Mastectomy

A mastectomy is an operation to remove a breast. It's used to treat breast cancer in some women and breast cancer in men.

It usually can take 4 to 6 weeks to recover from a mastectomy. It might be 3 months before the patient is back to normal.

When is a mastectomy recommended?

A mastectomy may be recommended if:

• a few cancers are found in different parts of the breast
• the cancer is large
• the patient has a preference for it
• there are extensive suspicious findings on mammography
• there is an inability to obtain clear or negative margins of lumpectomy
• the patient is unable to have radiotherapy

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 discuss the operation with a specialist breast care nurse or surgeon.

You'll get practical advice about bras and bra inserts, if you need them.

Your surgeon will discuss the type of mastectomy you'll have. They'll tell you the possible complications and discuss the option of breast reconstruction. Sometimes you may need to have chemotherapy or hormone therapy before the operation to reduce the size of the cancer.

The operation

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:

• standard 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. Sometimes the nipple may be
• left in place after this procedure. Skin -sparing mastectomy is often combined with breast reconstruction
• subcutaneous mastectomy – a skin-sparing mastectomy where the nipple isn't 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 the operation.

If pre-surgery tests didn't find cancer in your lymph nodes, a few may be removed during the operation for further testing. This is called a sentinel node biopsy. If these tests find cancer, you might need radiotherapy or another operation.

Breast reconstruction

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

Breast reconstruction is an operation to make a replacement for 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.

Some people decide not to have breast reconstruction.

Recovery

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

You will probably feel sore for a few days and should be given painkillers in hospital. If they don't work, tell the nursing staff before you leave so you can try something else.

Most people find their wounds take around 2 to 3 weeks to heal, but it may be several months before your chest and arm area fully recover.

The area will be bruised, swollen and stiff at first. You may also have:

• painless swelling around your stitches (seroma). This usually happens after your drain is removed. The swelling usually disappears without treatment after several weeks
• numbness where your lymph nodes were removed – this should improve with time

Scar

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

Going home

Most people go home a few days after their operation.

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.

The results of the operation and any further treatment will be discussed at a follow-up appointment around 2 weeks after the operation.

Arm exercises

Arm exercises are recommended to encourage the full range of movement back to your arm and shoulder.

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

You may be given an exercise leaflet. You may also be offered physiotherapy.

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

Bra inserts

Before leaving hospital, you'll have the opportunity to be fitted with a lightweight breast shape (prosthesis) to wear inside your bra.

You'll usually be fitted with a longer-term prosthesis and given advice on bra fitting 6 to 8 weeks after the operation.

Driving

Get advice from your doctor or nurse about when to start driving. 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 the operation, 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 you may want to check your policy.

Returning to work

You can return to work when you feel up to it. Taking 4 to 8 weeks off is fairly typical, but it varies from person to person.

The hospital staff or your GP can supply you with a medical note for your employer if needed.

Complications

If you're concerned your wound isn't healing well, contact hospital staff or your GP.

Emotional support

Recovering from a mastectomy can be difficult. You may find it helpful, before and after your mastectomy, to talk to others who have had the operation.

You can get information on contacting others who have had a mastectomy from your doctor or nurse.