Mastectomy

A mastectomy is an operation (surgery) to remove a breast. It's used to treat breast cancer.

It usually takes 4 to 6 weeks to recover from a mastectomy. But it can sometimes take up to 3 months.

When you may need a mastectomy

A mastectomy may be the recommended treatment for breast cancer if:

• the size of the cancer and how it appears on the mammogram are 'suspicious'
• cancer is found in different parts of your breast
• there are cancer cells in the rim of tissue surrounding the cancer that was removed
• you cannot have radiotherapy
• you would prefer to have this surgery

Some women at high risk of breast cancer choose to have a mastectomy even when there's no sign of cancer.

Preparing for a mastectomy

Before having a mastectomy, you can talk to a specialist breast care nurse or surgeon about the surgery.

Your surgeon will explain the type of mastectomy you'll have. They'll tell you the possible side effects or health problems (complications) from having a mastectomy.

You can also talk about the option of breast reconstruction. You'll get advice about bras and bra inserts, if you need them.

Sometimes you may need to have chemotherapy or hormone therapy before surgery to reduce the size of the cancer.

The surgery

A mastectomy is carried out under general anaesthetic, so you'll be asleep while it happens.

The surgeon will usually put 1 or 2 drainage tubes in place to stop fluid building up in the breast space. These may be left in for a few days.

Types of mastectomy

Some of the main types of mastectomy are:

Simple mastectomy

All the breast tissue and most of the skin covering it is removed.

Skin-sparing mastectomy

All the breast tissue is removed, including the nipple. But most of the skin covering the breast is left. Skin-sparing mastectomy is often combined with breast reconstruction.

Subcutaneous mastectomy

This is a skin-sparing mastectomy - but the nipple is not removed.

Risk-reducing mastectomy

This is used in a small minority of women who carry a gene abnormality that greatly increases their chances of developing breast cancer.

Lymph nodes

Lymph nodes are small, oval-shaped balls that help remove bacteria and other waste from the body. If the cancer has spread to them, the lymph nodes under your arm will be removed during surgery.

If tests before surgery did not find cancer in your lymph nodes, a few may be removed during surgery for further testing. This is called a sentinel node biopsy. If these tests find cancer, you might need radiotherapy or another surgery.

Breast reconstruction

If you're having a mastectomy, your surgeon will usually talk to you about having breast reconstruction.

Breast reconstruction replaces the tissue removed during a mastectomy. It's often done at the same time as a mastectomy, but it can be done at a later date.

There are 2 ways to do a breast reconstruction:

• by inserting a breast implant
• using tissue from another part of your body to create a new breast substitute

The best type for you will depend on:

• the treatment you've had
• any ongoing treatment
• the size of your breasts
• your general health

Talk to your surgeon about which reconstruction is suitable for you.

Some people decide not to have breast reconstruction.

Recovery from a mastectomy

Most people who have a mastectomy recover well.

You may wake up with:

• a drip in your arm so you can be given fluids
• one or more drainage tubes coming from the wound
• a dressing to help keep your wound clean

The area will be bruised, swollen and stiff at first.

You will probably feel sore for a few days and should be given painkillers in hospital. If they do not work, tell a nurse before you leave so you can try something else.

You may also have:

• painless swelling around your stitches (seroma) - this usually happens after your drain is removed and goes away after a few weeks
• numbness around your armpit (where your lymph nodes were removed) and sometimes going down inside your arm - this should improve with time

Your wounds may take around 2 to 3 weeks to heal. But it may be several months before your chest and arm area fully recover.

Scar

The scar from a mastectomy will go across the skin of the chest and into the armpit, usually hidden by the bra cup. It will fade over time. But it will never completely disappear. It will also feel permanently numb.

Going home

Most people go home a few days after their surgery.

If you've had breast reconstruction, you may need to stay in hospital for up to a week depending on how you're recovering.

Before you leave hospital, your doctor or nurse will talk to you about what to do when you get home. You'll probably feel more tired than usual for several weeks and will need a lot of rest, so try not to do too much.

If you're concerned your wound is not healing well or want to know what to do with wound dressings, contact hospital staff or your GP.

Your healthcare team will talk to you about the results of the surgery and any further treatment at a follow-up appointment. This takes place around 2 weeks after surgery.

Arm exercises

Arm exercises will help you get back the full range of movement to your arm and shoulder.

You can do gentle exercise as soon as you feel comfortable. This is usually around 3 to 4 weeks after surgery.

You may be given a leaflet with exercises. You may also be offered physiotherapy.

Avoid more strenuous physical activity, including housework and heavy lifting, until you get the all-clear from your doctor or nurse.

Bra inserts

Before leaving hospital, you'll be given a lightweight breast shape (prosthesis) to wear inside your bra. This is to replace the breast that has been removed.

You can wear it until the area affected by surgery or radiotherapy has healed.

Your healthcare team will give you information about getting a silicone prosthesis at a follow-up appointment after your mastectomy.

These come in many shapes and sizes, and you should be able to find one that suits you. You will also get advice on bra fitting.

About 6 to 8 weeks after surgery, you'll can start wearing a silicone prosthesis to use longer-term.

Driving

Get advice from your doctor or nurse about when to start driving again. Generally, you should be OK to drive if you can make an emergency stop without discomfort in the wound.

Some people are able to drive about 3 weeks after their surgery. But it may be sooner or later than this depending on how you feel.

Some insurance companies will not insure drivers for a number of weeks after surgery, so check your policy.

Returning to work

You can return to work when you feel up to it. Most people take 4 to 8 weeks off work, but it varies from person to person.

Usually your GP can give you a medical note for your employer.

Emotional support

Recovering from a mastectomy can be difficult.

It can help to talk to others who have had a mastectomy. You can get information about support groups from your doctor or nurse.

Dealing with changes to your body