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Home > Understanding Breast Cancer > Treatment > Mastectomy - The Surgical Procedure

  


Mastectomy - The Surgical Procedure

 

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The procedure

A mastectomy is performed under general anesthesia, which means you are unconscious (asleep) during the surgery. The surgeon removes all of the breast tissue (in most, but not all, cases includes the nipple and areola). The lining of the chest muscles may also be removed. The surgeon then closes the skin with stitches and attaches a temporary tube so that fluid from the wound can drain out (see image below).

 Surgical drain 

 Image courtesy of Lange Productions (http://langeproductions.com/).

 

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. When no reconstruction is planned, the surgeon will leave the area fairly flat so that a breast prosthesis can be comfortably fitted to the chest.  

Learn more about breast reconstruction.   

Learn about insurance coverage and financial assistance for breast reconstruction.  

Breast prosthesis

If you don’t want to have reconstruction, you can get a breast prosthesis. This is a breast form made of silicone gel, foam or other materials that is fitted to your chest. The form is either placed directly on top of 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 prosthesis

 Breast prosthesis and air travel 

Susan G. 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 medications 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.  

 

Assessing lymph nodes (Has the cancer spread to the lymph nodes?)

During a mastectomy for invasive breast cancer (and in some cases of ductal carcinoma in situ (DCIS)), some of the lymph nodes in the underarm area (axillary nodes) are removed to check for cancer cells. The axillary nodes are the first place breast cancer is likely to spread. 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 axillary 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 first axillary node(s) to absorb the tracer or dye is called the sentinel node(s). This is also the first axillary node(s) where breast cancer is likely to spread. 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 (which turns the lymph node(s) blue). The radioactive tracer or blue dye usually identifies one to several (usually fewer than five) nodes as the sentinel nodes. The surgeon removes the sentinel node(s). A pathologist checks the sentinel 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 underarm area have cancer. So, no further surgery will be 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 goals of axillary dissection are to check how many lymph nodes have cancer (to see how far the cancer has spread in the lymph nodes) and to reduce the chances of cancer returning in the axillary lymph nodes. Most people with a positive sentinel lymph node will need an axillary dissection.  

Axillary dissection is more invasive than a sentinel node biopsy. It disrupts more of the normal tissue in the underarm 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?

Some people cannot have a 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) need axillary dissection when one or two sentinel lymph nodes are positive (learn more). Today, most women who have a mastectomy still need axillary dissection when a sentinel lymph node is positive.

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 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. By looking at the tissue under the microscope, the pathologist determines whether the entire tumor was removed and whether the margins (the edges of the tissue removed) are clean. 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 most cases, margins are clean and no more surgery is needed.  

In rare cases, normal tissue does not completely surround the tumor (involved or positive margins) and more surgery (called re-excision) may be done to get clean margins. 

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For more information on mastectomy, visit the National Comprehensive Cancer Network (NCCN) or the American Society for Clinical Oncology (ASCO).

Transportation and lodging assistance

You may not live near the hospital where you will have your surgery. Sometimes, there are programs that offer help with local or long-distance transportation and lodging. Some also offer transportation and lodging for a friend or family member going with you. Learn more about these programs.

Updated 03/28/14

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