(Removal of the breast through surgery)

Mastectomy is the removal of the whole breast including the nipple through surgery. It is usually done to treat breast cancer.

This surgery is most likely to be recommended if you have:

  • a large lump (tumour), particularly in a small breast
  • a tumour in the middle of your breast
  • more than one area of cancer in your breast
  • had radiotherapy to the breast before

Types of Mastectomies

There are different types of mastectomy: simple (or total), modified radical, skin-sparing, nipple-sparing mastectomy

Simple (or total) Mastectomy

This surgery involves the removal of the whole breast, including the nipple and the lining of the chest muscle but does not remove underarm lymph nodes from beneath the breast.

Simple mastectomy is the most common type of mastectomy used to treat breast cancer.

Double mastectomy

If a mastectomy is done on both breasts, it is called a double (or bilateral) mastectomy. When this is done, it is often as preventive surgery for women at very high risk for getting cancer in the other breast, such as those with a BRCA gene mutation.

Skin-sparing mastectomy and nipple-sparing mastectomy

Some women prefer immediate breast construction; a skin-sparing mastectomy is then considered. In this procedure, most of the skin over the breast (other than the nipple and areola) is left intact. Implants or tissue from other parts of the body are then used to reconstruct the breast.

Nipple-sparing mastectomy is a variation of the skin-sparing mastectomy. It is more often an option for women who have a small, early-stage cancer near the outer part of the breast, with no signs of cancer in the skin or near the nipple.

In this procedure, the breast tissue is removed, but the breast skin and nipple are left untouched. This is followed by breast reconstruction. The surgeon often removes the breast tissue beneath the nipple (and areola) during the procedure to check for cancer cells. If cancer is found in this tissue, the nipple must be removed. Even when no cancer is found under the nipple, some doctors give the nipple tissue a dose of radiation during or after the surgery to try to reduce the risk of the cancer coming back.

Modified radical mastectomy

The surgeon removes the whole breast, the lining of the chest muscle and some of the lymph nodes under the arm.

Factors affecting which surgery might be best for you:

  • stage of cancer
  • size of the cancer
  • size of the breast,
  • where the cancer is in your breast
  • whether the lymph nodes are involved.
  • Your general health

Which surgery option is best for you?

  • Ask your surgeon which options are best for you and why. You may want to get a second opinion.
  • Think about which option is best for you, given your peculiar situation and consider carefully the risk factors

What to expect after surgery

Before surgery, ask your doctor what changes you might expect afterwards:

  • Risk of infection, bleeding or slow healing of the wound.
  • Visible scars in the breast and underarm area.
  • Change in breast shape or size of the breast.
  • Pain or tenderness
  • Limited arm or shoulder movement
  • Numbness in the chest or upper arm
  • Nerve (neuropathic) pain in the chest wall, armpit, arm that doesn’t go away over time (called post-mastectomy pain syndrome or PMPS)
  • Also, lymphedema may occur, if axillary lymph nodes are also removed.