Mastectomy means removal of all the breast tissue. The skin over the breast and the nipple/areola will be removed (but may be left in place if reconstruction is done — see Breast Reconstruction after Mastectomy). A modified radical mastectomy means the removal of the breast tissue and the axillary (arm pit) lymph nodes. A simple mastectomy means removal of the breast tissue and no lymph nodes. Many times a sentinel lymph node biopsy will be added to a simple mastectomy, and the axillary lymph nodes will not be completely removed unless cancer is found in those sentinel nodes. A subcutaneous mastectomy means that most of the breast tissue is removed, but the nipple/areola complex is left in place.
Who requires a mastectomy?
Mastectomies are required when the breast cancer is too large to remove with a lumpectomy or the patient cannot take the required radiation after a lumpectomy. Some women choose a mastectomy because they feel more comfortable with it as the treatment for their breast cancer.
Should I have reconstruction?
Reconstruction is usually offered to most patients who decide on a mastectomy. There are a variety of options available for reconstruction. Your doctor should talk to you about the possibility of reconstruction if a mastectomy is chosen as your breast cancer surgery, but there are times where it is best to delay reconstruction due to a very advanced cancer. There are also times when pre-existing medical problems such as heart or lung disease may make a long reconstructive surgery dangerous. If you decide against reconstruction there are special bras and prosthetics that you may be fitted with.
Details of the surgery
Mastectomy is performed under general anesthesia. You will have at least one drain in place and sometimes two drains are left in place to remove any fluids that may accumulate. The drains are typically left in place for one to two weeks. You will be taught how to take care of your drains.
Recovery time is usually a few weeks, but sometimes longer. Depending on the extent of your surgery, you may experience pain, swelling and bruising in your chest area.
Radiation therapy is not usually required after a mastectomy, but may be recommended if the tumor is large (greater than five centimeters), if multiple nodes are involved with cancer (four or more) or if it has spread to your skin, ribs or chest muscles.