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).
Mastectomy is an operation to remove your breast or breasts. The operation is done either to treat breast cancer or to prevent cancer if you have a strong family history of breast cancer.
You will meet the surgeon carrying out your procedure to discuss your care. It may differ from what is described here, as it will be designed to meet your individual needs.
There are two main types of breast removal surgery.
Your surgeon will advise which type of breast removal surgery is best for you.
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:
However, surgery is the main treatment for breast cancer.
Ask your surgeon for advice about the best treatment option for you.
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 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:
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:
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.
Reviewed by Jane McQueen, Bupa Health Information Team, April 2014.
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