Mastectomy: 11 Things Doctors Want You to Know

  • senior age black woman with cancer in medical consultation
    Expert Insight from Mastectomy Doctors
    More than 100,000 women undergo some type of mastectomy in the U.S. each year. Usually, this is done to treat breast cancer (which is expected to be newly diagnosed in about 276,480 American women and 2,620 men in 2020). Sometimes, it is done to prevent cancer. Some women have strong family histories or carry gene mutations putting them at high risk for breast cancer, so they may have healthy breasts removed to avoid getting the disease. We talked to mastectomy doctors to find out more about mastectomy for breast cancer and what you can expect.
  • female doctor pointing to x-ray film while talking with female patient at desk in medical office
    1. "Mastectomy is not the same for every patient."
    Benjamin O. Anderson, MD, a breast cancer surgeon in Seattle, says three types of mastectomy are common. Standard mastectomy removes the breast plus skin and "nipple-areola complex." If the patient would like breast reconstruction after mastectomy, one of two other procedures are performed: skin-sparing mastectomy and skin-and-nipple-sparing mastectomy, both of which take out breast tissue while leaving skin and, when possible, nipple. "For some women whose cancer has spread into her lymph nodes, a radical mastectomy, which removes the breast plus lymph nodes, may be required," says Elizabeth Mittendorf, MD, a Boston-based breast cancer surgeon. Radical mastectomy, which also takes chest muscles, is rare today, she says.
  • breast cancer surgery scar after partial mastectomy or lumpectomy
    2. "Women are increasingly opting for mastectomy over lumpectomy."
    Most women with less-advanced breast cancer undergo lumpectomy, which removes just the tumor and nearby tissue. Yet a growing number (about 37% nationally) are opting for mastectomy, a riskier procedure with more complications, says Batul Al-Zubeidy, MD, a breast cancer surgeon near Chicago. Of these, more women – especially those under 40 – also are choosing to have both cancerous and healthy breasts removed (called a bilateral mastectomy), she says, even if they are not at high risk for recurrence. Nationally, mastectomy rates rose 34% from 1998 to 2011, with bilateral mastectomy increasing from 1.9% to 11.2%, she says.
  • portrait of smiling breast cancer survivor with single mastectomy
    3. "Patients say they want peace of mind, despite the data."
    For women with newly diagnosed breast cancer, "it's very common that they will come in and say, 'I just want them gone,' because they think doing the biggest operation they can do will make them safer," says Dr. Anderson. "But only about 10% need bilateral mastectomy from a medical standpoint," such as family history, says Dr. Anderson. Dr. Al-Zubeidy says in her experience, women who choose bilateral mastectomy often have had a loved one go through breast cancer treatment and are seeking "peace of mind." Yet, says Dr. Mittendorf, "in appropriately selected patients, a lumpectomy followed by radiation has a survival equivalent to a mastectomy."

  • technician-reviewing-breast-mammogram-image
    4. "Mastectomy carries many more risks than lumpectomy."
    "About 57 to 64% of women undergoing bilateral mastectomy with reconstruction will have an unanticipated operation in the next 10 years," says Dr. Al-Zubeidy. Skin may die or become infected; implants may contract or cause scarring, requiring their removal and replacement. These procedures can delay much-needed cancer treatment, such as radiation or chemotherapy, she says. Women who skip reconstruction are much less likely to have unanticipated operations—only about 5 to 7%, she says. Also, the overall complication rate from bilateral mastectomy is 15 to 20%, she says, compared with 3 to 5% with lumpectomy.
  • Breast X-ray
    5. "Even if you have a bilateral mastectomy, you can still get breast cancer later."
    Mastectomy does provide a "slight survival benefit" for women at higher risk, such as people with a family history or genetic mutations, explains Dr. Al-Zubeidy. But, about 2 to 10% of women experience recurrent breast cancer in the 20 years post-mastectomy, even if both breasts have been removed, she says. "That's surprising to them. They think if they have a bilateral mastectomy, they don't have to worry about breast cancer in the future," but that is not correct. Tumors can form in the skin flap left after a breast is removed.
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    6. "Women must be vigilant with self-exams after mastectomy."
    "After a mastectomy, women typically are no longer getting imaging," such as mammograms, says Dr. Al-Zubeidy. "So we are missing that screening and surveillance." Doctors will do physical exams twice a year to check for this, while patients must do monthly self-exams to watch for signs of recurrence or new breast cancers: small nodules, redness and thickness of the skin. Women with implants may have MRIs to detect ruptures (and doctors can look for cancer then), but the women do not have routine screening mammograms or ultrasounds, says Dr. Al-Zubeidy. However, women who have lumpectomies can continue being screened with mammograms.

