What is a mastectomy?
A mastectomy is an operation to remove a breast, usually because of breast cancer. A partial mastectomy is a term used to describe operations that remove part of the breast tissue. A total mastectomy is an operation to remove the cancer, the breast tissue, some skin and the nipple. If the cancer has spread into the underlying muscle, this may have to be removed as well.
Some lymph nodes will also be removed from your armpit. Lymph nodes are small bean-shaped organs that are part of your immune system. They are usually taken out because cancer tends to spread to the lymph nodes. The nodes are examined under a microscope to see if the cancer has spread into them. Axillary clearance is when all the lymph nodes in your armpit are taken out.
The procedure is usually done under general anaesthesia which means you will be asleep and will feel no pain. You will need to stay in hospital for several days. The length of your stay will depend on the extent of your surgery and how you feel afterwards. Your surgeon will explain the benefits and risks of having a mastectomy, and will discuss any alternatives to the procedure. Your surgeon will also discuss your options for breast reconstruction after the mastectomy, taking your personal preferences into account.
About the operation
Once the anaesthesia has taken effect, your surgeon will make a diagonal or horizontal cut across the skin of your breast. All the necessary tissue is removed. The skin is re-shaped and the cut is closed up with very fine stitches. Sometimes, a breast reconstruction operation may be performed at the same time. Your surgeon will discuss your options with you.
After surgery, the breast area will feel tender and tight. Your arm and shoulder will also feel sore and stiff, especially if you’ve had all your lymph nodes removed. Many women develop a seroma after mastectomy. This is a collection of fluid under the arm on the side of the operation. The fluid is absorbed into the body in time, but if the seroma is large or uncomfortable it may need to be drained.
A physiotherapist will visit you after your operation to discuss a programme of exercises to do in hospital and at home. These will help you regain strength and movement in your arm and speed up your recovery.
Mastectomy is generally a safe operation. For most people, the benefits are much greater than any disadvantages. However, like all surgery, there are some risks.
Removing lymph nodes can cause fluid to build up in your arm, making it swollen and painful. This is called lymphoedema. Your breast care nurse will give you advice about how to prevent lymphoedema.
Some women still feel pain and sensations where the breast used to be, even though the breast has been removed. This can last for years after surgery. Your breast care nurse will be able to give you help and support.
Your surgeon will be very experienced at this procedure but sometimes the cosmetic result is disappointing. Ask your surgeon to show you some photographs so that you know what to expect.
The chance of complications depends on the exact type of operation you are having and other factors such as your general health. Ask your surgeon to explain in more detail how any risks apply to you.
Breast reconstruction following mastectomy
Before you undergo a mastectomy your surgeon will be happy to discuss your options for breast reconstruction surgery. Breast reconstruction can take place either at the same time as a mastectomy operation, or in a separate operation afterwards. The timing that is best for you will depend upon a number of factors which your surgeon will be able to explain to you.