Breast removal—or mastectomy—is a surgical procedure involving the removal, either partially or fully, of one or both breasts. It is usually performed on women who have contracted breast cancer, and involves removing the breast tissue that contains cancerous cells.

Breast removal is just one of many treatment methods for breast cancer. Other options include radiotherapy, chemotherapy, and hormone therapy.

There is a whole spectrum of mastectomy methods. The type of cancer and the level of cancer growth in the breast tissue will determine which method your surgeon chooses.

• In a partial mastectomy, better known as a lumpectomy, only the cancerous lump is removed from the breast, with a small amount of the surrounding breast tissue. Chest muscles and underarm lymph nodes are not removed. Usually, radiotherapy treatment is necessary after a partial mastectomy.
• In a radical mastectomy the breast, underarm lymph nodes and chest muscles, also known as the major and minor pectoral muscles, are removed, leaving a large hollow under the collarbone. Radical mastectomy was once the standard treatment for all breast cancer.
• In a modified radical mastectomy the breast is removed, as are the minor pectoral muscles and all lymph nodes. The major pectoral muscle is left intact.
• In a simple or total mastectomy the entire breast, including the breast tissue, nipples and areola, is removed. Chest muscles and lymph nodes are not removed.

When both breasts are removed, the procedure is referred to as a double mastectomy.

Most mastectomies require breast reconstruction, which can be performed at the same time. Depending on the amount of breast tissue taken, a lumpectomy usually doesn’t require a reconstruction. Patients may choose immediate reconstruction, or they may choose to have it later. Research shows no difference in aesthetic or medical outcomes between immediate or delayed mastectomies, and both are equally safe. If the cancer is in it’s later stages, immediate breast reconstruction may not be possible.

For those who prefer not to undergo breast reconstruction, or decide to do it later, there are artificial breasts, called prosthetics that can be worn inside a bra or camisole. Usually a soft temporary prosthetic will be supplied by the hospital to wear until the wound area is healed. At that point a permanent implant can be surgically inserted.

Reasons to have a breast removed

Breast removal is predominantly performed on women who have breast cancer or who have a history of breast cancer, but men have also been known to develop male breast cancer.

Doctors will recommend breast removal surgery in any of the following cases:

• If the cancer growth is large in comparison to the breast size.
• If more than one cancer is present in the breasts (multifocal disease).
• If cancer cells have been found in the areas surrounding a lumpectomy.
• In women who have a high risk of developing breast cancer, breast removal is considered a way of prevention. This is referred to as a preventive, prophylactic or risk-reducing mastectomy.

Women can be tested for the genetic mutations that cause breast cancer if they think they might be at risk, but the presence of mutations on specific genes does not determine with absolute certainty that cancer will develop. Other alternatives, such as the removal of ovaries and fallopian tubes, have also been known to reduce this risk and do not carry the high levels of social, psychological and intimacy issues associated with breast removal.

• In cases of sexual reassignments from female to male.

What to expect

Breast removal surgery takes between one and two hours to complete under a general anaesthetic. If a breast reconstruction is to be performed at the same time, the surgery will take longer.

While lumpectomies are often performed on an outpatient basis, more invasive types of mastectomies will require a hospital stay of up to a week. The length of stay depends on how well the body heals. Most patients can go home in a day or two following surgery

The amount of pain felt after the surgery varies from person to person. It is advisable to take the prescribed pain medications that your surgeon has given you before the pain becomes severe. Because some painkillers can cause constipation, it is a good idea to drink a lot of water during the recovery process and eat high fibre foods.

Placing a small pillow under the armpit will help reduce discomfort, especially when lymph nodes have been removed. Using icepacks to reduce swelling and discomfort in the armpit area will also reduce the pain.

Bruising and swelling for a few weeks are common. Some people develop a slight fever on the day following surgery, but it usually subsides after 24 hours.

Surgical dressings protecting the stitched area will be removed on the postoperative visit following surgery, after which you should be able to shower.

How soon a patient can return to work depends on the type of work they do, their overall health and their personal preferences. Most people return to work three to six weeks after surgery.

Some specific risks and complications of breast removal surgery include:

• Bruising and swelling around the wound area, in the armpit or chest. This is normal and usually subsides within a few weeks.
• Lymphoedema. Swelling in the arms, breast, chest or hands may occur after lymph node removal and can remain after the initial side effects have subsided. This swelling can persist for a few months or years following surgery.
• Stiffness of the arm or shoulder. Patients should ask the doctor or physiotherapist for exercises to do during the recovery period.
• Tingling and numbness may occur if the lymph nodes were removed. You should expect this to improve with time. It is rare that this will be permanent.
• Pain in the upper arm or armpit – Some patients whose lymph nodes have been removed may feel mild pain, which can last a year or longer after surgery.

Dealing with breast cancer

Women who have undergone a mastectomy often feel overwhelmed by the effects. The trauma of life-threatening illness combined with a body-image change can be devastating. Support of family, loved ones and friends is crucially important.

Breast reconstruction or a well-fitted prosthetic device can be helpful in rebuilding confidence, but the emotional implications may go much further than losing the breast itself. Psychological counseling, cancer-survivor support groups, and other community-based help can be crucial in the recovery process.

Some mastectomies can have a negative impact on intimate and romantic relationships; feelings of loss are often magnified. Grief and anger are major issues that many women face.

This information is correct as of 2019.