Mastectomy

April 10, 2025

This page was reviewed under our medical and editorial policy by Susan Yost, Ph.D., staff scientist, Department of Medical Oncology & Therapeutics Research, City of Hope^® Cancer Center Duarte

Mastectomy is a common treatment option for breast cancer, with many patients undergoing some form of this surgery as part of their care. Depending on their situation, patients might choose between breast-conserving surgery (BCS) and mastectomy.

There are a few types of mastectomy. Each type of surgery serves different purposes and is tailored to patient needs and the cancer’s features. Certain people at high risk for developing breast cancer in the future might also consider a mastectomy.

What Is a Mastectomy?

A mastectomy is a surgical procedure in which the entire breast is removed, sometimes along with nearby tissues. It is a common treatment for breast cancer, aiming to remove as much cancer as possible and reduce the risk of recurrence.

Mastectomy is often combined with other cancer treatments. After surgery, patients might receive hormone therapy to reduce the risk of cancer returning. Some may also need chemotherapy, targeted therapy or radiation therapy for breast cancer.

Many patients consider breast reconstruction after a mastectomy to restore the breast’s appearance. Most patients are able to have reconstruction to restore the breast size and shape, if they desire it, which may be started during the mastectomy or at a later time.

When You Might Need a Mastectomy

There are several situations in which a mastectomy might be the recommended option for treating breast cancer. This includes when radiation therapy is not a viable option or the patient has already had radiation therapy to the same breast. Some patients prefer a mastectomy over BCS if previous attempts to remove the cancer did not succeed completely.

If cancer is present in multiple areas of the same breast, a mastectomy may be the appropriate choice to ensure all affected tissue is removed. This is especially true when the cancer is spread across different quadrants. A mastectomy may also be more appropriate when the tumor is large or large relative to the breast size. A mastectomy is also often recommended for those with inflammatory breast cancer.

Other factors influencing the decision for a mastectomy include pregnancy (where radiation therapy could harm the fetus) or a genetic mutation like BRCA, which increases the risk of a second cancer. Additionally, certain connective tissue diseases, such as scleroderma or lupus, may increase the side effects of radiation therapy that is recommended with other treatment options.

While opting for a mastectomy may reduce the chance of cancer returning in the same breast, it does not decrease the risk of cancer developing in the other breast or other parts of the body. Each person is unique, and the decisions that need to be made may feel difficult. Patients are encouraged to discuss all their options with their care team.

Simple or Total Mastectomy

A simple or total mastectomy involves removing the entire breast, including the nipple, areola, skin and the fascia (thin layer of connective tissue) covering the main chest muscle. Depending on the situation, the surgeon may also remove a few underarm lymph nodes for a procedure called a sentinel lymph node biopsy.

Modified Radical Mastectomy

A modified radical mastectomy combines the removal of the entire breast with an axillary lymph node dissection, where lymph nodes under the arm are also removed. By removing both the breast tissue and nearby lymph nodes, doctors are more able to assess if the cancer has spread.

Radical Mastectomy

A radical mastectomy is an extensive surgery where the entire breast, underarm lymph nodes and chest wall muscles are removed. It is rarely performed today because less extensive surgeries, like the modified radical mastectomy, are just as appropriate with fewer side effects.

The surgery involves removing a large amount of tissue, often requiring a skin graft to cover the chest area. Due to its complexity and higher risk of complications, it is usually reserved for specific cases where cancer has spread extensively.

Skin-Sparing Mastectomy

A skin-sparing mastectomy involves removing the breast tissue, nipple and areola while leaving most of the breast skin intact. The amount of breast tissue removed is the same as in a simple mastectomy. During the surgery, surgeons may use implants or tissue from other parts of the body to reconstruct the breast.

Many patients prefer this option because it results in less scar tissue and a more natural-looking reconstructed breast. However, it may not be suitable for larger tumors or those near the skin’s surface. The risk of cancer coming back in the same area is the same as with other mastectomy types.

Nipple-Sparing Mastectomy

A nipple-sparing mastectomy is similar to a skin-sparing mastectomy, but the nipple and areola are left intact if possible. During the procedure, the surgeon checks for cancer cells under the nipple and areola. If cancer is found, these areas must be removed as well. If not, reconstruction may begin during the surgery.

This procedure is often an option for patients with small, early-stage cancer located away from the nipple and areola. Risks include poor blood supply to the nipple, leading to shrinkage or deformation, and loss of sensation due to nerve damage.

While this option leaves fewer visible scars, it may leave behind more breast tissue, potentially increasing the risk of cancer recurrence. Improvements in technique have helped reduce this risk, making it a viable option for some patients.

Double Mastectomy

A double mastectomy, or bilateral mastectomy, involves removing both breasts. This procedure is sometimes performed as a risk-reducing measure for patients at high risk for breast cancer, such as those with a BRCA gene mutation. Most double mastectomies are simple mastectomies, where all breast tissue is removed, but some may be nipple-sparing to preserve the nipple and areola.

In addition to risk reduction, a double mastectomy may also be part of a treatment plan for patients diagnosed with cancer in one breast. Sometimes, these patients may choose to remove the other healthy breast as well. This procedure is known as a contralateral prophylactic mastectomy. This option is considered to reduce the risk of developing cancer in the remaining breast.

This decision is made after careful discussion with the cancer care team, weighing the benefits and risks. While removing the healthy breast may lower the risk of future breast cancer, doctors typically only recommend it for those with a high genetic risk. For some patients, the risk of developing cancer in the other breast is often low, especially with additional treatments like chemotherapy or hormone therapy.

