy).
The surgeon will make a cut in your breast and perform one of these operations:
• Nipple-sparing mastectomy: The surgeon removes the entire breast, but leaves the nipple and areola (the colored circle around the nipple) in place. If you have cancer, the surgeon may do a biopsy of lymph nodes in the underarm area to see if the cancer has spread.
• Skin-sparing mastectomy: The surgeon removes the breast with the nipple and areola with minimal skin removal. If you have cancer, the surgeon may do a biopsy of lymph nodes in the underarm area to see if the cancer has spread.
• Total or simple mastectomy: The surgeon removes the entire breast along with the nipple and areola. If you have cancer, the surgeon may do a biopsy of lymph nodes in the underarm area to see if the cancer has spread.
• Modified radical mastectomy: The surgeon removes the entire breast with the nipple and areolar along with some of the lymph nodes underneath the arm.
• Radical mastectomy: The surgeon removes the skin over the breast, all of the lymph nodes underneath the arm, and the chest muscles. This surgery is rarely done.
• The skin is then closed with sutures (stitches).
One or two small plastic drains or tubes are very often left in your chest to remove extra fluid from where the breast tissue used to be.
A plastic surgeon may be able to begin reconstruction of the breast during the same operation. You may also choose to have breast reconstruction at a later time. If you have reconstruction, a skin- or nipple-sparing mastectomy may be an option.
Mastectomy will take about 2 to 3 hours.
WOMAN DIAGNOSED WITH BREAST CANCER
The most common reason for a mastectomy is breast cancer.
If you are diagnosed with breast cancer, talk to your health care provider about your choices:
• Lumpectomy is when only the breast cancer and tissue around the cancer are removed. This is also called breast conservation therapy or partial mastectomy. Most of your breast will be left.
• Mastectomy is when all breast tissue is removed.
You and your provider should consider:
• The size and location of your tumor
• Skin involvement of the tumor
• How many tumors there are in the breast
• How much of the breast is affected
• The size of your breast
• Your age
• Medical history that may exclude you from breast conservation (this may include prior breast radiation and certain medical conditions)
• Family history
• Your general health and whether you have reached menopause
The choice of what is best for you can be difficult. You and the providers who are treating your breast cancer will decide together what is best.
WOMEN AT HIGH RISK FOR BREAST CANCER
Women who have a very high risk of developing breast cancer may choose to have a preventive (or prophylactic) mastectomy to reduce the risk of breast cancer.
You may be more likely to get breast cancer if one or more close family relatives has had the disease, especially at an early age. Genetic tests (such as BRCA1 or BRCA2) may help show that you have a high risk.
However, even with a normal genetic test, you may still be at high risk of breast cancer, depending on other factors. It may be useful to meet with a genetic counselor to assess your level of risk.
Prophylactic mastectomy should be done only after very careful thought and discussion with your doctor, a genetic counselor, your family, and loved ones.
Mastectomy greatly reduces the risk of breast cancer, but does not eliminate it.