Mastectomy (Breast Removal Surgery)

A mastectomy is a surgical procedure that involves the removal of some or all of the breast tissue. It's typically done as a treatment for breast cancer, but it can also be performed preventively in individuals at high risk of developing breast cancer. Nowadays, there are ways to do the surgery that can leave some of the skin or nipple. This can make the breast look better after the surgery.

Here are some common reasons why mastectomy is done:

• Treatment of Breast Cancer: Mastectomy may be performed to remove cancerous breast tissue when other treatments such as chemotherapy or radiation therapy are not suitable or when the cancer is large or has spread extensively within the breast.
• As a Preventive Measure: In individuals with a high risk of developing breast cancer, such as those with a strong family history of the disease or carriers of certain genetic mutations like BRCA1 or BRCA2, mastectomy may be recommended as a preventive measure to reduce the risk of developing breast cancer in the future.
• Risk Reduction in High-Risk Patients: For individuals with a history of breast cancer in one breast, mastectomy of the other breast (contralateral prophylactic mastectomy) may be recommended to reduce the risk of developing cancer in the unaffected breast.
• Treatment of Precancerous Conditions: Mastectomy may be recommended for individuals with precancerous conditions such as ductal carcinoma in situ (DCIS) or lobular carcinoma in situ (LCIS) to prevent the development of invasive breast cancer.
• When Conservative Treatments Aren’t Enough: In some cases, conservative treatments such as lumpectomy followed by radiation therapy may fail to adequately treat the cancer or prevent its recurrence, leading to the need for mastectomy.

The decision to undergo mastectomy is often made collaboratively between the patient and their healthcare team, taking into account factors such as the stage of cancer, the individual's overall health, personal preferences, and potential risks and benefits of the procedure.

There are several types of mastectomy, each with varying degrees of tissue removal. The choice of mastectomy type depends on various factors including the size and location of the tumour, whether the cancer has spread to lymph nodes, the patient's preference, and the possibility of breast reconstruction. Here’s a list of the different types of mastectomies. 

• Total (Simple) Mastectomy: In this procedure, the entire breast tissue is removed, including the nipple, areola, and the skin covering the breast, but the chest muscles underneath are left intact.
• Modified Radical Mastectomy: This involves the removal of the entire breast tissue, including the nipple, areola, and some of the lymph nodes under the arm (axillary lymph nodes), but the chest muscles remain intact.
• Radical Mastectomy: A less common procedure now, radical mastectomy involves the removal of the entire breast tissue, including the nipple, areola, chest muscles (pectoralis major and minor), and axillary lymph nodes. It is typically reserved for advanced cases where the cancer has spread extensively.
• Skin-Sparing Mastectomy: This procedure removes all breast tissue but preserves as much of the breast skin as possible, including the nipple-areola complex. It's often followed by breast reconstruction surgery.
• Nipple-Sparing Mastectomy (NSM): This technique involves removing all breast tissue while preserving the skin envelope, nipple, and areola. It is often combined with immediate breast reconstruction to create a natural-looking breast mound.
• Subcutaneous (Total Skin-Sparing) Mastectomy: Similar to skin-sparing mastectomy, this technique removes all breast tissue while preserving the entire skin envelope, including the nipple and areola. It's commonly followed by breast reconstruction.
• Partial (Segmental) Mastectomy or Lumpectomy: In this procedure, only the cancerous part of the breast and a margin of surrounding healthy tissue is removed, leaving the rest of the breast intact. It's often followed by radiation therapy.

Preparing for Mastectomy

Before undergoing mastectomy, individuals typically engage in thorough preparation both physically and emotionally. Key steps to consider during this phase include:

• Consultation with Healthcare Team: Patients schedule consultations with their healthcare team, including surgeons, oncologists, and specialists, to discuss the procedure details, potential risks, benefits, and address concerns.
• Medical Evaluation: A comprehensive medical evaluation is conducted to assess the patient's overall health and determine the appropriate surgical approach. This may include diagnostic tests such as blood tests and imaging scans.
• Emotional Preparation: Patients take time to process their emotions and seek support from loved ones or mental health professionals as needed. They may discuss concerns with their healthcare team to explore coping strategies.
• Preoperative Instructions: Patients adhere to preoperative instructions provided by their healthcare team, including guidelines on fasting, medication adjustments, and skincare routines.
• Logistical Planning: Patients make arrangements for transportation to and from the hospital and arrange for assistance during the initial recovery period at home.

