Mastectomy is a way of treating breast cancer by removing the entire breast through surgery. It’s often done when a woman cannot be treated with breast-conserving surgery (lumpectomy), which spares most of the breast. It can also be done if a woman chooses mastectomy over breast-conserving surgery for personal reasons. Women at very high risk of getting a second cancer sometimes have a double mastectomy, the removal of both breasts.
Types of mastectomies
There are several different types of mastectomies, based on how the surgery is done and how much tissue is removed.
Simple (or total) mastectomy
Simple mastectomy is the most common type of mastectomy used to treat breast cancer. In this procedure, the surgeon removes the entire breast, including the nipple, but does not remove underarm lymph nodes or muscle tissue from beneath the breast. (Sometimes lymph nodes are removed in a different procedure during the same surgery.) Most women, if they are hospitalized, can go home the next day.
If a mastectomy is done on both breasts, it is called a double (or bilateral) mastectomy. When this is done, it is often as preventive surgery for women at very high risk for getting cancer in the other breast, such as those with a BRCA gene mutation.
For some women considering immediate breast reconstruction, a skin-sparing mastectomy can be done. In this procedure, most of the skin over the breast (other than the nipple and areola) is left intact. This can work as well as a simple mastectomy. The amount of breast tissue removed is the same as with a simple mastectomy. Implants or tissue from other parts of the body are then used to reconstruct the breast.
Skin-sparing mastectomy may not be suitable for larger tumors or those that are close to the surface of the skin. This approach has not been used for as long as the more standard type of mastectomy, but many women prefer it because it offers the advantage of less scar tissue and a reconstructed breast that seems more natural.
Nipple-sparing mastectomy is a variation of the skin-sparing mastectomy. It is more often an option for women who have a small, early-stage cancer near the outer part of the breast, with no signs of cancer in the skin or near the nipple. (Cancer cells are more likely to be hidden in the nipple if the breast tumor is larger or close to the nipple, which means there is a higher risk the cancer will come back if the nipple is not removed.)
In this procedure, the breast tissue is removed, but the breast skin and nipple are left in place. This is followed by breast reconstruction. The surgeon often removes the breast tissue beneath the nipple (and areola) during the procedure to check for cancer cells. If cancer is found in this tissue, the nipple must be removed. Even when no cancer is found under the nipple, some doctors give the nipple tissue a dose of radiation during or after the surgery to try to reduce the risk of the cancer coming back.
There are still some issues with nipple-sparing surgeries. Afterward, the nipple does not have a good blood supply, so sometimes it can wither or become deformed. Because the nerves are also cut, there is little or no feeling left in the nipple. For women with larger breasts, the nipple may look out of place after the breast is reconstructed. As a result, many doctors feel that this surgery is best done in women with small to medium sized breasts. This procedure leaves less visible scars, but if it isn't done properly, it can leave behind more breast tissue than other forms of mastectomy. This could result in a higher risk of cancer developing than for a skin-sparing or simple mastectomy. This was more of a problem in the past, but improvements in technique have helped make this surgery safer. Still, many experts do not yet consider nipple-sparing procedures to be a standard treatment for breast cancer.
Modified radical mastectomy
A modified radical mastectomy combines a simple mastectomy with the removal of the lymph nodes under the arm (called an axillary lymph node dissection).
In this extensive operation, the surgeon removes the entire breast, axillary (underarm) lymph nodes, and the pectoral (chest wall) muscles under the breast. This surgery was once very common, but less extensive surgery (such as modified radical mastectomy) has been found to be just as effective and with fewer side effects, so this surgery is rarely done now. This operation may still be done for large tumors that are growing into the pectoral muscles.
Who should get a mastectomy?
Many women with early-stage cancers can choose between breast-conserving surgery (BCS) and mastectomy. You may have an initial gut preference for mastectomy as a way to "take it all out as quickly as possible." But the fact is that in most cases, mastectomy does not give you any better chance of long-term survival or a better outcome from treatment. Studies following thousands of women for more than 20 years show that when BCS can be done, doing a mastectomy instead does not provide any better chance of survival.
Although most women and their doctors prefer BCS (with radiation therapy) when it's a reasonable option, there are cases where mastectomy is likely to be the best choice. For example, mastectomy might be recommended if you:
- Are unable to have radiation therapy, or would prefer a more extensive surgery to having radiation therapy
- Have already had the breast treated with radiation therapy
- Have already had BCS along with re-excision(s) that did not completely removed the cancer
- Have two or more areas of cancer in the same breast that are not close enough together to be removed without changing the look of the breast too much
- Have a larger tumor (greater than 5 cm [2 inches] across), or a tumor that is large relative to your breast size
- Are pregnant and would need radiation therapy while still pregnant (risking harm to the fetus)
- Have a genetic factor such as a BRCA mutation, which might increase your chance of a second cancer
- Have a serious connective tissue disease such as scleroderma or lupus, which may make you especially sensitive to the side effects of radiation therapy
- Have inflammatory breast cancer
For women who are worried about breast cancer recurrence, it is important to understand that having a mastectomy instead of breast-conserving surgery plus radiation only lowers your risk of developing a second breast cancer in the same breast. It does not lower the chance of the cancer coming back in other parts of the body.
