Monica Morrow, Chief of MSK's Breast Surgical Service, explains how your doctors make treatment and surgery decisions with you.
A mastectomy is the removal of the entire breast to treat cancer. Doctors may remove one breast or both. When both breasts are removed, doctors refer to it as a bilateral mastectomy. This surgery usually includes the removal of the nipple and the areola (the dark skin around the nipple). The chest (pectoral) muscles under the breast are left intact unless the cancer is near or touching the muscles. If that happens, a small area of muscle may be removed.
Here you will find more in-depth information on mastectomy, along with answers to some common questions.
A mastectomy is medically necessary when:
- the cancer is scattered throughout the breast (multicentric)
- too much tissue would need to be removed during a lumpectomy to achieve a good cosmetic outcome
- radiation therapy is not possible
A mastectomy is not necessary for the majority of women with early-stage breast cancer.
Most women with early-stage breast cancer have the option of choosing between a mastectomy and breast-conserving therapy (lumpectomy followed by radiation treatment). This can be a difficult decision for some women who may be worried about the cancer coming back if they choose breast-conserving therapy. However, there is strong research to show that women with early-stage cancer are not putting themselves at a greater risk by choosing this approach over a mastectomy.Back to top
MSK’s breast surgeons generally recommend one of two types of mastectomy:
- total mastectomy
- modified radical mastectomy
Other aspects of a mastectomy surgery may include special techniques to preserve your breast skin or your nipple and areola.
Here is more in-depth information about the different types of mastectomy:
Also referred to as a simple mastectomy, this surgery removes the entire breast, including the breast tissue, nipple, and areola, and most of the skin covering the breast.
Total mastectomy may be a good option for women who have:
- a large area of DCIS or DCIS that appears in multiple places in the breast
- invasive breast cancer that is scattered throughout the breast
It’s also the surgery recommended for women who do not have cancer in the lymph nodes, but who are not candidates for lumpectomy.
This surgery combines a total mastectomy with the removal of underarm (axillary) lymph nodes. A modified radical mastectomy is the procedure of choice for women with invasive breast cancer that has spread to the underarm lymph nodes prior to surgery. For some women, we may suggest chemotherapy prior to surgery to try and eliminate the cancer in the lymph nodes.
In this kind of mastectomy, all of the tissue inside of the breast is removed, but doctors are able to keep most of the outside skin intact. Your skin will be used to create a kind of envelope to cover your reconstructed breast. Surgeons do not save the nipple or areola for a number of reasons, including if the cancer involves or is close to the nipple. Women who have a mastectomy with breast reconstruction usually have this type of surgery.
It’s sometimes possible for surgeons to save the nipple and areola during a skin-sparing mastectomy. Sensation is changed, and the nipple won’t become erect or function like it normally did. But many women find that this approach gives them excellent cosmetic results.Back to top
Some women, on the advice of their doctors, may choose to have their breasts removed as a precautionary measure if they are at a high risk for breast cancer. A prophylactic mastectomy can lower breast cancer risk by at least 95 percent in women with BRCA1 or BRCA2 gene mutations or with a strong family history of breast cancer, according to the National Cancer Institute. If you have a prophylactic mastectomy, you may want to combine it with breast reconstruction surgery. Some women with cancer in one breast choose to have a prophylactic mastectomy of the other breast to reduce the risk of future breast cancers. But for the average woman with breast cancer, the risk of cancer in the other breast is low enough that this is not medically necessary.
A prophylactic mastectomy is not the only risk-reducing option available to women at an increased risk of breast cancer development. For premenopausal women with BRCA mutations, removal of the ovaries reduces the risk of breast cancer as well as the risk of ovarian cancer, which is also higher among women with BRCA mutations. Treatment with drugs such as tamoxifen has been shown to reduce the risk for breast cancer by almost half for some patients.
MSK offers a comprehensive long-term screening program for women at an increased breast cancer risk.Back to top
This surgery combines the removal of the breast tissue with the removal of the chest wall muscle and all of the lymph nodes in your underarm (axillary lymph node dissection). At one time, a radical mastectomy was the standard surgery for women with breast cancer. Today, it is extremely rare for doctors to recommend it.Back to top
Women with breast cancer typically have one or more lymph nodes taken (biopsied) from the underarm area during a mastectomy. These nodes, called the sentinel nodes, are the first lymph nodes to which cancer cells would travel if they were to leave the breast. This is done so that a doctor can check to see if the cancer has spread.
If cancer is found in the sentinel nodes, most or all of the lymph nodes in the armpit may need to be removed.Back to top
Recovery and healing from a mastectomy is different for every woman. Healing time after surgery can range anywhere from three to six weeks. Generally speaking, women who have a mastectomy with breast reconstruction need four to six weeks to heal. Recovery time for women who do not have reconstruction is closer to three weeks.
As you are healing from your surgery, you may feel a variety of different sensations in your arm, breast, or chest wall. Tenderness, numbness, and twinges are common examples. After your mastectomy, you may also feel like your breast or nipple is still present. This is called a phantom sensation.
These sensations usually come and go, and often decrease within the first few months after surgery. However, some may last months, even five years or longer. This is because the nerves are the slowest part of your body to heal. Most people report that the sensations are not severe or distressing.
As you continue to heal, you may feel scar tissue begin to form. It will feel hard. This is common and will soften over the next several months.Back to top
If you have a mastectomy, you’ll have to decide whether you want the breast to be reconstructed and which type of reconstruction would work best for you.
Oftentimes, women begin the process of breast reconstructive surgery at the same time as a mastectomy. This is known as immediate reconstruction. However, you can have breast reconstruction any time after your mastectomy. As you learn more about your treatment, consider whether reconstruction is right for you and be sure to share your thoughts with your breast surgeon.
At Memorial Sloan Kettering, our breast surgeons work closely with you to understand your preferences and explain your treatment recommendations. We will help you decide on a plan together. We will also keep in close touch with the other members of your care team and ensure that you get the best combination of therapies possible.
Other aspects of your care may include radiation, drug therapies such as chemotherapy and targeted therapy, and integrative medicine approaches. These offerings are available at our New Jersey, Long Island, and Westchester County locations as well as at our Evelyn H. Lauder Breast Center in Manhattan.Back to top
Women who have a mastectomy may experience numbness in the skin of the breast from just beneath the collarbone to the top of the rib cage. About one and a half to two years after surgery, some feeling returns. Many women get a lot of feeling back, but it may never be completely normal.
This is true for all types of mastectomies, including total mastectomies and skin-sparing mastectomies.Back to top
MSK’s quality-of-life specialists are here to provide follow-up care to help you recover from a mastectomy. Many services are available at our locations in New Jersey and Westchester County as well as on Long Island.
- Wellness therapies from integrative medicine specialists can relieve emotional or physical symptoms and potential side effects, such as lymphedema or pain after breast surgery.
- Rehabilitation and exercise therapies can help you heal and recover your strength, flexibility, and stamina.
- Find emotional support through our Counseling Center, online support groups, or patient-to-patient support program, which connects you with other breast cancer survivors who understand your challenges and concerns. Our social workers are available across our treatment locations to provide emotional support and guidance. They can also help with some of the practical aspects of having cancer, such as transportation assistance and the impact on your job.