Your surgeon may advise you to have chemotherapy or hormone therapy before your breast removal operation. These treatments can help to reduce the size of the cancer, making it easier to remove.
Your surgeon will explain how to prepare for your operation. For example, if you smoke you will be asked to stop, as smoking increases your risk of getting a chest and wound infection. This can slow your recovery.
Breast removal surgery usually requires a hospital stay of one to two days and it’s usually done under general anaesthesia. This means you will be asleep during the operation.
You will be asked to follow fasting instructions. This means not eating or drinking, typically for about six hours beforehand. However, it’s important to follow your surgeon or anaesthetist’s advice.
At the hospital, your nurse may check your heart rate and blood pressure and test your urine.
Your surgeon will discuss with you what will happen before, during and after your procedure, and any pain you might have. This is your opportunity to understand what will happen. You can help yourself by preparing questions to ask about the risks, benefits and any alternatives to the procedure. This will help you to be informed, so you can give your consent for the procedure to go ahead. You may be asked to do this by signing a consent form.
Depending on the size, position and type of cancer you have, your surgeon may suggest alternative treatment options to breast removal surgery. These may include:
- breast lump removal together with some surrounding tissue, not your whole breast
- breast reduction-type surgery to remove a larger cancer
- radiotherapy – a treatment to destroy cancer cells with radiation
- chemotherapy – a treatment to destroy cancer cells with medicines
- hormonal therapy – a treatment that can lower the levels of oestrogen in your body, or block the effects of this hormone, which can cause the cancer to shrink
However, surgery is the main treatment for breast cancer.
Ask your surgeon for advice about the best treatment option for you.
Depending on the type of operation you have, your operation may take up to two hours, or longer if you’re having breast reconstruction surgery at the same time.
The technique your surgeon will use depends on the type of breast removal you're having. If you're having a simple breast removal, your surgeon will make cuts across your breast above and below the nipple, and remove the breast tissue. Sometimes the nipple can be spared. To do this, the surgeon makes cuts around the nipple and areola.
Lymph nodes are glands throughout your body that are part of your immune system. Sometimes breast cancer can spread to the lymph nodes under your armpit. If cancer has spread to your lymph nodes, your surgeon will recommend that you have all your lymph nodes removed from that armpit. This is called an axillary clearance or axillary dissection.
If tests show the cancer hasn't spread to your lymph nodes, you will be advised to have a procedure called a sentinel lymph node biopsy. In this procedure, your surgeon will identify a type of lymph node called the sentinel lymph nodes and remove only these. He or she will send them to a laboratory to determine the type of cells and if these are benign (not cancerous) or cancerous.
It’s possible to have breast reconstruction surgery at the same time as having your breast removed, or you can have this at a later date. Alternatively you may decide not to have it at all. In breast reconstruction surgery, a new breast shape can be formed using tissue from your back, abdomen (tummy), buttocks or thigh. It can also be done by using a silicone implant, or a combination of these techniques.
When the operation is complete, your surgeon will close the cuts with stitches. These are usually dissolvable stitches.
You will need to rest until the effects of the anaesthetic have passed. You may need pain relief to help with any discomfort as the anaesthetic wears off.
You may have fine plastic tubes running out from the wound. These drain fluid into another bag and are usually removed after two to five days. You may be sent home with the drains still in place.
Your nurse will give you advice about getting out of bed, bathing, diet and gentle exercises. A physiotherapist (a health professional who specialises in maintaining and improving movement and mobility) will visit you to discuss a programme of exercises for you. These will help restore strength and movement in your arm and speed up your recovery.
Try to keep your dressings dry for a week after the operation. Your nurse will give you more advice about caring for your healing wound before you go home. You may be given a date for a follow-up appointment.
If you haven't had breast reconstruction surgery, you may be offered a lightweight foam bra-insert, called a cumfie or softie. At your follow-up, you may be fitted for a permanent, soft plastic (silicone) false breast to wear inside your bra. This will closely match the size and shape of your other breast.