Should I have breast reconstruction surgery after mastectomy?
After having a mastectomy a woman might want to consider having the breast mound rebuilt to restore the breast's appearance. This is called breast reconstruction. Although each case is different, most mastectomy patients can have reconstruction. Reconstruction can be done at the same time as the mastectomy or sometime later.
If you are thinking about having reconstructive surgery, it’s a good idea to discuss it with your surgeon and a plastic surgeon before your mastectomy. This allows the surgical teams to plan the treatment that’s best for you, even if you wait and have the reconstructive surgery later. Insurance companies typically cover breast reconstruction, but you should check with your insurance company so you know what is covered.
Some women choose not to have reconstructive surgery. Wearing a breast prosthesis (breast form) is an option for women who want to have the contour of a breast under their clothes without having surgery. Some women are also comfortable with just ‘going flat’, especially if both breasts were removed.
Recovering from a mastectomy: What to expect after surgery
In general, women having a mastectomy stay in the hospital for 1 or 2 nights and then go home. However, some women may be placed in a 23-hour, short-stay observation unit before going home. How long it takes to recover from surgery depends on what procedures were done. Most women can return to their regular activities within about 4 weeks. Recovery time is longer if breast reconstruction was done as well, and it can take months to return to full activity after some procedures.
Ask a member of your health care team how to care for your surgery site and arm. Usually, you and your caregivers will get written instructions about care after surgery. These instructions should cover:
- How to care for the surgery site and dressing
- How to care for your drain, if you have one (this is a plastic or rubber tube to coming out of the surgery site that removes the fluid that collects during healing)
- How to recognize signs of infection
- Bathing and showering after surgery
- When to call the doctor or nurse
- When to start using the arm again and how to do arm exercises to prevent stiffness
- When you can start wearing a bra again
- When to begin using a prosthesis and what type to use
- What to eat and not to eat
- Use of medicines, including pain medicines and possibly antibiotics
- Any restrictions on activity
- What to expect regarding sensations or numbness in the breast and arm
- What to expect regarding feelings about body image
- When to see your doctor for a follow-up appointment
- Referral to a Reach To Recovery volunteer. Through our Reach To Recovery program, a specially trained volunteer who has had breast cancer can provide information, comfort, and support.
Will more treatment be needed after mastectomy?
Some women might get other treatments after a mastectomy, such as radiation therapy, hormone therapy, chemotherapy, or targeted therapy. Talk to your doctor about what to expect.
Side effects of mastectomy
To some extent, the side effects of mastectomy can depend on the type of mastectomy you have (with more extensive surgeries tending to have more side effects). Side effects can include:
- Pain or tenderness
- Swelling at the surgery site
- Buildup of blood in the wound (hematoma)
- Buildup of clear fluid in the wound (seroma)
- Limited arm or shoulder movement
- Numbness in the chest or upper arm
- Nerve (neuropathic) pain in the chest wall, armpit, and/or arm that doesn’t go away over time (called post-mastectomy pain syndrome or PMPS)
As with all operations, bleeding and infection at the surgery site are also possible. If axillary lymph nodes are also removed, other side effects such as lymphedema may occur.
Chung AP, Sacchini V. Nipple-sparing mastectomy: where are we now? Surg Oncol. 2008;17:261-266.
Morrow M, Burstein HJ, Harris JR. Chapter 79: Malignant Tumors of the Breast. In: DeVita VT, Lawrence TS, Rosenberg SA, eds. DeVita, Hellman, and Rosenberg’s Cancer: Principles and Practice of Oncology. 10th ed. Philadelphia, Pa: Lippincott Williams & Wilkins; 2015.
National Comprehensive Cancer Network (NCCN). Practice Guidelines in Oncology: Breast Cancer. Version 2.2016. Accessed at www.nccn.org on June 1, 2016.
Wolff AC, Domchek SM, Davidson NE, Sacchini V, McCormick B. Chapter 91: Cancer of the Breast. In: Niederhuber JE, Armitage JO, Doroshow JH, Kastan MB, Tepper JE, eds. Abeloff’s Clinical Oncology. 5th ed. Philadelphia, Pa: Elsevier; 2014.
Last Medical Review: June 1, 2016 Last Revised: August 18, 2016