Breast removal surgery (mastectomy)

Published by Bupa's Health Information Team, July 2010.

This factsheet is for women who are planning to have a breast removed (mastectomy), or who would like information about it.

Mastectomy is an operation to remove your breast. The operation is done either because you have breast cancer or 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.

About breast removal surgery

There are two types of breast removal:

• simple breast removal – your breast tissue is removed
• radical breast removal – your breast tissue and the underlying muscle in the chest is removed (this is rarely needed unless cancer has spread into the chest wall muscles)

Your surgeon will advise you about the type of breast removal you may  need.

What are the alternatives to breast removal surgery?

A mastectomy is usually done to remove all cancerous cells from the breast. Depending on the size, position and the type of cancer you have, your surgeon may suggest alternative treatment options. These may include a simple breast lump removal and radiotherapy, chemotherapy (anti-cancer drugs), and/or hormonal therapy.

Your surgeon will advise you which treatment is best for you.

Preparing for your operation

You may be advised to have chemotherapy or hormone therapy (medicines to stop the hormones in your body that encourage breast cancer) before your breast removal operation. These can help to reduce the size of the cancer, which makes it easier to remove.

You will be able to see a specialist breast care nurse before you are admitted to hospital. Your nurse will provide advice and support on the practical and emotional aspects of having your breast removed, and offer information on bras and prostheses (bra inserts).

Your surgeon will discuss 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 wound infection and slows your recovery.

Breast removal surgery usually requires a hospital stay of one to two days. The length of your stay will depend on the extent of your surgery and how you feel afterwards.

The procedure is done under general anaesthesia. This means you will be asleep during the operation.

You will be asked to follow fasting instructions. Typically, you must not eat or drink for about six hours before a general anaesthetic. However, some anaesthetists allow occasional sips of water until two hours beforehand.

At the hospital your nurse will 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, and 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, which you may be asked to do by signing a consent form.

You may be asked to wear compression stockings to help prevent blood clots forming in the veins in your legs. You may need to have an injection of an anticoagulant medicine called heparin as well as, or instead of, stockings.

What happens during breast removal surgery?

Depending on the type of breast removal you have, your operation may take up to two hours.

The technique your surgeon will use will depend on the type of breast removal you're having.

If you're having a simple breast removal, your suregon will make a diagonal or horizontal cut across your breast, and remove the breast tissue.

Your surgeon may do a sentinel lymph node biopsy and remove lymph nodes from under your armpit through the same cut.

A breast reconstruction may be done at the same time as your breast removal or at a later date, or not at all.

When the operation is complete, the cuts are closed with stitches (which may be dissolvable).

Fine plastic tubes may be left in your breast area for up to 48 hours afterwards. These allow blood and fluids to drain into a bag.

What to expect afterwards

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 a drip in your arm to keep you hydrated and give you painkillers and antibiotics.

When you feel ready, you can begin to drink and eat, starting with clear fluids.

You may have a catheter (a fine tube) to drain urine from your bladder into a bag. This will usually be removed when you are ready to get out of bed and walk around.

Your surgeon will visit you to assess your progress and answer any questions you may have about the operation.

Your nurse will give you advice about getting out of bed, bathing, diet and gentle exercises.

A physiotherapist (a specialist in 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.

You will go home with appropriate dressings in place and you will be given a date for a follow-up appointment.

If you haven't had a breast reconstruction, 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.

Dissolvable stitches usually disappear in seven to 10 days. Non-dissolvable stitches are removed seven to 14 days after surgery.

Recovering from breast removal surgery

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.

After having breast removal surgery, there is a risk of infection. An infected wound can take longer to heal and may result in a more noticeable scar. Contact your breast cancer care nurse, consultant or GP if you have any of these symptoms:

• increasing pain
• a high temperature
• your wound looks red, inflamed or starts to weep

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. You shouldn't drive until you are confident that you could perform an emergency stop without discomfort.

Help and support

Contact with other women who have had breast removal surgery can be helpful before and after the procedure. Ask your breast care nurse for information. You may also find it helpful to talk to someone from a support organisation such as Breast Cancer Care.

What are the risks?

Breast removal is commonly performed and generally safe. However, in order to make an informed decision and give your consent, you need to be aware of the possible side-effects and the risk of complications of this procedure.

Side-effects

These are the unwanted, but mostly temporary effects of a successful treatment, for example feeling sick as a result of the general anaesthetic.

Side-effects of a mastectomy include:

• soreness, swelling, bruising and tightness in your breast area and in your arm and shoulder
• scarring - you will have a permanent scar, this usually fades over time
• numbness and tingling in your upper arm

Complications

This is when problems occur during or after the operation. Most women aren't affected. The possible complications of any operation include an unexpected reaction to the anaesthetic, excessive bleeding or developing a blood clot, usually in a vein in the leg (deep vein thrombosis, DVT).

Complications of breast removal are uncommon, but can include:

• infection - antibiotics may be needed
• build up of fluid around the healing wound (seroma) - this may require further surgery
• change in sensation in the operated area - this can be permanent
• unusual red or raised scars (keloids) - these can take years to improve

If you have lymph nodes removed from under your arm in the same procedure, there is a risk of having a build up of fluid in your arm (lymphoedema). This causes swelling, pain and tenderness in your arm and hand and may require further treatment.

The exact risks are specific to you and will differ for every person, so we have not included statistics here. Ask your surgeon to explain how these risks apply to you.

For answers to frequently asked questions on this topic, see Common questions.

For sources and links to further information, see Resources.