Prophylactic Mastectomy

A prophylactic mastectomy is a surgery aimed at significantly reducing the risk of breast cancer for individuals at very high risk. This procedure is most often considered for those with harmful mutations in breast cancer susceptibility genes, such as BRCA1, BRCA2, TP53 or PTEN, which increase the lifetime risk of developing breast cancer.

The surgery involves removing both breasts, known as a bilateral prophylactic mastectomy. There are two main types: a total mastectomy, where the nipple and areola are removed, and a nipple-sparing mastectomy, which preserves the nipple and areola. While a total mastectomy offers slightly more risk reduction, a nipple-sparing mastectomy allows for a more natural appearance after breast reconstruction.

This risk-reducing measure is typically only recommended for those with a high genetic risk. Thorough discussions with the care team are important to understand the benefits, risks and emotional impacts of this surgery.

Breast Reconstruction After Mastectomy

Many patients consider breast reconstruction to restore the breast’s size and shape after a mastectomy. Breast reconstruction may begin during the mastectomy or be delayed until a later time, depending on many physical and cancer factors, and the patient’s preferences.

Breast reconstruction may be done with implants or tissue from other parts of the body.

When using breast implants, a staged procedure involving at least two surgeries is often necessary. In the first surgery, a tissue expander resembling a flat balloon is placed under the skin. This expander is gradually filled with saline during office visits until the desired breast size is reached.

Once the tissue expansion is complete, a second surgery replaces the expander with a permanent breast implant. The patient may also need additional procedures to reconstruct the nipple-areola area or make adjustments to enhance the overall appearance.

With tissue flap reconstruction, a piece of tissue is taken from the stomach, thighs, back or buttocks and attached to the breast area. This leaves surgical wounds that require healing in two places: the area where the flap was removed and at the reconstruction area. Several flap types and surgery methods may be used in flap reconstruction. Breasts reconstructed with flap tissue look and act more like natural breasts, but this option typically requires more surgical and recovery time.

Patients should discuss reconstruction options with their surgeon and a plastic surgeon before the mastectomy. This early planning helps create a surgical plan that aligns with the patient’s goals, even if the reconstruction is performed later.

What to Expect From Mastectomy Surgery

Before a mastectomy, patients might undergo blood tests and imaging tests, such as computed tomography (CT) scans, bone scans or positron emission tomography (PET) scans, to determine if cancer has spread beyond the breast and underarm lymph nodes. These tests may not be needed for early-stage breast cancer.

It is important for patients to inform their care team if they could be pregnant, are taking any medications or supplements, or if they smoke. The week before surgery, patients might be asked to stop taking medicines that affect blood clotting, such as aspirin, ibuprofen, naproxen, vitamin E, clopidogrel and warfarin. They should check with their care team about which medications to take on the day of surgery.

On the day of surgery, patients should follow their surgeon’s instructions about eating or drinking and take any prescribed medications with a small sip of water. It is important to arrive at the hospital at the specified time.

The mastectomy procedure involves a team of health care professionals, including a general or breast surgeon, perioperative nurses, anesthesia providers and surgical technologists. A radiologist or nuclear medicine technologist may be involved if an axillary node biopsy is needed. A plastic surgeon will also participate if the patient has opted for reconstruction.

The surgery typically lasts a few hours, and most patients stay in the hospital for one or two nights before going home.

Mastectomy Recovery

Recovery time after a mastectomy varies, depending on the specific procedures performed. Some patients need temporary assistance at home after surgery. Most patients are able to return to their regular activities within about four weeks, although recovery may take longer if breast reconstruction is also performed.

Patients should follow their care team’s instructions on caring for the surgery site. These instructions usually include how to care for the surgery site and dressing, how to identify signs of infection, and guidelines for bathing and showering. Patients also receive advice on when to call the doctor, when to start using their arm again and how to perform arm exercises to prevent stiffness.

Some patients may go home with drainage tubes still in place. These drains are small plastic tubes inserted at the surgery site to remove excess fluid that may accumulate during healing. The fluid collects in a soft rubber ball attached to the tube. Nurses provide instructions on how to care for the drains, or a home care nurse may assist. The drains are usually removed during a follow-up visit once fluid production slows.

Additional instructions advise patients on when to start wearing a bra, using a prosthesis and any activity restrictions. Patients are also informed about expected sensations or numbness in the breast and arm, feelings about body image and when to schedule follow-up appointments.

Pain around the surgery site is common and usually most intense in the first few days. Patients are given pain medication during the hospital stay and for use at home. Some patients may experience fluid collection (seroma) in the mastectomy area, which may need to be drained by a health care provider if it does not get better on its own.

Side Effects and Complications

Overall, most patients tolerate having a mastectomy well, but there is a risk of complications with any surgery. Some common possible side effects reported by patients after a mastectomy may include the following.

Seroma: Fluid collection may occur at the surgery site, and is often managed with suction drains.

Hematoma: Collection of blood in the tissue may develop, which may need drainage.

Wound infection: Often caused by bacteria like Staphylococcus aureus, such infections are treated with antibiotics.

Skin flap necrosis: This refers to a breakdown of skin, due to inadequate blood supply, and is often managed with debridement to remove dead tissue and sometimes skin grafts.

Lymphedema: This is swelling in the arm, due to lymph node removal, and is more common after axillary lymph node dissection. Early intervention with physical therapy may help manage symptoms.

Pain: Discomfort is common around the surgery site, especially in the first few days post-surgery.

Emotional impact: Feelings about body image and changes may be significant after surgery, requiring support and counseling.

Numbness or sensation changes: This may occur in the breast or arm due to nerve damage.