A mastectomy is performed under general anesthesia. This means you’re asleep during the surgery.
The surgeon removes all 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.
Image courtesy of Lange Productions (http://langeproductions.com/).
Assessing tumor margins
A pathologist checks the tissue removed during breast surgery. By looking at the tissue under a microscope, the pathologist determines whether there are cancer cells in the rim of tissue around the tumor (called a margin).
Whether or not the margins contain cancer cells doesn’t usually affect treatment after a mastectomy since the entire breast is removed.
However, in rare cases after a mastectomy, the margin closest to the chest wall (called the deep margin) or the skin margin (called the superficial margin) contains cancer cells. In these cases, more surgery and/or radiation therapy may be recommended.
With a nipple-sparing mastectomy, whether or not the margin closest to the nipple (called the nipple margin) contains cancer cells can affect treatment. If the nipple margin contains cancer cells, more surgery is recommended.
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 lymph 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 (chances for survival).
Learn more about assessing axillary lymph nodes.
Ductal carcinoma in situ (DCIS) and sentinel node biopsy
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 may be 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, some people avoid having an axillary dissection.
Learn more about sentinel node biopsy and a 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 at a later time (delayed). In general, cosmetic results are better with immediate reconstruction.
If you want reconstruction, find out if there’s a plastic surgeon available who specializes in breast reconstruction. This may be important when making a decision about surgery. Discuss your reconstruction options with your plastic surgeon before your breast surgery.
Learn more about breast reconstruction.
Mastectomy with breast prosthesis
If you don’t 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.
Length of hospital stay
Most people 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 a 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 usually doesn’t go away. 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 and elder care costs.
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