What is a double mastectomy?
A double mastectomy is surgery to remove both breasts. It is most often a preventive option for breast cancer. However, it can also be a treatment when cancer is in both breasts. Other names for this procedure include bilateral mastectomy and bilateral mastectomy surgery.
There are several types of double mastectomy surgery. The one that is right for you will depend on the reason you are having the surgery. A double mastectomy procedure may include:
- Subcutaneous mastectomy removes all or most of the breast tissue under the skin. It leaves the nipple-areola complex intact. Nipple-sparing mastectomy and skin-sparing mastectomy are other names for this procedure. It may be an option for women having double mastectomy to prevent breast cancer.
- Simple mastectomy removes the entire breast, which includes the breast tissue, nipple, areola and skin. Another name for this procedure is total mastectomy. It is the most common form of preventive double mastectomy.
- Modified radical mastectomy removes the same tissues as a simple mastectomy along with some underarm, or axillary lymph nodes. This is a common procedure for invasive breast cancer.
- Radical mastectomy removes the same tissues as a modified radical mastectomy along with additional underarm lymph nodes and the chest wall muscles under the breast. Doctors rarely use this procedure today, unless cancer has spread to the chest muscles.
Women who have a double mastectomy will need to decide whether or not to have breast reconstruction. This surgery rebuilds the breast with the goal of restoring the size, shape and feel of the breasts. It may also be possible to recreate a nipple and areola. Doctors may be able to perform this surgery at the same time as double mastectomy. This immediate double mastectomy reconstruction means only having one major surgery. However, it is usually a flap reconstruction and can lengthen your recovery time. Flap reconstruction removes a flap of tissue from another site to rebuild the breast mound.
In some cases, doctors recommend delaying reconstruction due to surgical risks or the need for postsurgical cancer treatments. Delayed reconstruction means having two major surgeries. But this still may be the best choice, especially if you want an implant reconstruction. Implant reconstruction usually requires an expander to stretch the remaining tissue enough to accommodate the breast implant.
Breast reconstruction is a personal choice and it isn’t right for every woman. Talk with your doctor and with other women who have and have not had reconstruction surgery. Getting input from others who have been in your place may help with your decision.
Why is double mastectomy performed?
Doctors may recommend double mastectomy to prevent or treat breast cancer. When it is a treatment, it is usually because cancer is present in both breasts.
There are two scenarios when doctors may perform double mastectomy to prevent breast cancer. The first is in women who have healthy breasts, but are at high risk for developing breast cancer. This includes women with a very strong family history of breast cancer and those with gene mutations, such as BRCA1 and BRCA2 gene mutations. In this scenario, it is a bilateral prophylactic mastectomy.
In the other scenario, a woman has breast cancer in one breast, but chooses to remove both the breast with cancer and the other healthy breast. This is a contralateral prophylactic mastectomy. Women may decide on this option if there is a high risk or concern about breast cancer occurring in the other breast.
Deciding to have double mastectomy is an easy decision for some women and a stressful, emotional one for other women. Take your time and talk with your doctor about the risks and benefits of surgery. Consider getting a second opinion and talking to other women who have been through the surgery you are considering. Both of these things can help you make an informed and confident decision about your breast health.
Who performs double mastectomy?
General surgeons typically perform double mastectomies. These doctors surgically treat a wide variety of diseases, disorders and conditions. Some general surgeons specialize in treating people with breast disease. They may call themselves breast surgeons. If you decide to have breast reconstruction, a plastic surgeon will rebuild your breasts using either flap or implant reconstruction. Plastic surgeons use reconstructive and cosmetic procedures to repair physical defects that affect a person’s appearance or ability to function.
How is a double mastectomy performed?
Double mastectomy typically takes place in a hospital using a general anesthetic. This type of anesthesia is a combination of IV (intravenous) medicines and gases that put you in a deep sleep.
The extent of the surgery will depend on the type of mastectomy you are having. In general, your doctor will make an oval incision in your breast and remove tissue through it. The incision will cut out the nipple-areola complex unless you are having a nipple-sparing mastectomy. For nipple-sparing mastectomies, your doctor will use a different kind of incision.
If you are having immediate reconstruction, a plastic surgeon will work with your general surgeon to reconstruct your breasts. If you are having delayed reconstruction, your doctor will place tissue expanders, which will remain in place for several weeks.
When the surgery is complete, your doctor will close the incision with stitches. He or she will also place thin tubes to drain fluid from the surgical site.
How long is double mastectomy surgery?
The length of your surgery will depend on the specific procedure and whether or not you are having immediate reconstruction. In general, a simple mastectomy will take 2 to 3 hours, so a double mastectomy will take longer. Having immediate reconstruction will lengthen this time.
What to expect the day of your double mastectomy
In general, this is what happens the day of your surgery:
- You will change into a hospital gown and talk with a preoperative nurse who may perform a brief exam.
- You will talk with an anesthesiologist or nurse anesthetist about your medical history and the anesthetic you will have.
- You will get a sedative to help you relax before the team takes you to the operating room (OR).
- Your team will start general anesthesia in the OR. With general anesthesia, you won’t remember anything else until you wake up in the recovery room.
