What is mastectomy?

• In a simple or total mastectomy, the entire breast is removed. The lymph nodes may be removed. This surgery is often done for women who have ductal carcinoma in situ (DCIS) or for women who have invasive breast cancer. This surgery is also used for women who are having a breast or both breasts removed to prevent breast cancer.
• In a modified radical mastectomy, the entire breast and the lymph nodes under the arm (axillary lymph nodes) are removed.
• In breast-conserving surgery, the tumor and some healthy breast tissue are removed. Most of the breast remains. The doctor may remove only the cancer and a small part of the breast or up to about a quarter of the breast. The amount of breast tissue that is removed is different for each surgery.
• A skin-sparing technique may be used for a simple or modified radical mastectomy. The breast tissue is removed through a cut that is made around the nipple. This technique does not harm the skin. Sometimes the nipple can be saved. Lymph nodes may be removed through the same cut made around the nipple or through another cut in the armpit.
• A radical mastectomy is very rarely done. In this surgery, the entire breast, all of the lymph nodes in the armpit, muscles under the chest, and some of the surrounding fatty tissue are removed. It is used only when a woman has many tumors and when cancer has entered the chest.

The type of surgery you have depends on:

• The tumor size, type, and location.
• The size of your breast.
• The cancer stage.
• Whether or not the cancer has spread to the lymph nodes.
• Whether or not you've had radiation treatment.
• Your age and health.

You and your doctor can decide which surgery is right for you.

Activity

• Rest when you feel tired. Getting enough sleep will help you recover. After any activity, rest and raise your affected arm for a period of time equal to your activity time.
• Try to walk each day. Start by walking a little more than you did the day before. Bit by bit, increase the amount you walk. Walking boosts blood flow and helps prevent pneumonia and constipation.
• Avoid strenuous activities, such as biking, jogging, weightlifting, or aerobic exercise, until your doctor says it is okay. This includes housework, especially if you have to use your affected arm. You will probably be able to do your normal activities in 3 to 6 weeks. Avoid repeated motions with your affected arm, such as weed pulling, window cleaning, or vacuuming, for 6 months.
• Avoid lifting anything over 10 to 15 pounds for 4 to 6 weeks. This may include a child, grocery bags, a heavy briefcase or backpack, cat litter or dog food bags, or a vacuum cleaner.
• Ask your doctor when you can drive again.
• You will probably be able to go back to work or your normal routine in 3 to 6 weeks. This depends on the type of work you do and any further treatment.
• Your doctor will let you know how soon you can take showers or baths.

Diet

• You can eat your normal diet. If your stomach is upset, try bland, low-fat foods like plain rice, broiled chicken, toast, and yogurt.
• Drink plenty of fluids (unless your doctor tells you not to).
• You may notice that your bowels are not regular right after your surgery. This is common. Try to avoid constipation and straining with bowel movements. Take a fiber supplement such as Citrucel or Metamucil every day. If you have not had a bowel movement after a couple of days, take a mild laxative like Milk of Magnesia or a stool softener like Colace.

Medicines

• Your doctor will tell you if and when you can restart your medicines. He or she will also give you instructions about taking any new medicines.
• If you stopped taking aspirin or some other blood thinner, your doctor will tell you when to start taking it again.
• Take pain medicines exactly as directed.
  • If the doctor gave you a prescription medicine for pain, take it as prescribed.
  • If you are not taking a prescription pain medicine, ask your doctor if you can take an over-the-counter medicine.
• If your doctor prescribed antibiotics, take them as directed. Do not stop taking them just because you feel better. You need to take the full course of antibiotics.
• If you think your pain medicine is making you sick to your stomach:
  • Take your medicine after meals (unless your doctor has told you not to).
  • Ask your doctor for a different pain medicine.

Incision care

• You will have a dressing over the cut (incision). A dressing helps the incision heal and protects it. Your doctor will tell you how to take care of this.
• A woman may wear a special bra (surgi-bra) that holds the dressing in place after the surgery. The doctor will say when the bra is no longer needed.

Drain care

• You may have one or more drains near your incision. Your doctor will tell you how to take care of them.

Arm exercises

• If you had any lymph nodes removed from under your arm, your doctor will advise you to do arm exercises. Do not do the exercises until your doctor says it is okay.

