What You Need to Know About Having a Mastectomy

What You Need to Know About Having a Mastectomy

More than 100,000 women in the US have some type of mastectomy every year. That’s a lot, considering that around 230,000 American women are diagnosed with breast cancer annually.

Choosing to undergo a mastectomy—and which type to have—is a life-changing decision, with many complex factors. Will you have a partial or total procedure? Will you opt for breast reconstruction at the time of the surgery? Or maybe you’ve tested positive for the mutated BRCA1 gene and are considering mastectomy as a preventive measure, as actress Angelina Jolie did in 2013.

We talked with Kay Shawchuck, MD, breast cancer surgeon at St. Petersburg General Hospital in Florida, to get the facts on what’s involved with each type of mastectomy, and other tips you need to know.

Surgery Types:
There are several different kinds of mastectomy, including:

  • Partial Mastectomy (Lumpectomy):  In this procedure for patients with small tumors, only the tumor and surrounding tissue are removed.
  • Total (Simple) Mastectomy: The breast, nipple and areola are removed. In a double total mastectomy, both breasts are removed.
  • Modified Radical Mastectomy: The breast, nipple, areola and lymph nodes under the arms are removed.
  • Skin-Sparing Mastectomy: The breast, nipple and areola are removed, and overlying skin is kept intact for reconstruction.    
  • Nipple-Sparing: Depending on the location of the tumor, the breast tissue can sometimes be removed, leaving the nipple for reconstruction. In some cases the aereola is spared, too.

Facts You Need to Know:
It’s not “one size fits all.” “The type of breast cancer surgery a patient has is based on the size, location and biology of the tumor. We know so much more than we did 20 years ago, and that’s a great thing,” says Shawchuck. "There are more personalized treatments.” Based on the tumor and your decision about reconstruction, you and your doctor can determine which treatment plan is right for you.

If cancer appears in one breast and the other remains healthy, some women choose to have a single mastectomy. Others, however, opt to have both breasts removed as a precaution, even though this isn't recommended unless there's a heightened risk for further cancer. This procedure, called contralateral prophylactic mastectomy (CPM), is becoming more popular; six times as many women opted for CPM in 2011 as in 1998. And while research shows few benefits, a 2017 study in JAMA Surgery found that surgeons are increasingly getting on board. Reasons include maintaining patients' peace of mind and "improving cosmetic outcomes."

Talk to a plastic surgeon first. “It’s almost always appropriate and safe to have breast reconstruction surgery at the time of the mastectomy if the patient wants it,” says Shawchuck. She always asks her patients to see a plastic surgeon before making a mastectomy decision to ensure they’re aware of what reconstruction options are available.

Recovery time varies. With a partial mastectomy (lumpectomy), you can be back to work in just a week, but you’ll need to avoid any heavy lifting or pushing for at least another week. Recovery for a mastectomy without reconstruction is usually three to four weeks; six to eight weeks with reconstruction. Learn how to stay healthy post-surgery.

Risks are minimal. “The risks associated with having a mastectomy are those that come with any surgery, including bleeding, infection and scarring after the procedure,” says Shawchuck. Post-surgery infections and bleeding occurs in just 2 to 3 percent of surgery patients. The size of the scar depends on the type of surgery and the size of your breasts. Other more uncommon risks include numbness, tingling, shoulder pain or stiffness, swelling of the arm and nerve damage.

There is good news. “The survival rate is much better than it was 30 years ago,” says Shawchuck. “Given all stages of breast cancer, survival is at least 90 percent.”  Doctors are catching the disease earlier, she adds, and the variety of surgery options allows patients to feel confident about the way they look and feel afterward. 

See More from Dr. Shawchuck:
What is skin sparing mastectomy?
Can breast cancer recur in a reconstructed breast?
How have the surgical options for breast cancer improved?

Medically reviewed in May 2019.

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