Having a Mastectomy: What to Expect, Before and After
A diagnosis of breast cancer is understandably shocking. Being told you need a mastectomy can be downright brutal, because all most women can think about when they hear that word is, “They’re going to cut off my breast!”
Emotionally, it takes time to internalize that you’re going to lose your breast. But remember: literally millions of women have had this operation and have gotten through it all right. Of course, if you’re worried about your physical appearance, you can choose to have reconstructive surgery or implants.
Another worry many women have is that once the need for surgery is indicated, it can take weeks, or even months, to schedule the procedure and that can seem like an eternity. However, especially if you’re having reconstruction, remember that it takes time to schedule two surgeons (one to remove your breast, another to rebuild a new one) and find an open operating room.
So yes, it can be a while between diagnosis, your decision to have a mastectomy, and the actual operation. But with the exception of inflammatory breast cancer, most breast cancers are relatively slow-growing. A typical tumor grows for eight years before it is large enough to be felt or detected on a mammogram. An extra few weeks shouldn’t make a difference.
Types of mastectomies
The simplest type of mastectomy, which some women choose when they’re diagnosed with DCIS (non-invasive cancer), removes just your breast skin and tissue, without any of your chest wall or muscles, and without any underarm lymph nodes. It takes one surgeon up to two hours or so, and is done under general anesthesia.
A modified radical mastectomy without reconstruction, which takes two to three hours, is also performed by one surgeon. This operation removes your breast tissue, as well as lymph nodes from under the arm, so the pathologist can determine if your cancer has spread outside the breast.
A modified radical mastectomy with reconstruction can take up to seven or eight hours, possibly more, depending on the complexity of the reconstruction. Typically, a reconstruction that uses tissue from another part of your body (as opposed to an implant) takes longer, as the two surgeons will be working on two different sites: your breast, and the place from which the healthy tissue is harvested.
As with any serious surgery, you’ll be admitted to the hospital, asked to change into a gown, and be assigned a bed in the waiting area. You may be asked to “X” or sign the affected breast with a marker; a nurse may also draw on the breast to show the surgeon where to start the incision. You’ll be prepped with a drug to relax you before you go to the operating room.
Once in the operating room, you’ll be anesthetized, and the operation performed. All of your breast tissue will be removed; your breast skin may or may not be removed, as well, depending on whether you’re having an immediate reconstruction. The surgeon will either continue on and perform the reconstruction or, if you’re not having an immediate reconstruction, (s)he will insert some drainage tubes into the wound, close up the incision, and apply a loose bandage.
You’ll wake up in the recovery room. Expect discomfort, both from the operation itself and from the anesthesia. You’ll be given anti-pain drugs, and may be given drugs to deal with any nausea, as well.
You may not want to — for some women, this is very hard — but try and look at your chest. You’ll see a bandage, probably blood, and perhaps a flat place where your breast used to be (if you didn’t have reconstruction). It’s an odd sensation. Take a deep breath, and move on; you’ll get used to this “new you” in time.
You don't have to have reconstructive surgery right away. You can always go back and have it done later. In fact, sometimes your surgeon and oncologist will recommend that you wait, for example if they feel it’s important for you to start chemotherapy quickly or if you’re going to need radiation, which can sometimes negatively affect a reconstruction.
If you do decide to have reconstruction done immediately, you also have to decide whether you want implants (saline or silicone) or an autologous reconstruction, which means your breast is rebuilt using another part of your body, usually tissue from your belly or back.
If you’re having an immediate reconstruction, you may be offered a "skin-sparing mastectomy," in which the surgeon removes your nipple and breast tissue, but leaves the skin of your breast intact. This kind of surgery makes reconstruction easier, as there’s already a natural pouch there to hold the new breast. It also gives you a better cosmetic result, as the scar is limited to a small circle around your areola.
Unfortunately, some women aren’t eligible for skin-sparing mastectomies. If the tumor was very close to your skin, or you have inflammatory breast cancer, you probably won’t be offered this procedure.
Your hospital stay and recovery
A typical hospital stay for a mastectomy without reconstruction is on average, three days or less. With reconstruction, it may take a little longer, depending on what type of reconstruction you have.
Recovery time, meanwhile, depends on your exact surgery, as well as your definition of what getting back to "normal" might be. Even the simplest type of mastectomy, one without reconstruction, is still a fairly serious surgery.
Count on one day of feeling “off” for every hour you’re under general anesthesia. You’ll experience enough pain to take painkillers for at least a day or so; you’ll certainly be sore for a while after that; and you’ll be fatigued, as surgery is a real challenge to your system.
You’ll also be dealing with drainage tubes. These flexible tubes, with a collection bulb at the end, drain excess fluid from your wound. You’ll measure and empty this fluid from the bulbs regularly. When the drainage slows to a certain point (that’s why you’re measuring), a nurse will remove the tubes. Expect a short, sharp pain, like a bee sting. You may have the tubes in for only a couple of days, or they may be with you for a couple of weeks or more. While they’re in, you can’t shower; so be prepared to have someone help you bathe, either in the tub or with a sponge and basin.
How quickly you heal will be a reflection of both the length and complexity of your surgery and how healthy you are in general. Smokers take longer to heal, due to a compromised vascular system. In fact, smokers usually don’t have the option of reconstruction, as there’s such an increased chance of it failing.
You should probably plan to take a minimum of one week off of work for a simple mastectomy; and at least two or three weeks for a mastectomy with reconstruction. If you have a physically challenging job, you’ll need to take longer, in order to let everything heal thoroughly before you put it to the test by lifting, carrying, etc.
Your doctor will give you exercises to do at home, and will tell you when to start doing them. Don’t shirk this responsibility; exercise after surgery, even when painful, will help prevent arm and shoulder problems later on.
As with any surgery, be sensible. Don’t overdo. No lifting or carrying with your affected arm till your surgeon says it’s okay. If you have signs of infection (fever, swelling, redness), let the surgeon or nurse know immediately. And if your arm and/or trunk swells, you may be experiencing lymphedema; this is another thing to report.
A simple mastectomy will leave you with a flat place on your chest bisected by a horizontal scar. A reconstruction will look anywhere from nearly natural to not-so-good, depending on the skill of your surgeon and the size of your breasts. (Smaller breasts are easier to reconstruct than larger ones.) But remember, hardly anyone (maybe only you) will see your reconstruction au naturel; most reconstructions look just fine covered by a bra and shirt.
Most women go on to have further treatment — radiation, or chemo, or both — after their mastectomy. You’ll soon get past worrying about your surgery, as you’ll have other things to worry about! Good luck, and remember: you’re doing everything you can to prevent cancer form coming back, so it’s all worth it.
Having trouble deciding whether to have a lumpectomy or mastectomy? Here’s some guidance on how to make this important decision.
Breast cancer survivor and award-winning author PJ Hamel, a long-time contributor to the HealthCentral community, counsels women with breast cancer through the volunteer program at her local hospital. She founded and manages a large and active online survivor support network.
Updated June 6, 2016