The Who, What, Where, When and Sometimes, Why.

Mastectomy – The Procedure

A mastectomy is performed under general anesthesia. This means you are asleep during the surgery.

The surgeon removes all of the breast tissue. In most, but not all cases, the nipple and areola are also removed.

The surgeon closes the skin with stitches and puts in 1-2 tubes (surgical drains) so fluid from the wound can drain out (see image below). The drain(s) stays in for about a week to 10 days after surgery.

 Surgical drains after mastectomy

Image courtesy of Lange Productions (http://langeproductions.com/).

Assessing tumor margins

A pathologist checks the tissue removed during breast surgery. Using a microscope, the pathologist determines whether there are cancer cells in the rim of tissue around the tumor (called a margin).

In rare cases after a mastectomy, the margin closest to the chest wall (the deep margin) or the skin margin (the superficial margin) contain cancer cells. In these cases, more surgery and/or radiation therapy may be recommended.

Typically, whether or not the margins contain cancer cells doesn’t affect treatment after a mastectomy since the entire breast is removed.

Learn more about assessing tumor margins

Assessing lymph nodes (Has the cancer spread to the lymph nodes?)

If breast cancer spreads, the lymph nodes in the underarm area (axillary nodes) are the first place it’s likely to go.

During a mastectomy for invasive breast cancer, some of the axillary lymph nodes are removed to check for cancer cells. The presence or absence of cancer in these nodes is an important factor in cancer staging and prognosis.

Learn more about assessing axillary lymph nodes.  

Ductal carcinoma in situ (DCIS)

A sentinel node biopsy removes some axillary lymph nodes so they can be checked for cancer cells. When a mastectomy is used to treat DCIS (a non-invasive breast cancer), a sentinel node biopsy is usually done. This helps some people avoid an axillary dissection (a more invasive surgery to remove axillary lymph nodes).

Once a mastectomy has been done, a person can’t have a sentinel node biopsy. If it turns out there’s invasive breast cancer (along with DCIS) in the tissue removed during the mastectomy, a sentinel node biopsy will have already been done. In this way, people avoid having an unnecessary axillary dissection.

Learn more about sentinel node biopsy and mastectomy for DCIS.

Mastectomy with breast reconstruction

Some women choose to have breast reconstruction to help restore the look of the breast that was removed.

Reconstruction may be done at the same time as the mastectomy (immediate) or later (delayed). In general, cosmetic results are better with immediate reconstruction.

Discuss your reconstruction options with your plastic surgeon before your breast surgery.

Not all women choose to have reconstructive surgery. Some women choose to get a breast prosthesis. Others choose to “go flat”, with no reconstruction or prostheses.

Learn more about breast reconstruction.

Learn about insurance coverage and financial assistance for breast reconstruction.  

Read our blog, Despite What Doctors Told Me, I’ve Never Regretted My Decision to Go Flat After a Double Mastectomy.

Mastectomy with breast prosthesis

If you don’t want to have breast reconstruction, you can get a breast prosthesis. This is a breast form made of silicone gel, foam or other materials that’s fitted to your chest.

Learn more about breast prosthesis.

Learn about insurance coverage for breast prosthesis and financial assistance for breast prosthesis.

Length of hospital stay

Most people will stay in the hospital overnight after a mastectomy.

If breast reconstruction is done, the stay may be longer, depending on the type of reconstruction.

Discuss the expected length of stay with your surgeon, plastic surgeon (if you’re having reconstruction) and insurance company.

Learn more about insurance issues related to mastectomy and breast reconstruction.  

What to expect after a mastectomy

After a mastectomy (with or without breast reconstruction), you will have some soreness in your chest, underarm and shoulder.

You will be numb across your chest (from your collarbone to the top of your rib cage). Unfortunately, this numbness is usually permanent. You may get some feeling back over time, but it will never be the same as before surgery.

If lymph nodes in the underarm area (axillary lymph nodes) are removed during surgery, you may also have some numbness and a burning feeling under and behind your arm. There’s also some risk of lymphedema.

Lymphedema is a condition where fluid collects in the arm (or other area such as the hand, fingers, chest or back), causing it to swell.

Learn about the management of surgery-related pain

Transportation, lodging, child care and elder care assistance

You may not live near the hospital where you’ll have your surgery. 

Sometimes, there are programs that help with local or long-distance transportation and lodging. Some also offer transportation and lodging for a friend or family member going with you.

There are also programs to help you with child care and elder care costs.

Learn about transportation, lodging, child care and elder care assistance programs

 SUSAN G. KOMEN® SUPPORT RESOURCES 

  • If you or a loved one needs more information about breast health or breast cancer, call the Komen Breast Care Helpline at 1-877 GO KOMEN (1-877-465-6636). All calls are answered by a trained specialist or oncology social worker in English and Spanish, Monday through Friday from 9:00 a.m. to 10:00 p.m. ET. You can also email the helpline at helpline@komen.org
  • We offer an online support community through our closed Facebook Group – Komen Breast Cancer group. The Facebook group provides a place where those with a connection to breast cancer can discuss each other’s experiences and build strong relationships to provide support to each other. Visit Facebook and search for “Komen Breast Cancer group” to request to join the closed group.
  • Our fact sheets, booklets and other education materials offer additional information.

 

Updated 05/19/21

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