A mastectomy is performed under general anesthesia, which means you are unconscious (asleep) during the surgery. The surgeon removes all of the breast tissue, including the nipple and tissue around the nipple. The lining of the chest muscles may also be removed.
Mastectomy with and without breast reconstruction
Breast reconstruction
Some women choose to have breast reconstruction to help restore the look and feel of the breast that was removed. This may be done at the same time as the mastectomy (immediate) or later (delayed).
For some women who choose immediate reconstruction, surgeons may use a special skin-sparing technique (and possibly a nipple sparing technique) during the mastectomy, which saves much of the skin of the breast. The plastic surgeon can use this skin as an envelope to help form the reconstructed breast.
Some women choose not to have reconstructive surgery or to do it later. In these cases, the surgeon will close the incision with stitches and attach a temporary tube so that fluid from the wound can drain out.
Learn more about breast reconstruction.
Breast prosthesis
If you choose not to have reconstructive surgery, you can get a breast prosthesis. This is a breast form made of silicone gel, foam or other materials that either is placed directly on your skin or in the pocket of a special bra. Your health care provider can discuss breast prosthesis options with you and help you choose the type that best fits your lifestyle.
Learn about insurance coverage and financial assistance for breast reconstruction and breast prosthesis.
Breast prosthesis and air travel
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Komen wants to ensure breast cancer survivors are treated with respect and dignity. Here are some steps you can take that may help as you plan your travel:
- You may want to arrive earlier than usual at the airport, so you have ample time to go through secondary screening if necessary.
- If you are concerned about going through the body scanner for any reason, you may request a private pat-down screening.
- If you choose, or are selected for, a pat-down screening, you may request a private screening away from public areas.
- If you feel comfortable doing so, tell the Transportation Security Administration (TSA) agent you are a breast cancer survivor and are wearing a breast prosthesis. If you prefer to give this information more discreetly, the TSA now offers a notification card you can give to the agent (find this card on the TSA website).
- You should not be asked to lift or take off any clothing to show your breast prosthesis, nor should you be asked to remove it.
- Most airlines strongly recommend that customers pack breast prosthesis (if not wearing it) or medicines in carry-ons, rather than in checked luggage.
If you wear a breast prosthesis and have concerns about airline security screening, visit the TSA website for the latest information and a list of other tips to make the process as comfortable as possible.
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Assessing lymph nodes (Has the cancer spread to the lymph nodes?)
During surgery for invasive cancer, some of the lymph nodes in the armpit (axillary nodes) are removed to check for cancer cells. The presence or absence of cancer in these nodes is one of the most important factors affecting cancer stage and prognosis.
Sentinel node biopsy and axillary dissection
To see if cancer has spread to the lymph nodes, most people have a procedure called sentinel node biopsy. During or before this procedure, a radioactive substance (called a tracer) and/or a blue dye is injected into the breast. The surgeon locates the sentinel node(s) by looking for the node that has absorbed the tracer (using a special device called a gamma probe) or the dye (a blue lymph node). One to three nodes are typically identified as sentinel nodes. The surgeon removes the sentinel node(s) and in some cases, may remove one or two additional non-sentinel nodes. A pathologist checks the removed node(s) for cancer cells.
If cancer is not found in the sentinel node (the sentinel node is “negative”), it is unlikely that other lymph nodes in the armpit have cancer and no further surgery is needed. If the sentinel node does contain cancer cells (the sentinel node is “positive”), more nodes may be removed with a procedure called axillary dissection. The goal of axillary dissection is to check how many lymph nodes have cancer (to see how far the cancer has spread in the lymph nodes) and reduce the chances of cancer returning under the arm.
Axillary dissection is more invasive than a sentinel node biopsy. It disrupts more of the normal tissue in the armpit and is more likely to affect function in the arm and cause lymphedema. This has made sentinel node biopsy the preferred first step to assessing lymph nodes.
Learn more about lymphedema.
Who cannot have a sentinel node biopsy?
Not everyone is a candidate for sentinel node biopsy (for example, a person who has had a prior lymph node surgery). And, sometimes, the sentinel node cannot be found. Sentinel node biopsy also may not be done if your physician feels suspicious lymph nodes and a needle biopsy shows that the nodes contain cancer.
Learn more about sentinel node biopsy and axillary dissection.
Positive sentinel lymph node and axillary dissection
There is ongoing discussion as to whether some women who have lumpectomy (and will get radiation therapy) require axillary dissection when the sentinel lymph node is positive (learn more). At present, however, most women who have a mastectomy and a positive sentinel lymph node still require axillary dissection.
Length of hospital stay
Most people will stay in the hospital at least overnight after a mastectomy. If breast reconstruction is done, the stay may be a day or two longer, depending on the procedure. You should discuss the expected length of stay with your surgeon and insurance provider.
Learn more about insurance issues related to mastectomy and breast reconstruction.
Assessing margins (Was the entire tumor removed?)
A pathologist checks the tissue removed during surgery. He/she determines whether or not the entire tumor was removed by looking at the normal tissue around the tumor (called margins).
Clean (uninvolved or negative) margins mean there is only normal tissue (and no cancer cells) at the edges of the tissue removed from the breast. In this case, no more surgery is needed. If normal tissue does not completely surround the tumor (involved or positive margins), more surgery (called re-excision) is usually done to get clean margins.
Transportation and lodging assistance
You may not live near the hospital where you will have your surgery. There are many programs that offer help with local or long-distance transportation and lodging. Many also offer transportation and lodging for a friend or family member going with you. Learn more about these programs.
Updated 11/21/11
