Mastectomy

A mastectomy is a surgical procedure that involves removing an entire breast along with some nearby lymph nodes and other tissues. This surgery may be elected by a patient who has breast cancer or is at high risk of developing it. After a mastectomy, some women choose to have breast reconstruction surgery performed to rebuild the affected breast so that it will match the shape and size of the other breast.

Tampa General Hospital’s Cancer Institute and Breast Cancer Center proudly offers the latest diagnostic and treatment options for all types of breast cancer. Accredited by the Commission on Cancer (CoC), TGH has earned the “High Performing in Cancer” designation from U.S. News & World Report for 2022-23, ranking us among the top 10% of hospitals in the nation.

What Conditions Can Be Treated With a Mastectomy?

A mastectomy may be an option for treating many types of breast cancer, including:

Noninvasive breast cancer (ductal carcinoma in situ)
Early-stage breast cancer (stages 1 and 2)
Locally advanced breast cancer (stage 3) after chemotherapy
Inflammatory breast cancer after chemotherapy
Paget’s disease of the breast
Locally recurrent breast cancer

A mastectomy may be preferred over a less invasive lumpectomy followed by radiation therapy if:

The tumor is large in relation to the size of the affected breast.
Two or more tumors are located in different areas of the breast.
Calcium deposits (microcalcifications) in the breast were biopsied and found to be cancerous.
Radiation therapy was previously delivered to the breast and the cancer came back.
Positive margins were found after a lumpectomy.
The patient is not a candidate for radiation therapy due to a current pregnancy, lupus or another reason.

Additionally, some patients who are at high risk for breast cancer choose to have a mastectomy performed as a preventive measure. For instance, a patient who is known to carry a gene that has been conclusively linked to breast cancer, such as BRCA1 or BRCA2, might elect to undergo a mastectomy to help prevent cancer from developing.

What Does a Mastectomy Involve?

There are several types of mastectomy procedures, including:

Total mastectomy – The entire breast is removed, including the nipple, areola and most of the overlying skin.
Modified radical mastectomy – The entire breast is removed, including the nipple, areola and overlying skin, along with the lining over the chest muscles. Some lymph nodes under the arm are also removed.
Radical mastectomy – The entire breast is removed, including the nipple, areola and overlying skin, along with the lymph nodes under the arm and the chest muscles under the breast.
Skin-sparing mastectomy – The breast tissue, nipple and areola are removed, but most of the overlying skin is preserved.
Nipple-sparing mastectomy – All breast tissue is removed, including the ducts to the nipple and areola, but the skin of the nipple and areola are preserved.

What Is the Hidden Scar Technique?

When performing a nipple-sparing mastectomy, the surgeon may utilize the Hidden Scar technique to improve the cosmetic outcome in some cases if the patient so elects. This advanced surgical procedure involves making a single incision in the natural crease underneath the breast (inframammary fold) so the scar will be less visible after the incision heals.

A Hidden Scar mastectomy may be an option for a patient who has noninvasive breast cancer or no cancerous cells are found in the nipple. To determine the optimal surgical approach, the surgeon will also consider other factors, such as the location and size of the tumor(s) and the shape and size of the breast.

What to Expect With a Mastectomy

Immediately after a mastectomy, the patient is monitored in a recovery room until they are admitted to a hospital room. Most patients are hospitalized for three days or less depending on the extent of their surgery, including whether any lymph nodes (other than the sentinel nodes) were removed and whether the mastectomy was immediately followed by a breast reconstruction procedure.

When the patient is discharged, their care team will provide detailed instructions on:

How to manage the post-surgical pain
How to manage the side effects of a lymphatic mapping procedure (if applicable)
Whether the bandage should be kept in place until the first follow-up visit or, if not, when and how to remove it and how to care for the incision site
How to care for the surgical drain (if applicable)
How to recognize signs of infection and lymphedema (swelling due to insufficient lymph drainage) and when to call the surgeon
When to begin targeted exercises to prevent shoulder and arm stiffness
When it is safe to wear a prosthetic breast form or bra, shower and resume daily activities

The recovery period that follows a mastectomy can vary. Full healing can take up to several weeks or longer.

Mastectomy vs. Lumpectomy

Breast-conserving surgery is not appropriate for every patient with breast cancer. Those who have the option to choose between a mastectomy and a lumpectomy followed by radiation therapy may want to consider many factors, including:

Whether they would like to keep their breast
Whether they want their breasts to closely match in terms of shape and size
Whether they would like to avoid radiation therapy
Whether having their entire breast removed would provide valuable peace of mind regarding the prospect of cancer recurrence

The decision to undergo a mastectomy instead of a lumpectomy followed by radiation therapy is a highly personal one that should be made only after carefully considering the risks and benefits of each treatment approach. Significantly, both procedures are highly safe and effective, and the survival rate is essentially the same.

Benefit From World-Class Care at TGH

The compassionate experts at TGH can help you understand the implications of your breast cancer diagnosis and provide in-depth information about your treatment options, including a mastectomy. To request an appointment with an expert on our team, contact us at (800) 844-4554.