During the Procedure

During the mastectomy procedure, the surgical team performs the necessary steps to remove breast tissue while ensuring patient safety and comfort. Here's an overview of the procedure:

• Anaesthesia: Patients receive anaesthesia to remain comfortable and pain-free throughout the surgery.
• Surgical Technique: The surgeon makes an incision in the breast to access and remove breast tissue based on the planned mastectomy type.
• Lymph Node Evaluation: If necessary, lymph nodes may be sampled or removed to assess cancer spread.
• Closure and Dressing: Following tissue removal, the surgeon closes the incisions and applies dressings to promote healing.
• Reconstruction: Immediate breast reconstruction may be performed concurrently with mastectomy to restore breast shape and contour.

Post-Mastectomy Care

After a mastectomy, proper post-operative care is essential for healing, symptom management, and recovery. Here's what patients can expect:

• Pain Management: Patients may experience discomfort managed with prescribed medications or pain relief techniques.
• Wound Care: Patients follow guidelines for caring for incisions, keeping them clean and dry to reduce infection risk.
• Physical Activity: Patients gradually resume light activities, avoiding strenuous exercise until cleared by their healthcare team.
• Emotional Support: Patients seek support from loved ones or professionals to address emotional challenges and body image concerns.
• Follow-Up Care: Patients attend follow-up appointments to monitor progress, discuss concerns, and receive further treatment recommendations as needed.

Mastectomy as a treatment option for breast cancer offers several potential benefits. These include:

• Effective Cancer Removal: Mastectomy offers a highly effective means of removing breast cancer, particularly in cases where the tumour is large or located in multiple areas of the breast.
• Reduced Risk of Cancer Recurrence: By removing the entire breast tissue, including any cancerous cells, mastectomy can significantly reduce the risk of cancer recurrence in the affected breast.
• Preventive Measure: In individuals at high risk of developing breast cancer, such as those with a strong family history or genetic mutations like BRCA1 or BRCA2, mastectomy can be performed as a preventive measure to reduce the risk of developing the disease.
• Peace of Mind: For some individuals, a mastectomy may offer peace of mind and a sense of control over their cancer treatment, knowing that the affected breast has been surgically removed.
• Opportunity for Reconstruction: Mastectomy provides an opportunity for breast reconstruction surgery, allowing individuals to restore the shape and appearance of their breasts following surgery.
• Mitigation of the Requirement for Radiation Therapy: Depending on the specific case and the extent of the cancer, a mastectomy might make radiation therapy unnecessary. This can help reduce exposure to radiation and its potential side effects.

While mastectomy can offer significant benefits in treating breast cancer, it also carries certain risks and potential complications. These may include:

• Surgical Risks: As with any surgical procedure, mastectomy carries risks such as bleeding, infection, and adverse reactions to anaesthesia.
• Changes in Breast Appearance: Mastectomy results in the permanent removal of the breast tissue, which can lead to changes in breast appearance, size, and shape. While breast reconstruction surgery can help restore breast shape, it may not fully replicate the appearance of the natural breast.
• Emotional Impact: Losing a breast can have significant emotional implications for some individuals, leading to feelings of loss, grief, or changes in body image and self-esteem. It's important for individuals to receive adequate support and counselling to address these emotional concerns.
• Functional Changes: Mastectomy may result in changes in sensation, mobility, or function of the arm and shoulder on the side of the surgery. Physical therapy and rehabilitation exercises may be recommended to improve range of motion and strength in the affected arm.
• Risk of Complications: Mastectomy may be associated with complications such as lymphedema (swelling of the arm), seroma (fluid buildup), or chronic pain at the surgical site. These complications may require additional treatment or management.

While both mastectomy and lumpectomy aim to remove cancerous tissue, they differ in the extent of tissue removal and their impact on breast appearance and function. Understanding the differences between mastectomy and lumpectomy is crucial for individuals diagnosed with breast cancer to make informed treatment decisions.

Extent of Tissue Removal

• Mastectomy removes the entire breast tissue, while lumpectomy removes only the tumour and surrounding tissue.
• Mastectomy may be recommended for larger tumours or cases where the cancer has spread extensively, while lumpectomy is suitable for smaller tumours.

