A mastectomy is a surgical procedure that removes the entire breast primarily to treat breast cancer or to reduce one's risk of breast cancer.
Types of mastectomy
There are several different types of mastectomy, and each is performed based on the amount of breast tissue involved in the surgery:
Standard or total mastectomy
The surgeon removes all of the breast tissue including the nipple, areola, and most of the overlying skin.
The whole breast, including the nipple is removed, but most of the skin over the breast is preserved. This is typically done together with immediate breast reconstruction.
A skin-sparing mastectomy where only the breast tissue is removed, leaving the skin, nipple, and areola intact.
It is a more extensive procedure in which the entire breast, including the skin covering it, the two muscles under the breast, and the axillary (underarm) lymph nodes, are removed. This is done if the cancerous involvement is extensive.
Modified radical mastectomy
The procedure involves the removal of the entire breast. This includes the nipple, the areola, and the overlying skin except for the muscles behind the breast.
Why do you need a mastectomy?
A mastectomy is done to reduce one’s risk of breast cancer (prophylactic mastectomy) and to treat several types of breast cancers such as:
Ductal carcinoma in situ (DCIS). This is a type of non-invasive breast cancer that develops in the milk duct and has not spread to the breast tissue.
Stages 1, 2 (early-stage) and 3 (locally advanced) breast cancer. Mastectomy is used to treat breast cancer that has not spread to involve other body systems e.g. lung, liver, bones, brain (metastasised).
Inflammatory breast cancer. Mastectomy is recommended after chemotherapy as this is an aggressive form of breast cancer.
Paget's disease of the breast. A rare type of cancer that affects the skin of the nipple and areola.
Locally recurrent breast cancer. This refers to cancer that has returned to the same breast despite breast conserving surgery and radiation treatment.
The procedure may also be done if:
Cancer has spread to a large area of the breast and cannot be treated with a lumpectomy (a breast-conserving surgery)
An individual (e.g. genetic mutation carrier) has a high lifetime risk of developing breast cancer. In this case, a double mastectomy (removal of both breasts) will be recommended
Who should not go for a mastectomy?
Mastectomy is generally not recommended for women who:
Have a known metastatic disease (cancer that spreads from one part to another)
Have an advanced disease that requires neoadjuvant therapy (any treatment given for the cancer before the main treatment) to shrink the tumour before surgical resection
What are the risks and complications of a mastectomy?
Although mastectomy is considered a relatively safe procedure, it has a few post-operative side effects, the majority of which are temporary and will resolve with time:
Fluid accumulation beneath the surgical wound (seroma). This arises from the raw surgical surfaces but reduces in amounts over time. A drainage tube is typically required for 7 – 14 days to assist with drainage so it does not build up to cause discomfort.
Pain in the shoulder and stiffness
Hardness due to scar tissue at the surgical site
How do you prepare for a mastectomy?
Before surgery, you should inform your doctor about any medications, vitamins or supplements you are taking. In addition, you may be advised to:
Stop taking any blood-thinning medications
Fasting (no food for 6 hours and no drink for 2 hours) prior to surgery
What can you expect in a mastectomy?
A mastectomy usually takes around 2 – 4 hours. Skin and nipple sparing mastectomies take a longer time due to greater complexity.
During the procedure
A mastectomy is performed under general anaesthesia, so you will not be aware during the procedure.
Your surgeon will make a cut for access in order to remove the entire breast. The type of incisions varies according to the type of mastectomies performed.
The tissue removed will then be sent to the lab for examination.
Drainage tube(s) will be placed into the operative site to assist with the fluid build-up.
After the procedure
After the surgery, you will be taken to the recovery room in the operating theatre where you will be monitored to ensure your parameters (heart rate, blood pressure and breathing) are stable. You will also be checked for any post-operative pain.
You will be escorted to your room in the hospital ward once it is safe to do so.
Care and recovery after a mastectomy
Depending upon the surgery you had, you can expect to:
Return home 1 – 2 days after your surgery
Resume normal daily activities in 1 – 2 weeks
Resume light to moderate exercises in 1 month
Frequently asked questions
A: Breast surgery or mastectomy may be recommended to treat ductal carcinoma in situ (DCIS) or non-invasive breast cancer if:
The cancer cells have spread to a large portion of your breast
It is not possible to obtain a clear region of normal tissue around the cancer cells with a wide incision
More than one area of DCIS exists
A: Seromas typically subside on their own after about a month, but it can take longer and in some cases, 1 – 2 years. For some individuals, it may be normal to expect a small to moderate amount of “chronic” seroma to be present at the surgical cavity in the long term. If it does not cause any discomfort, chronic seroma may be left alone.
If the seroma causes pain or discomfort, restricting your range of arm movements, your doctor may insert a fine needle to drain out the fluid. This procedure is usually painless and safe. Repeated drainage may be required in some cases.
