Mastectomy surgery – what it is and what to expect

When we think about breast cancer surgery, probably one of the most commonly talked about options is a mastectomy, but what it actually involves isn’t always clear. Following on from our previous article about breast-conserving surgical cancer treatments, we wanted to take some time to look at the range of mastectomy options available depending on you and your cancer, in the hope of demystifying the process a little, and giving you a greater sense of control at what can understandably be an overwhelming time…

What is a mastectomy? 

A mastectomy is breast cancer surgery that removes the entire breast. Depending on how advanced your breast cancer is, you may need to have chemotherapy or hormone therapy before the operation to reduce the size of any tumours. In broad terms, there are five different types of mastectomy, the NHS lists them as follows:

• Standard mastectomy – this is where all of the breast tissue and most of the skin covering it is removed.
• Skin-sparing mastectomy – this is where all of the breast tissue is removed, including the nipple, but most of the skin covering the breast is left.
• Subcutaneous mastectomy – this is the same as a skin-sparing mastectomy, but in this case the nipple isn't removed
• Radical mastectomy – this is not often performed anymore, however, it’s where all of the breast tissue is removed, as well as the skin covering it, the two muscles behind the breast and the lymph nodes in the armpit.
• Modified radical mastectomy – this is similar to the above, except the large muscle behind the breast (the larger of the two pectoral muscles) is left in place

Typically, with any breast cancer surgery, the surgeon will also look at the lymph nodes under your arm as well. If the cancer has spread to them, they will be removed during the procedure, if pre-surgery tests didn’t find cancer in the lymph nodes, your surgeon may still remove a few for further testing. If those further tests do show that the cancer has spread, then you may require follow up treatment such as radiotherapy.

Who might be offered a mastectomy surgery and why?

A mastectomy is usually offered to someone who cannot be treated for breast cancer using breast conserving surgery because it is too advanced. A mastectomy would typically be recommended if:

• Cancer is in a large area of the breast
• Cancer has spread throughout the breast
• The breast is full of pre-cancerous cells

Someone with earlier stage breast cancer may opt for a mastectomy over breast conserving surgery as a preference to undergoing radiation treatment or other personal reasons. If someone is at very high risk of getting a second breast cancer, they may also be advised or opt to have a double mastectomy (remove both breasts).

Is a mastectomy right for you?

As mentioned, in some cases a mastectomy is the only recommended course of treatment. This is highly dependent on the size and extent of the cancer. However, there are some instances in which you may opt for a mastectomy in order to avoid further treatment such as radiotherapy.

Before surgery you will have the chance to speak to your oncologist about the process, and how you feel about it. They should offer the opportunity to get practical advice as well about bras and bra inserts if you need them. You may also choose to discuss the possibility of breast reconstruction. This can be done at the same time as your mastectomy but can also be done at a later date if you prefer or if your surgeon recommends it for any reason.

What does a mastectomy involve?

A mastectomy is carried out under general anaesthetic, and the operation takes about 90 minutes. Most people go home the following day. The operation will involve an incision to remove the breast tissue, although the amount removed will depend on the type of mastectomy you're having. The surgeon will usually put one or two drainage tubes in place to stop fluid building up in the breast space. These may be left in for a few days.

What to expect during your recovery

When you first wake up you will likely have a drip to provide fluids, one or more drainage tubes from the incision and a dressing. You will probably have some bruising, swelling and stiffness, or possibly some numbness where any lymph nodes were removed. Soreness is normal for a few days, but you will be given painkillers to help.

Typically, full recovery from a mastectomy takes up to six weeks, although most people feel a lot better before then. Normally the wound itself will heal in two to three weeks, although it may take a few months for your chest and arm to fully recover. You will be given advice regarding when to resume normal activities, and you may also be given some light exercises to do at home to help recovery.

Lots of people ask us about the scar that they are likely to have from a mastectomy. This usually extends across the skin of the chest and into the armpit, and most people experience a permanent loss of sensation in the area. There are products that can help to reduce scarring, such as our Defiant Beauty Smooth Skin Oil, and the location of it would normally mean it is covered by a bra or swimming costume. However, there are corrective surgery options available to help if you would like to speak to your doctor.

Things to be aware of include:

• Taking care of the wound and dressing
• Check for signs of infection: painful swelling, red inflammation or discharge
• If your arm and hand begin to swell you should contact your doctor immediately
• You should also seek medical advice straight away if your wound begins to bleed
• As with any surgery, there is usually a short time period in which you can’t drive immediately post op. This is usually up to six weeks depending on your recovery

Outcomes of a mastectomy for breast cancer

As with all parts of a cancer diagnosis, treatment and recovery, the emotional side effects can be as difficult to handle as the physical side effects. A mastectomy can be a particularly challenging form of cancer treatment. For many people, it can have a significant impact on your sense of self and personal identity, which is entirely understandable.

While self-care in the form of aromatherapy at home, using products such as our Well Being Beauty - Calming Bath Collection, and allowing yourself the time to feel the way you feel is important, talking to others in a similar situation may also be helpful.

There are lots of support groups available, many of whom we have worked with and know to be extremely helpful. Your doctor or nurse will be able to give you information and recommendations on who to contact, and you’re always welcome to ask us about local charities that we work with too.