Breast Appearance and Sensation

• Mastectomy results in the complete removal of the breast, which may impact breast appearance and sensation. Breast reconstruction surgery can be performed to restore breast shape after mastectomy.
• Lumpectomy preserves most of the breast tissue, minimising changes in breast appearance and sensation. However, some women may experience changes in breast shape or size after lumpectomy.

Risk of Recurrence

• Mastectomy reduces the risk of cancer recurrence in the affected breast to a greater extent compared to lumpectomy.
• Lumpectomy followed by radiation therapy has been shown to be equally effective in terms of long-term survival rates as mastectomy for early-stage breast cancer.

Recovery and Follow-Up Care

• Mastectomy may require a longer recovery period compared to lumpectomy, particularly if breast reconstruction is performed.
• Both procedures require follow-up care and monitoring to detect any signs of cancer recurrence or complications.

Healthcare professionals may recommend mastectomy over lumpectomy with radiation in the following scenarios:

• Multiple cancerous areas are present in different parts of the breast.
• Extensive microcalcifications indicate cancer post-biopsy.
• Breast cancer recurs after prior radiation treatment.
• Pregnancy poses radiation risks to the unborn child.
• Lumpectomy leaves residual cancer, raising spread concerns.
• Genetic predisposition heightens secondary cancer risk.
• Cancer size hinders acceptable cosmetic outcomes post-lumpectomy.
• Connective tissue diseases increase radiation side effect intolerance.

What stage of breast cancer requires a mastectomy?

Mastectomy may be recommended for various stages of breast cancer, depending on factors such as tumour size, location, and spread. It's commonly considered for larger tumours, extensive cancers involving multiple areas of the breast, or cases where lumpectomy isn't feasible.

Is mastectomy a major surgery?

Yes, mastectomy is considered a major surgical procedure as it involves the removal of breast tissue, which requires anaesthesia and typically involves a hospital stay. Recovery can vary depending on individual factors and the extent of the surgery.

How long does it take to recover from a mastectomy?

Recovery time from a mastectomy varies from person to person but generally ranges from a few weeks to several months. Factors such as overall health, extent of surgery, and any additional treatments like chemotherapy or radiation therapy can influence recovery duration.

What are the possible side effects of radiation therapy after a mastectomy?

Common side effects of radiation therapy after mastectomy may include skin irritation, fatigue, and changes in breast tissue texture. Less common side effects can include lymphedema, radiation pneumonitis (lung inflammation), and cardiac issues.

Will I need to stay in the hospital after a mastectomy?

The length of hospital stay after a mastectomy varies depending on factors such as the type of mastectomy performed, individual recovery, and any postoperative complications. In many cases, patients may stay in the hospital for one to two days.

Can I choose to have breast reconstruction surgery after a mastectomy?

Yes, breast reconstruction surgery is an option for individuals undergoing mastectomy. It can be performed at the same time as mastectomy (immediate reconstruction) or delayed until after the mastectomy site has healed (delayed reconstruction).

How will a mastectomy affect my risk of breast cancer recurrence?

Mastectomy significantly reduces the risk of breast cancer recurrence in the affected breast. However, there is still a small risk of cancer recurrence in the chest wall or other areas, which is why regular follow-up screenings and surveillance are important.

Will I still need regular breast cancer screenings after a mastectomy?

Yes, even after mastectomy, regular follow-up appointments with your healthcare provider and periodic imaging studies may be recommended to monitor for any signs of cancer recurrence or other breast health issues.

What are the changes needed in diet and lifestyle after a mastectomy?

Following a mastectomy, maintaining a healthy diet and lifestyle can support overall recovery and well-being. Focus on nutritious foods, adequate hydration, regular physical activity within your capabilities, and emotional support as needed.

What are the long-term effects of mastectomy surgery?

Long-term effects of mastectomy may include changes in body image, emotional adjustment, and physical sensations in the chest area. Some individuals may experience chronic pain, lymphedema, or limitations in arm and shoulder mobility. Regular follow-up care can help address any long-term concerns and provide support as needed.

Reviewed by Dr. Hardeep Singh, Director – Oncoplastic & Reconstructive Surgery, Oncology Reconstructive Surgery, on 08 September 2025.