Other treatments for seroma include:
A: The main disadvantage of a mastectomy is that it is a more radical procedure than a lumpectomy, and your recovery time will be longer. However, the chance of recurrence in the breast is less than that with a lumpectomy.
Consult your specialist to find out if your condition allows you to choose between a mastectomy and a lumpectomy. Weigh the risks and advantages of each procedure to determine the best treatment option for you.
A: Sometimes, the nearby lymph nodes in the underarm are removed during mastectomy. This is to check if any breast cancer cells have spread to the lymph nodes.
Removal of a large number of lymph nodes may disrupt the lymphatic flow and its ability to drain fluid in this area. The scarring that occurs following surgery as well as post-operative radiotherapy to the area can cause further obstruction. Thus, lymph fluid can build up in the surrounding tissues, leading to lymphedema (swelling) of the arm.
Fortunately, the incidence of lymphedema has reduced over the years due to:
Improved surgical technique. Less extensive sentinel lymph node biopsy (1 – 3 lymph nodes) is done in place of axillary clearance (where more lymph nodes are removed) in most cases
Early mobilisation with arm exercises
Arm care and awareness to avoid untreated ascending arm infections
Maintenance of a healthy weight and avoidance of weight gain
A: During a mastectomy, your surgeon will aim to remove the entire breast together with the cancerous areas it contains. Despite this, a tiny portion of breast tissue may still be left on the skin. Thus, the chances of local recurrence (in the same breast or chest wall) are possible after a mastectomy, although it is usually low.
Distant recurrence in other parts of the body (i.e. lung, liver bones and brain) may also occur following a mastectomy. Invasive cancer cells can spread beyond the confines of the breast by the blood stream to other parts of the body. This risk is reduced by the use of drugs like chemotherapy, targeted treatments or anti-hormone medications.
A: Mild to moderate pain and discomfort after a mastectomy is common. However, in most cases the surgical site feels numb and tight.
Some patients may experience chronic or long-term pain from nerve disturbances persisting beyond 6 months. This is uncommon and may be felt in the chest wall, armpit, or arm. If you are having prolonged post-mastectomy pain, consult your doctor for options to cope with your symptoms.
Regaining a “lost” organ and restoring their physical appearance, which can help boost self-confidence
Not needing to wear a breast prosthesis (an artificial breast form)
Breast reconstruction can be done at the same time as the mastectomy (immediate reconstruction) or after a period of time (delayed reconstruction). Immediate breast reconstruction has benefits such as:
Fewer operations needed
Better results as it is easier to preserve more of the native breast skin
Not needing to wear a breast prosthesis at any time
A: A mastectomy is necessary if there are:
Two or more tumours in different parts of the breast
Widespread or malignant-appearing calcium deposits in the breast that have been diagnosed as cancer during a breast biopsy
Increased chances of recurrent breast cancer
A: You may feel pain and discomfort (e.g. pulling and stretching around your breast area for 2 – 3 weeks) after mastectomy.
A: The most suitable time to start wearing a prosthesis depends on your medical condition, the post-operative healing process, and the type of mastectomy performed.
Usually, it takes around 6 weeks to wear a permanent prosthesis after a mastectomy.
A: You can resume your usual diet as soon as you are able to swallow fluids. Make sure your diet includes:
Protein-rich foods such as fish, eggs, poultry and low-fat dairy. Lean proteins can aid in cell repair and healing.
Phytonutrient-rich fruits and vegetables as they contain carbohydrates, providing energy and preventing fatigue during recovery.
Healthy fats such as omega-3 as they help to increase immune function, reduce inflammation in the body, and promote heart health.
A: Your doctor may recommend chemotherapy as adjuvant therapy with mastectomy. However, this completely depends on your overall health, age and medical history, as well as the type, stage and nature of your breast cancer.
If the cancer is in situ type, it is unlikely to spread to other areas. Chemotherapy may not be recommended.
If you are premenopausal, you may require chemotherapy due to an increased risk of aggressive types of breast cancer that readily spread at this age.
If cancer is found in the lymph nodes, or has spread to locations other than the breast tissue, chemotherapy is usually required to eradicate the significant amount of cancer cells in the systemic circulation despite surgery.
Doctors typically recommend chemotherapy within 30 days of surgery. Early treatment minimises the risk of cancer spread, and improves the chances of survival.
Why choose Mount Elizabeth Hospitals?
We have over 40 years of experience in caring for patients in need of diagnosis and treatment for various types of cancer, including breast cancer. At Mount Elizabeth Hospitals in Singapore, we have a comprehensive range of medical and surgical facilities, as well as rehabilitation and palliative services, to ensure our patients receive the full spectrum of care.
Our general surgeons and plastic surgeons
At Mount Elizabeth Hospitals, we provide individualised care to patients in need of all types of breast cancer treatments. Our specialists include plastic surgeons and general surgeons proficient at performing different types of mastectomy that have been proven to be safe and effective for our patients.