Ice and elevation

• Do not use ice for swelling or pain.
• Prop up your arm on a pillow when you sit or lie down. Try to keep your arm above the level of your heart. This will help reduce swelling.

For early-stage breast cancer, having a lump or part of the breast removed (breast-conserving surgery) along with radiation therapy has the same survival rate as mastectomy. But many women still have a mastectomy, even though it is a more extensive surgery. They may be unwilling or unable to have the radiation therapy that usually follows breast-conserving surgery. Or they may feel that by having a mastectomy, they are taking every possible action they can to prevent the return of cancer.

Women who have metastatic breast cancer don't always have surgery. Survival may not be increased by having surgery.

Surgery can be stressful. This information will help you understand what you can expect. And it will help you safely prepare for surgery.

Preparing for surgery

• Be sure you have someone to take you home. Anesthesia and pain medicine will make it unsafe for you to drive or get home on your own.
• Understand exactly what surgery is planned, along with the risks, benefits, and other options.
• If you take a medicine that prevents blood clots, your doctor may tell you to stop taking it before your surgery. Or your doctor may tell you to keep taking it. (These medicines include aspirin and other blood thinners.) Make sure that you understand exactly what your doctor wants you to do.
• Tell your doctor ALL the medicines, vitamins, supplements, and herbal remedies you take. Some may increase the risk of problems during your surgery. Your doctor will tell you if you should stop taking any of them before the surgery and how soon to do it.
• Make sure your doctor and the hospital have a copy of your advance directive. If you don’t have one, you may want to prepare one. It lets others know your health care wishes. It’s a good thing to have before any type of surgery or procedure.

After your surgery, you will be taken to a recovery room. A nurse will be able to help with any nausea, pain, or anxiety you might have.

When you wake up from surgery, you will have a bandage over the surgery site. You will also have one or two drainage tubes to collect fluid and keep it from building up around the surgery area. If these tubes are still in place when you go home, your nurse will teach you how to take care of them.

Your doctor or nurse will give you instructions on pain control and caring for your incision. In most cases, you can remove the bandage and take a shower on the day after the surgery.

Most people go home within 24 hours after a mastectomy. If you have breast reconstruction during the same surgery, you may be in the hospital longer.

A physical therapist may show you exercises while you are still in the hospital. These should help keep your shoulder from getting stiff. You will need to avoid strenuous activity for several weeks. Your doctor will let you know how soon you can increase your activity level.

Breast cancer surgery helps many women go on to lead normal lives. Your outcome depends on many things, especially the stage of the cancer.

You will probably be able to go back to work or your normal routine in 3 to 6 weeks. This depends on the type of work you do and any further treatment. Talk with your doctor about other treatment you may need.

Your personal preferences and considerations are important when choosing a treatment that is right for you.

Lymph nodes

If you had an axillary lymph node dissection at the time of your surgery, many lymph nodes were removed from your armpit area. Without these lymph nodes, your arm may swell. This is called lymphedema. You will have to take good care of your affected arm. Don't carry heavy things with that arm. Wear loose sleeves and bracelets. Your doctor or physical therapist can teach you arm exercises that will let you move your arm as you always have.

Before you get blood pressure tests, blood draws, or shots in that arm, tell your doctor that you had lymph nodes removed.

Appearance

You will have a scar, but it will fade in time.

You have some choices in how you look. Talk to your doctor about breast forms. Ask about reconstructive surgery. This can sometimes be done at the same time as the mastectomy.

Mastectomy is done to remove as much cancer as possible and give the greatest chance of staying cancer-free.

• Follow the instructions exactly about when to stop eating and drinking. If you don't, your surgery may be canceled. If your doctor told you to take your medicines on the day of surgery, take them with only a sip of water.
• Take a bath or shower before you come in for your surgery. Do not apply lotions, perfumes, deodorants, or nail polish.
• Do not shave the surgical site yourself.
• Take off all jewelry and piercings. And take out contact lenses, if you wear them.

At the hospital or surgery center

• Bring a picture ID.
• The area for surgery is often marked to make sure there are no errors.
• You will be kept comfortable and safe by your anesthesia provider. You will be asleep during the surgery.
• The surgery will take about 1 to 3 hours.
• You will have one or two tubes under your skin. These will drain fluid from the surgery area while you heal. The doctor will take these out 2 to 10 days after surgery.