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HealthInfo Canterbury

Mastectomy

mastectomy processA mastectomy is when the whole breast is removed to treat breast cancer.

Doctors will recommend a mastectomy if the tumour is large (compared to the size of the breast). They'll also recommend it if more than one area of the breast has cancer (multi-focal cancer).

Some women may not want to have radiotherapy after a lumpectomy and decide to have a mastectomy instead. Often older women choose this option. But having a mastectomy doesn't always remove the need for radiotherapy.

Some women may choose to have a mastectomy instead of a lumpectomy for personal reasons.

There are several different types of mastectomy operations, depending on exactly what's removed. The Breast Cancer Foundation explains what each one involves.

If you have a mastectomy, you may be able to have immediate or delayed breast reconstruction. This will depend on the type or stage of your cancer and the type of treatment needed.

If you don't have immediate breast reconstruction, you'll be fitted with a temporary breast prosthesis that fits inside your bra. The breast care nurses will talk to you about this before and just after your surgery.

You'll be given a Ministry of Health prosthesis subsidy form when you're discharged from hospital.

You'll be fitted for a permanent prosthesis when your mastectomy wound has healed. This usually takes six to seven weeks.

For more information, contact the breast care nurses on (03) 364-1804 or the Cancer Society.

Risks and possible complications

Scarring

The wound is usually straight and flat, with dissolvable stitches. Your scar will be more noticeable in the first few weeks after surgery but will fade to a finer line. Some people may form thickened or raised (hypertrophic or keloid) scars. If this happens, contact the breast care nurses on (03) 364-1804, who may be able to help with special dressings.

Pain

Some people may have long-term pain along their scar and chest wall after a mastectomy. If your pain is severe, you can discuss it with your surgeon or breast care nurse. They can refer you to the Pain Management Centre at Burwood Hospital.

Wound infection

The risk of a wound infection is small (around 5%). But the risk is higher if you have diabetes or if you smoke. In most cases the infection can be treated with antibiotics alone.

Seroma

A seroma is a pocket of fluid that sometimes forms after a mastectomy. You'll have a drain in the wound to remove the excess fluid for the first week after surgery.

Some women continue to form a seroma after the drain is removed. In this case, the breast care nurses will drain it with a needle.

Bruising and haematoma

Early and delayed bleeding can cause a collection of blood in the tissues called a haematoma. This may mean that you need further surgery. The risk is higher if you're taking aspirin or another blood thinning medication such as warfarin, clopidogrel or dabigatran.

You should avoid any heavy lifting, pushing or pulling in the initial weeks after surgery. Talk to the breast care nurses if you aren't sure what you can do.

Shoulder stiffness and weakness

The risk of stiffness and weakness in your shoulder is higher if you've had the lymph nodes removed from your armpit. It's also higher if you already had a frozen shoulder. You'll be given shoulder exercises to do after your surgery.

Lymphoedema

If you've had the lymph nodes removed from your armpit, you're at risk of developing lymphoedema. The risk is higher if you've also had radiotherapy.

Early signs of lymphoedema include swelling and a feeling of heaviness in your arm.

If your arm feels heavy or swollen, contact the breast care nurses on (03) 364-1804 as soon as possible. They'll refer you to a lymphoedema specialist who'll fit you with a compression sleeve.

General surgical risks

All surgery and anaesthetics have some risks. See General surgical risks and Having an anaesthetic.

You'll be invited to attend a pre-admission clinic before your surgery. You can discuss any concerns then.

Written by HealthInfo clinical advisers. Endorsed by oncoplastic breast and general surgeon, Canterbury DHB. Page created December 2018.

Sources

See also:

Communication cards in multiple languages

Overview of surgery

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