Breast Cancer Surgery
Surgery is usually the first
choice of treatment for breast cancer. In the
past, most women were treated by a radical mastectomy
- the removal of the entire breast and muscles
of the chest. Surgical techniques have been
refined and studies have shown that it is now
possible and safe to conserve most of the breast
while treating a breast cancer. However, in
some cases lumpectomy may not be an option due
to the characteristics of the patient's
cancer or history, or a patient may personally
choose mastectomy as an option.
Standard Treatments for Breast
Mastectomy with immediate or delayed reconstruction
What is a mastectomy?
A mastectomy is the surgical
removal of the breast tissue. It is done to remove
all evidence of breast cancer. Since a mastectomy
may not remove all microscopic (too small to be
seen by the eye alone) cancer cells that may be
beyond the removed area, additional treatments
such as chemotherapy, hormonal therapy, or radiation
may be recommended.
When is a mastectomy recommended
for the treatment of breast cancer?
In general, a mastectomy is
The breast tumor is more than 4-5 cm in size.
There are multiple tumors in the breast that cannot
be removed by one incision.
There is previous history of radiation therapy
to the breast or chest wall.
There is a personal history of connective tissue
The breasts are small and/or the tumor is large
causing the breast to be disfigured following
The patient does not want to have radiation therapy,
which is necessary with lumpectomy.
The patient prefers mastectomy as a personal choice.
Are there different types of mastectomies?
There are a few different types
of mastectomies. Your surgeon will explain which
mastectomy is being recommended for your diagnosed
cancer and why.
A simple mastectomy involves the removal of the
entire breast, skin, and nipple.
A modified radical mastectomy involves removal
of the entire breast, skin, and lining over the
chest muscles and the nipple. Some axillary (underarm)
lymph nodes may be removed. Your surgeon may do
a sentinel node procedure prior to surgery or
a complete axillary dissection. This helps to
determine if the cancer has spread beyond the
breast area to the lymph nodes.
A skin–sparing mastectomy involves the removal
of the entire breast, tissue and nipple. The majority
of the breast skin is left. This surgery is usually
done at the same time as breast reconstruction.
An axillary lymph node dissection may also be
A radical mastectomy involves removal of the entire
breast, surrounding lymph nodes, chest wall muscles,
and fatty tissue.
What are the risks of mastectomy?
As with any surgery, there is
a risk of bleeding, infection, and poor wound
healing. Fluid and/or blood can accumulate and
require drainage. Numbness and tingling across
the arm and chest can occur due to nerves being
cut during surgery. If an axillary dissection
is performed, then lymphedema (swelling of the
arm) can occur.
How long will I be in the hospital?
Most patients are discharged
from the hospital one or two days after surgery.
If immediate reconstruction is performed, the
hospital stay is usually two or three days.
How will I look and feel after
The chest area will be flat,
have a scar, and no longer have a nipple. Initially,
there will be some swelling and discomfort. Some
drains (thin flat rubber tubes a few inches long)
will be in place for a few days to a week to collect
fluid. The chest area may be numb and tingling.
You will be bandaged for approximately one week.
Removal of the breast tissue may cause you to
shift your body weight, potentially causing some
back and neck pain while you adjust. If an axillary
dissection was done, you may have some numbness
and tingling of the underarm and arm, which usually
lessens with time.
What are my options for breast
There are many issues to consider
when deciding if and when you may want breast
reconstruction. Some women prefer reconstruction
at the same time as their mastectomy and others
choose to wait. Medical considerations along with
personal feelings lead to a decision that is best
for you. Women often choose to have a consultation
with a plastic surgeon prior to making a decision.
We would be happy to assist you in setting up
a consultation with a plastic surgeon to discuss
your reconstructive options.
After a mastectomy,
you may choose to wear a breast prothesis if you
do not have immediate reconstruction. Once your
scar has healed, you can obtain a prothesis. A
prosthesis is a soft form, shaped like a breast,
which is worn under a bra. Most forms are made
from silicone or cotton and come in different
sizes and weights. A proper fitting can be done
by a certified prothesis fitter. Prosthesis are
usually covered by insurance when your surgeon
writes a prescription. Some insurance companies
will cover several special bras for prosthesis
each year as well with a prescription. We would
be happy to give you a resource list for places
you can purchase a prothesis.
For more information,