Mastectomy

Whenever possible we try to treat breast cancer through breast conserving surgery. Sometimes, however, removal of the whole breast (mastectomy) is unavoidable. Your breast care nurse and surgeon will explain to you the reasons why you require a mastectomy in detail.

Sometimes women will choose to have a mastectomy even when one isn’t required, perhaps because they have concerns about keeping breast tissue or because they wish to reduce the chance of needing radiotherapy, which is almost always given after breast conserving surgery. Sometimes radiotherapy isn’t able to given, either because of it having been given to the same area in the past, or because some people are particularly sensitive to it, and in that case you may be advised to have a mastectomy.

A common reason for needing a mastectomy is that the tumour size is large compared to the breast size, making it difficult for us to leave you with a breast that looks cosmetically attractive after treatment. In this case there may be an option to try to reduce the size of the tumour with treatments before surgery (neo-adjuvant treatment), or to do an operation which purposefully makes the breast smaller and reshapes it (therapeutic mammoplasty). Your Surgeon and Breast Care Nurse will explain if these are options for you.

Mastectomy involves removal of the whole breast and usually the nipple also. The breast tissue is almost entirely taken away, but small amounts remain because strands of breast tissue grow out into the skin and these can’t be removed. All women who are having a mastectomy will be able to discuss the options for breast reconstruction with their Breast Care Nurse and Surgeon. If you choose not to, or are recommended not to, have an immediate reconstruction, the skin of your chest wall will usually be left as flat as possible to allow you to wear a prosthesis in your bra. Sometimes it is hard to get the tissue entirely flat at the side of the chest, and if you have a bulge in this area after surgery we will be happy to try to improve this for you at a later date. You will be able to consider having a delayed reconstruction in the future if you wish, and there is no time limit or age limit on returning for this. For some women having a mastectomy the skin and fat left behind is deliberately shaped so that the chest wall is not flat but has a mound on it instead (Goldilocks mastectomy).

It may be possible for you to go home the same day after mastectomy, although most women would prefer to stay in hospital for at least one night. Physical recovery is usually quite quick with not too much discomfort. We will usually leave 1-2 tube drains in place to drain off any extra fluid that collects. There is a small risk of a bigger collection of blood (haematoma) that requires a second operation to wash it out, and of infection. You are likely to notice numbness around the scar and on the chest wall, which may improve over time but never entirely resolve. Sometimes a fluid collection gathers after removal of the drains (seroma); this is harmless and your body will gradually absorb it, but if it is troubling you we can drain it with a needle and syringe in clinic. You will have waterproof dressings or skin glue on your wounds and will be able to have a gentle shower or sit in a shallow bath, but not soak in water. The Hospital at Home team will come and visit you each day when you return home and remove the drains when they are ready to come out. Although mastectomy may not affect you too much physically, emotionally it can be a difficult time. Your Breast Care Nurse will be happy to spend time talking with you and supporting you as you adjust after surgery.