What are the risks and potential complications of a double mastectomy?
As with any surgery, there are risks and potential complications with double mastectomy. Complications can develop during the procedure or afterwards during double mastectomy recovery. Some potential complications may be serious or even life threatening.
General risks of surgery
The general risks of surgery include:
- Anesthesia reaction, such as an allergic reaction and problems with breathing
- Bleeding, which can lead to shock
- Blood clot, in particular a deep vein thrombosis (DVT) that develops in the leg or pelvis. A DVT can travel to your lungs and cause a pulmonary embolism.
Potential complications of double mastectomy
In most cases, double mastectomy surgery is successful, but potential complications include:
- Fluid collection requiring drainage by your doctor
- Lymphedema, which is severe swelling after lymph node removal
- Nerve damage leading to numbness, tenderness, or extra sensitivity at the site
- Scarring problems or problems with tissue healing
Reducing your risk of complications
You can reduce your risk of certain complications by:
- Following activity, dietary and lifestyle restrictions and recommendations before your surgery and during recovery
- Notifying your doctor immediately of any concerns, such as bleeding, fever, or increase in pain
- Taking your medications exactly as directed
- Telling all members of your care team if you have allergies
- Wearing a postsurgical support bra as directed if you also have breast reconstruction
How do I prepare for double mastectomy?
You can prepare for double mastectomy by:
- Answering all questions about your medical history, allergies, and medications you take. This includes prescriptions, over-the-counter drugs, herbal treatments, and vitamins. It is a good idea to carry a current list of your medical conditions, medications, and allergies at all times.
- Getting preoperative testing as directed
- Losing excess weight before surgery through a healthy diet and exercise plan
- Not eating or drinking before surgery as directed. Your team may postpone your surgery if you eat or drink too close to the start of surgery because you can choke on stomach contents during anesthesia.
- Stopping smoking as soon as possible. Even quitting for just a few days can be beneficial and help the healing process.
- Taking or stopping medications exactly as directed. Your doctor will give you instructions for taking your specific medications and supplements.
Questions to ask your doctor
Making a list of questions can help you remember everything you want to ask during your appointments. Questions you may want to ask your doctor include:
- What is involved in the type of double mastectomy surgery you are recommending? What other treatments will I need?
- If I decide to do breast reconstruction, what type of reconstruction procedure is best for me and why?
- How long will the surgery take? When can I go home?
- What restrictions will I have after surgery? What kind of assistance will I need at home?
- When can I return to work and other activities?
- When will I start physical therapy? How many treatments are typically necessary for recovery?
- How will you manage my pain?
- What changes, if any, to my medication plan do I need to make?
- When should I follow up with you?
- How should I contact you after hours if I have a problem?
What can I expect with double mastectomy recovery?
When you know what to expect, it can be easier to plan and prepare for a successful recovery.
How long will it take to recover?
Double mastectomy, or bilateral mastectomy recovery time varies depending on the specific procedure and whether you have breast reconstruction. In general, you will stay in the hospital for about three days. Your age and your overall health can play a role in how quickly you heal. Having breast reconstruction at the same time will lengthen your recovery period. It can take up to eight weeks to fully recover.
Will I feel pain?
You will have pain and discomfort after double mastectomy. Managing your pain is important for a smooth recovery. Being comfortable allows you to participate in physical therapy and other rehabilitation activities that are necessary for smooth healing. However, you should tell your doctor if your pain worsens or changes in any way. This could be a sign of a complication.
When should I call my doctor?
If you have questions between follow-up appointments, call your doctor’s office during normal business hours. Your doctor may also give you instructions for after-hours concerns. Call your doctor right away or seek immediate medical care if you have:
- Breathing problems or shortness of breath
- Confusion or changes in level of alertness
- Chest pain, pressure or tightness
- Drainage of pus, redness or swelling around your incision
- It’s common to have a fever right after surgery. Your doctor will give you instructions about when to call for a fever.
- In ability to urinate or move your bowels
- Leg pain, redness or swelling, which could mean you have a blood clot
- Unexpected bleeding
How might a double mastectomy affect my everyday life?
Double mastectomy greatly reduces the risk of breast cancer recurring or a new breast cancer developing. However, it does not completely eliminate it. So you will still need to see your doctor regularly for exams. You also will still need mammograms if any breast tissue or the nipple-areola complex remains.
Some women struggle emotionally after double mastectomy and some do not. Because breasts are often a symbol of sexuality or femininity, some women feel a sense of loss. If you are feeling differently about yourself, know if can take time to process your feelings after surgery. Many women find breast reconstruction helps ease some of these feelings. It can also be useful to talk with therapists, support groups, and friends and family. Your doctor can refer you to resources for support.
Let your doctor know if you have symptoms of depression for more than a couple weeks including:
- Constant feelings of sadness or tiredness
- Difficulty concentrating
- Frequent feelings of hopelessness or worthlessness
- Loss of enjoyment or interest in activities that used to be a part of your life
- Sleep problems
- Thoughts of dying or wanting to die
Help is available. Be honest with your doctor about your feelings. Ask about your options for healing your emotions and getting back to your life.