  • A woman showing her mastectomy scar puts a breast prosthesis on her breast
    7. "Most breast cancer scars fade with time."
    "For most people with a well-done breast procedure, the scars fade with time and become less noticeable," says Dr. Anderson. Surgeons try to tuck them into hidden places, like beneath the crease where the breast attaches to the body (the "underwire" area). In general, depending on where your cancer is located, "surgeons try to put the incisions in places where they're going to be covered by a bathing suit top," he says. Sometimes, however, skin incisions do remain visible. Some patients form keloids, a type of scar tissue, he says. Plastic surgeons have various methods to address this problem, such as steroid injections.

  • Breast cancer doctor and patient
    8. "Reconstructed breasts are not the same as natural breasts."
    One reason more women may opt for mastectomy, Dr. Anderson says, is that they have unrealistic expectations about breast reconstruction. “Women think, ‘My breasts will be back and it will be like it was 20 years ago.’” But, he says, “they’re not the same as a natural breast or an augmented breast.” For example, he says, women often don’t regain sensation in the nipple Dr. Mittendorf also says surveys show that women who have had lumpectomies feel better about their breasts, sexuality and overall well-being than women who had mastectomies with reconstruction.
  • Middle-aged woman with cancer
    9. "You can always get a reconstruction later."
    "There are patients who will say they don't want reconstruction, and you can tell someone has made them feel guilty about that decision," says Dr. Mittendorf. She reassures patients who are on the fence about reconstruction that this procedure (which involves additional surgery) does not have to be done right away. Women can come back years later to have it done, if they want. "That's the way we used to do reconstruction—months after their mastectomy," she says. "Plastic surgeons are very skilled in doing a reconstruction in that setting."
    Black woman relaxing on sofa
  • loving senior couple hugging and looking at each other while attending cancer awareness fundraiser
    11. "Partners—usually, it's guys—need to shut up. It's not about you."
    Sometimes a woman's partner will be OK with her having a mastectomy, and then assume that means she will be OK with it, too, says Dr. Anderson. But for women, facing losing a breast brings up issues of "feeling whole, apart from being in a sexual relationship with someone." What a woman chooses to do is her decision; partners should "be present and be supportive," he says. "This means you don't talk, other than to ask clarifying questions. You don't put your own emotions into this. Listen to your partner, help her—but this is her call."
Mastectomy: 11 Things Doctors Want You to Know
Contributors
  • Dr. Batul Al-Zubeidy - Healthgrades - Mastectomy: 11 Things Doctors Want You to Know
    Dr. Al-Zubeidy is a board-certified surgeon specializing in breast cancer at Northwestern Medicine Regional Medical Group, Winfield, Ill.
  • Dr. Benjamin O. Anderson - Healthgrades - Mastectomy: 11 Things Doctors Want You to Know
    Dr. Anderson is board-certified surgeon specializing in breast cancer, and professor of surgery and global health at the University of Washington in Seattle.
  • Dr. Elizabeth Mittendorf - Healthgrades - Mastectomy: 11 Things Doctors Want You to Know
    Dr. Mittendorf is a board-certified surgeon specializing in breast cancer. She is also the Rob and Karen Hale Distinguished Chair in Surgical Oncology at Brigham and Women’s Hospital in Boston, Mass.

About The Author

Lorna Collier has been reporting on health topics—especially mental health and women’s health—as well as technology and education for more than 25 years. Her work has appeared in the AARP Bulletin, Chicago Tribune, U.S. News, CNN.com, the APA’s Monitor on Psychology, and many others. She’s a member of the American Society of Journalists and Authors and the Association of Health Care Journalists.
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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2020 Aug 13
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