You will need to arrange for someone to drive you home. Try to have a friend or relative stay with you for the first 24 hours after your operation.
The length of time your dissolvable stitches will take to disappear depends on what type you have. However, for this type of procedure, they should usually disappear in about two weeks. Non-dissolvable stitches will be removed seven to 10 days after your operation.
It usually takes at least three weeks to recover from breast removal surgery, but this varies between individuals, so it’s important to follow your surgeon’s advice.
At home, you will tire easily to begin with, so it's important to take it easy and eat a balanced diet. To improve your recovery, continue to do the exercises recommended by your physiotherapist.
If you need pain relief, you can take over-the-counter painkillers such as paracetamol or ibuprofen. Always read the patient information leaflet that comes with your medicine and if you have any questions, ask your pharmacist for advice.
At your follow-up appointment, your surgeon will give advice about when you can resume your usual activities and return to work. Your surgeon will also discuss any further treatment that you may need.
Follow your surgeon's advice about driving but don’t drive until you feel in full control of the car, probably a few weeks. Also contact your motor insurer so that you’re aware of their recommendations.
As with every procedure, there are some risks associated with breast removal surgery. We have not included the chance of these happening as they are specific to you and differ for every person. Ask your surgeon to explain how these risks apply to you.
Side-effects are the unwanted but mostly temporary effects you may get after having the procedure.
Side-effects of a mastectomy include:
- soreness, swelling, bruising and tightness in your breast area and in your arm and shoulder, which will last from a few days up to two weeks
- scarring – you will have a permanent scar but this usually fades over time
- numbness or tingling in your upper arm
Complications are when problems occur during or after the operation. The possible complications of any operation include an unexpected reaction to the anaesthetic, excessive bleeding or developing a blood clot. This is usually in a vein in your leg and is called deep vein thrombosis (DVT).
Complications of breast removal surgery can include:
- an infection – you may need antibiotics to treat it
- a build up of fluid around your healing wound (seroma) – this may need to be drained with a needle and syringe
If your surgeon also removes lymph nodes from under your arm, there is a risk of a build-up of fluid in your arm (lymphoedema). This is more likely if all the lymph nodes are removed. This causes swelling, pain and tenderness in your arm and hand, and may require further treatment. Your nurse or physiotherapist may give you advice about exercises you can do to help prevent this.
My surgeon has recommended I have breast removal surgery. What are the alternatives?
Your surgeon may recommend breast removal surgery to treat breast cancer. This decision will be based on the type of cancer you have, its exact location in your breast and how much of your breast tissue is affected. There are possible alternatives to breast removal, for example chemotherapy or radiotherapy first to shrink the cancer and then just removing the remaining breast lump.
There may be possible alternatives to having your breast removed. For example, a lumpectomy is the removal of the breast lump (tumour) and some surrounding tissue, rather than your whole breast (mastectomy). It is followed by treatment with radiotherapy. This type of surgery is also known as breast conserving therapy.
However, it may not be the most effective surgery for you. Your surgeon will discuss which surgery is best for you. The decision will depend on a number of factors including the type of cancer you have, its exact location in your breast and how much of your breast tissue is affected.
Having your breast removed can be a difficult decision to make. Before you have your operation, make sure you fully discuss with your surgeon why he or she has recommended breast removal for you, what the surgery will involve, and if there are any alternatives.
Will having breast removal surgery mean I don't need to have radiotherapy?
Radiotherapy is the use of radiation to kill cancer cells. Whether you need radiotherapy or not will depend on the type of cancer you have, its size and whether or not your lymph nodes are involved. Some women need radiotherapy after breast removal surgery to reduce the risk of the cancer coming back.
If you have breast removal surgery, you may need radiotherapy to get rid of any:
- remaining cancer cells in your breast area
- cancer cells in your lymph glands
Your surgeon will discuss your treatment with you and advise you if you need radiotherapy. If you do, you will see an oncologist (a doctor who specialises diagnosing and treating cancer using non-surgical treatments) to discuss this further.
