Surgery to remove your breast (mastectomy)

A mastectomy is surgery to remove all of the breast.

Why you might have it

Your surgeon is most likely to recommend this operation if you have:

• a large lump (tumour), particularly in a small breast
• a tumour in the middle of your breast
• more than one area of cancer in your breast
• large areas of DCIS in your breast
• had radiotherapy to the breast before

Mastectomy and breast reconstruction

A breast reconstruction is surgery to make a new breast after removal of the breast tissue. The surgeon creates a new breast shape using tissue from another part of your body, or an implant, or both.

Your surgeon will talk to you before the operation about the options for breast reconstruction.

It is your choice whether you have breast reconstruction or not but you should be offered one. Some women choose not to have reconstruction.

You might be able to have breast reconstruction at the same time as the mastectomy (immediate reconstruction). Or you might have it some months or years afterwards (delayed reconstruction). Whenever possible you should be able to choose when you have a reconstruction operation. Everyone is different and some women prefer to have it at the same time as the mastectomy while others prefer to delay it. 

You will have time to talk to your surgeon or specialist nurses and ask any questions you have. They may have photographs to show you of women who have had a breast reconstruction. 

If you aren't having an immediate breast reconstruction, your nurse will show you artificial breast shapes (prostheses). They are also called softies or cumfies.

You put these prostheses inside your bra to create a breast shape. Your nurse will help you find the right size and shape.

Choosing to go flat after a mastectomy

You might decide that you don’t want to wear a prosthesis or have a breast reconstruction after having a mastectomy. You may choose to be flat.

Women decide to do this for various reasons. It might be because you: 

• don’t want to have more surgery
• want to get back to everyday life as soon as possible
• don’t want to wear prosthesis, or find them uncomfortable

Your surgeon and breast care nurse will talk to you about all your options. They will explain the pros and cons to help you make the right decision for you. You may need time to make your decision. Talking to family and friends about how you feel can help. 

A charity called Flat Friends offers support to women who choose to be flat. You can get in touch with women who have had similar experiences via their online forum, Facebook, Twitter, or face to face. The website also has information about research, fashion ideas and personal stories.

Radiotherapy after surgery

You might need radiotherapy after a mastectomy if your doctor thinks there is a risk of the cancer coming back.

What happens?

The type of surgery depends on how big the cancer is, where it is in the breast and whether you have a breast reconstruction. 

During a simple mastectomy, the surgeon removes the breast tissue (including the nipple and some of the skin) and the tissues that cover the chest muscles. Rarely, the surgeon also removes the muscles of the chest wall. This is called a radical mastectomy.

The scar from a simple mastectomy extends across the skin of the chest and into the armpit.

You may have a different type of mastectomy if you have a breast reconstruction. These include:

• a skin sparing mastectomy – removal of the breast tissue and nipple but keeping most of the skin
• nipple sparing mastectomy – removal of the breast tissue but keeping most of the skin, the nipple and the area around the nipple (areolar)

Your surgeon will tell you what type of surgery is best for you. 

Checking lymph nodes

Sometimes breast cancer cells can spread into the lymph nodes in the armpit (axilla) close to the breast. It is important to know if there are cancer cells in the lymph nodes in the armpit and to find out how many of the lymph nodes contain cancer cells. This helps the doctors make decisions about your treatment.  

Checking the lymph nodes before surgery

You have an ultrasound scan of the lymph nodes under your arm at the same time as having other tests to diagnose breast cancer. You have a biopsy  of any lymph nodes that look abnormal. You have this to check if cancer cells have spread to the nearby lymph nodes. The biopsy is sent to the laboratory to check for cancer cells.

If this shows that the cancer has spread to the nodes in the armpit, you will have surgery to remove all or most of them. You have this at the same time as your mastectomy. This is called an axillary lymph node dissection (ALND) or axillary clearance.

If the lymph nodes look normal during the ultrasound scan, you don’t have a biopsy. But you have a sentinel lymph node biopsy (SLNB) at the same time as your breast surgery. You have this to check if cancer cells have spread to the nearby lymph nodes.

Checking lymph nodes during surgery (sentinel lymph node biopsy)

The sentinel node is the first node that fluid drains to from the breast into the armpit. This means it’s the first lymph node the breast cancer could spread to.

A few hours before the operation, you have an injection of a small amount of mildly radioactive liquid into your breast close to the cancer. You usually have this in the nuclear medicine department in the hospital. The radioactive liquid is called a tracer.

During the operation, your surgeon may also inject a small amount of blue dye into the breast. The dye and the tracer drain away from the breast tissue into nearby lymph nodes.

The surgeon can see which group of lymph nodes the dye reaches first. They also use a radioactive monitor to see which group of lymph nodes the tracer gets to first.

Removing the nodes

The surgeon usually removes about 1 to 3 of these nodes. They might remove other lymph nodes if they look as though they might contain cancer cells. They send the nodes to the laboratory to check for cancer cells. The results can take about a week.

The dye can stain your breast slightly blue. It gradually fades over a few weeks or months. The dye may also turn your urine green for a few days.

If none of the lymph nodes contain cancer cells, you won’t need to have any more nodes taken out.

If there are cancer cells in the sentinel nodes, you might have another operation to remove most or all of the lymph nodes under your arm. This is generally about 2 weeks after you get the results.

Some people have radiotherapy to the armpit to destroy any remaining cancer cells instead of surgery.

Getting results during the operation

In some hospitals, the surgeon gets the results of the sentinel lymph node biopsy during the operation. They can then remove the rest of the nodes if necessary and you avoid having a second operation.

Lymph node sampling

Instead of sentinel lymph node biopsy, your surgeon might take a sample of 4 or more lymph nodes from under your arm to check for cancer cells. This is called axillary sampling. They might use a blue dye to help to find the nodes.

Research into lymph node surgery

Research is looking at treatment of the lymph nodes during and after breast surgery.

Davina's story

This is how Davina coped with her diagnosis and surgery. 

"Take things slowly there is no rush. Sleep when you can. Eat healthy and drink plenty of water. Keep positive thoughts in your head. Talk to people, your family and friends. Read information and don’t be afraid to ask questions."

Pam's story

Read about Pam's diagnosis and treatment. 

"I decided not to have a breast reconstruction. I felt that a mastectomy bra and breast sponge would be OK for me."