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By Mayo Clinic staff
"Mastectomy" is an umbrella term used for several different procedures. Mastectomy also includes removing lymph nodes to determine whether the cancer has spread. For an axillary node dissection, the surgeon removes a number of nodes from your armpit on the side of the tumor. In a sentinel lymph node biopsy, your surgeon removes only the first one or two nodes into which a tumor drains (sentinel nodes). These are then tested for cancer. If no cancer is present, no further lymph nodes need be removed. If cancer is present, the surgeon will remove more lymph nodes in the armpit.
The different types of mastectomy are:
- Modified radical mastectomy — Removal of the entire breast, including the breast tissue, skin, areola and nipple. The lining over the chest muscles and sometimes part of the chest wall is also removed, as well as most of the underarm lymph nodes (complete axillary node dissection). This procedure may be recommended for large tumors or if the cancer has spread to the lymph nodes.
- Simple (total) mastectomy — Removal of the entire breast, including the breast tissue, skin, areola and nipple, but not the underlying chest tissue. A sentinel lymph node biopsy may be done at the time of a simple mastectomy.
- Skin-sparing mastectomy — Removal of all the breast tissue, nipple and areola, but not the breast skin. Breast reconstruction is performed immediately following the mastectomy. Skin-sparing mastectomy may not be suitable for larger tumors.
- Nipple-sparing (subcutaneous) mastectomy — removal of only breast tissue, sparing the skin, nipple, areola, chest wall muscles and lymph nodes. Breast reconstruction is performed immediately afterward.
Before the procedure
Your doctor or nurse will tell you when to arrive at the hospital. Mastectomy without reconstruction usually takes one to three hours. It usually requires a one- to two-day hospital stay, although more and more people are going home on the same day as the operation. If you're having both breasts removed (double mastectomy), expect to spend more time in surgery and possibly more time in the hospital. If you're having breast reconstruction following mastectomy, the procedure also takes longer.
If you're having sentinel node biopsy, several hours before your surgery a radioactive substance or blue dye or both will be injected into the area around the tumor or the skin above the tumor. In the hours before your surgery, the dye will travel to the sentinel node or nodes, allowing your doctor to see where they are and remove them during surgery.
Just before your surgery you will:
- Undress and put on a hospital gown
- Meet with your surgeon to go over any last-minute concerns
- Meet with an anesthesiologist or nurse anesthetist to go over the type of anesthesia you'll be given and ask any questions you have
- Have an intravenous (IV) line placed, usually into a vein in your arm, so that your medical team can give you medication during surgery
- Possibly be given a sedative
- Be transported on a wheeled bed (gurney) to the operating room
During the procedure
Mastectomy is usually performed under general anesthesia, so you're unconscious during the surgery. Your surgeon starts by making an elliptical incision around your breast. If you're having a simple mastectomy, the surgeon removes all your breast tissue — the lobules, ducts, fatty tissue and a strip of skin with the nipple and areola. If you're having a modified radical mastectomy, the surgeon also removes the lymph nodes under your arm. For a skin-sparing mastectomy, the surgeon makes a smaller incision that allows breast tissue to be removed but leaves the breast skin intact. Regardless of the type of mastectomy you have, some breast tissue and lymph nodes will be sent to the pathology lab for analysis.
If you're having breast reconstruction at the same time as mastectomy, the implants will be placed or the new breast mound will be built immediately after your breast tissue is removed. Some women who have skin-sparing mastectomy will have a temporary tissue expander placed. The expander holds the breast skin in place so you can delay having breast reconstruction until after radiation therapy.
As the surgery is completed, the incision is closed with sutures (stitches), which either dissolve or are removed later. Your surgeon may place thin adhesive strips across the incision to help hold it together while the incision heals. The strips normally loosen and come off on their own within a few weeks. You might also have one or two small plastic tubes placed where your breast was removed. The tubes will drain any fluids that accumulate after surgery. The tubes are sewn into place, and the ends are attached to a small drainage bag.
After the procedure
After your surgery, you can expect to:
- Be taken to a recovery room. A nurse will monitor your blood pressure, pulse and breathing.
- Have a dressing (bandage) over the surgery site
- Feel some pain, numbness and a pinching sensation in your underarm area
- Receive instructions on how to care for yourself at home, including taking care of your incision and drains, recognizing signs of infection and understanding activity restrictions
- Talk with a nurse about when to resume wearing a bra or wearing a breast prosthesis
- Be given prescriptions for pain medication and possibly an antibiotic
Most people meet with their doctor a week or two after surgery. Your drainage tubes will likely be removed at that time.
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