What is breast reconstruction?
Breast reconstruction surgery is an operation to restore the shape of your breast after you have surgery to remove your breast or breasts.
If you're having breast removal surgery, you may choose to have breast reconstruction to restore the shape and appearance of your breast to match your remaining natural breast. This can be done with an implant, your own body tissue, or a combination of these techniques.
Your surgeon can do breast reconstruction surgery immediately after breast removal (immediate reconstruction), or at a later date (delayed reconstruction).
Your surgeon or nurse will advise you on the type of reconstruction that is best for you and when this can take place, taking into account your personal preferences.
My mother had breast cancer and my doctor said a prophylactic mastectomy is an option for me – what is this?
If your mother had breast cancer, particularly before the age of 40, it’s possible that you may be more at risk of getting it too. You may wish to discuss your risk with a clinical geneticist (a doctor who specialises in diagnosing inherited conditions). He or she can help you to decide if you need additional breast screening or a genetic test. This test can assess your risk of carrying a genetic abnormality that pre-disposes you to breast cancer.
Breast cancer can run in some families, which is called familial breast cancer or hereditary breast cancer. It’s more likely if:
- one woman in your close family has had had breast cancer at a young age (under 40)
- one male has had breast cancer at any age
- two relatives had breast cancer at any age
- there is a history of both breasts being affected
- there is also a history of another cancer related to breast cancer, such as ovarian cancer
If any of these apply, you may have a higher risk of developing breast cancer than other women in the general population.
If breast cancer does run in your family, it could be caused by a fault in one of the genes that are known to be associated to breast cancer. Examples of these genes include BRCA1, BRCA2 and TP53. Being born with a faulty gene doesn't mean you will definitely get cancer, but you’re more at risk.
Speak to your GP about seeing a clinical geneticist or a breast surgeon to discuss your level of risk. If tests confirm that you are at high risk of breast cancer, you may decide to take steps to reduce your risk of getting breast cancer. This might mean taking medicines that can help prevent breast cancer, or having your breasts removed. You may decide to have regular checks, which may include an MRI scan each year. That way, if you do develop cancer, you can get treatment at an early stage.
- Modified radical mastectomy. Medscape. emedicine.medscape.com, published 27 August 2013
- Familial Breast Cancer. National Institute for Health and Clinical Excellence. Clinical Guideline 164. June 2013. www.nice.org.uk
- Simple mastectomy. Medscape. emedicine.medscape.com, published 12 September 2013
- Scottish Intercollegiate Guidelines Network (SIGN). Treatment of primary breast cancer: a national clinical guideline. SIGN publication134. Edinburgh: SIGN; 2013. www.sign.ac.uk
- Breast cancer – early stage/ locally advanced. Surgical options. Map of Medicine. eng.mapofmedicine.com, published 15 January 2014
- McLatchie G, Borley N and Chikew J. Oxford Handbook of Clinical Surgery. 3rd Ed. Oxford University Press 2007:230
- Breast cancer. Before surgery for breast cancer in women. Macmillan Cancer Support. www.macmillan.org.uk, published 1 October 2013
- Surgical treatment of breast cancer. Medscape. emedicine.medscape.com, published 4 November 2013
- Breast Cancer. Cancer Research UK www.cancerresearchuk.org, published 17 October 2012
- Lymphedema. Medscape. emedicine.medscape.com, published 6 February 2014
- Association of Breast Surgery. Oncoplastic Breast Reconstruction Guidelines for Best Practice. 2012. www.associationofbreastsurgery.org.uk
- Familial breast cancer. Map of Medicine. eng.mapofmedicine.com, published 15 January 2014
- Personal communication. Robert Hardy, Consultant Endocrine and Breast Surgeon, BMI Sefton Hospital, Liverpool, March 2014
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