When your doctor tells you that you need breast cancer surgery, it’s normal to have questions and want clear answers to understand your mastectomy. What exactly happens during a mastectomy? How long does recovery take? What will I look like after surgery? Will my breast be reconstructed?
A mastectomy is a common and effective treatment for breast cancer. Today, advances in breast cancer surgery offer more personalized options than ever before. Learning about these choices can make conversations with your doctor easier and help you feel more confident about your care.
This article explains what a mastectomy involves, the different types of surgery available and what to expect during recovery.
What Is a Mastectomy?
A mastectomy is a type of breast cancer surgery that removes nearly all breast tissue leaving behind skin, a small amount of subcutaneous fat beneath the skin and at times the nipple areolar complex. A surgeon may remove one breast or both breasts, depending on your specific condition and genetic testing.
This surgery is different from a lumpectomy. A lumpectomy removes only the tumor and a small ring of normal tissue around it. A mastectomy removes much more tissue.
When Is a Mastectomy Necessary?
Doctors recommend this surgery to treat existing breast cancer. In some cases, people choose it to lower their risk of getting breast cancer in the future if they are at an elevated risk.
Every breast cancer case is unique. Treatment decisions depend on the cancer stage, tumor size, breast size, overall health and what the patient wants.
There are several reasons a doctor might suggest a mastectomy:
- The tumor is very large compared to the size of the breast.
- There is more than one tumor in different parts of the breast.
- Cancer has come back after past treatments.
- Radiation therapy is not a safe option for the patient.
- The person has a high genetic risk for breast cancer.
- The patient prefers this surgery after talking with their doctor.
Exploring the Types of Mastectomy
Surgeons perform a few different types of mastectomies. The right choice depends on how much tissue needs removing, what parts of the breast can stay and other patient-specific factors.
Simple (Total) Mastectomy
This procedure removes the entire breast and a larger amount of skin. However, it leaves the chest muscles underneath the breast in place.
Skin-Sparing Mastectomy
In this surgery, the doctor removes the breast tissue but leaves most of the outer skin intact. Surgeons often use this method when a patient plans to have breast reconstruction at the same time.
Nipple-Sparing Mastectomy
Sometimes, surgeons can save the nipple during surgery. This is called a nipple-sparing mastectomy. It leaves the skin and the nipple areolar complex intact while removing the breast tissue underneath. This option depends on the size of the tumor, where it is located, the size of the breast and other health factors.
Double or Bilateral Mastectomy
A double mastectomy, also known as a bilateral mastectomy, removes both breasts. “Bilateral” simply means both sides.
Some patients need this because cancer is present in both breasts. Others choose it to prevent future cancer, especially if they carry certain genetic mutations. However, removing both breasts is not necessary for everyone.
What to Expect During Recovery After Mastectomy
Healing looks a little different for everyone. However, knowing what usually happens can help you plan your recovery after mastectomy.
- Hospital time: Most patients can go home the same day. Some patients may need to stay overnight if they require monitoring.
- Early side effects: Soreness, mild swelling and feeling very tired are completely normal for the first few weeks.
- Surgical drains: Doctors often place small tubes under your skin to catch extra fluid. They usually remove these within one to two weeks.
- Movement: Your care team will teach you gentle arm exercises to keep your joints moving well.
- Getting back to normal: Most people return to light activities in two to three weeks. Full healing takes longer, especially if you have breast reconstruction at the same time.
Your doctor will give you clear guidelines about lifting heavy objects, driving and going back to work.
Sensation and Breast Reconstruction
Many patients ask if their breast will look natural, or have feeling, after surgery. If you have a skin-sparing or nipple-sparing mastectomy along with breast reconstruction, the breast can look more natural.
The type of reconstruction; implant-based (silicone or saline implant) versus autologous tissue (tissue flaps taken from your own body to re-create a breast mound), can affect the appearance of the reconstructed breast as well. It is important to speak with your surgeon about your reconstruction options and what you are a candidate for. They will be able to refer you to a plastic surgeon who can provide you with more information regarding your options and help guide you.
Typically, the first stage of reconstruction is completed at the initial mastectomy operation. It is not uncommon to require additional surgeries before your reconstruction is completed.
If you are not a candidate for a nipple sparing mastectomy and you desire a more natural appearance of the breast, you can undergo nipple areolar reconstruction and/or 3D nipple tattooing.
Can You Regain Sensation After Breast Reconstruction?
It is completely normal to lose feeling in your chest after surgery. Surgeons must cut small nerves to remove the breast tissue, which causes numbness.
However, some surgeons now use techniques to help bring feeling back. This is called breast resensation. During reconstruction, the surgeon carefully reconnects nerves or uses nerve grafts. Feeling returns very slowly, and results differ from person to person. Some people get a lot of feeling back, while others see only small improvements.
Options if You Choose Not to Have Breast Reconstruction
Some patients do not wish to undergo reconstruction and in this case excess skin is removed with the breast and the incision is closed with sutures by your breast surgeon.
Additionally, an aesthetic flat closure can be offered which provides a more flat, smooth contour to the chest wall, reducing excess skin and subcutaneous fat over the anterior and lateral chest wall. This is performed by some breast surgeons and can also be performed by a plastic surgeon.
Survival Rates and Future Health
If you catch breast cancer early, the survival rate is very high. Surgery is just one piece of the puzzle. To keep you healthy, doctors might also use radiation, chemotherapy or hormone therapy. For early-stage cancers, survival rates are often the same whether you choose a mastectomy or a lumpectomy with radiation.
While surgery removes the tissue where cancer grows, it cannot remove every single cell. Sometimes, breast cancer comes back in the chest wall or another body part.
You will have regular follow-up visits with your doctor. They will check your health, perform clinical breast exams routinely and order imaging tests if needed. Following your treatment plan carefully is the best way to lower your risk.
Questions to Ask Your Doctor Before Surgery
It helps to write down your thoughts before you meet with your surgeon. Bring a friend or family member to help you remember the answers.
Here are a few questions you can ask:
- Am I a candidate for breast conservation or do you recommend a mastectomy?
- Which type of mastectomy is the safest choice for me?
- Do I actually need a bilateral mastectomy?
- What type of breast reconstruction am I a candidate for?
- Am I a good candidate for a nipple-sparing mastectomy?
- Is breast resensation an option for my surgery?
- What will my specific recovery look like?
- Will I need more treatments, like radiation, after I heal?
A mastectomy is a proven, effective way to treat breast cancer. With many choices available, you and your doctor can find a path that fits your specific needs. Talk openly with your healthcare team about your worries and goals. By understanding your options, you can make a confident decision for your health and your future.
