A woman with breast cancer has many options when it comes to a mastectomy, especially now that doctors seek to lessen the amount of scarring and disfigurement. A total mastectomy, also called a simple mastectomy, involves the surgical removal of the entire breast, but leaves the lymph nodes under the arm (called axillary lymph nodes) and the muscle tissue beneath the breast in place. During a modified radical mastectomy, the entire breast and the axillary lymph nodes are surgically removed. When the tumor is large and has spread to the muscles of the chest wall, a radical mastectomy, the most extensive type of mastectomy, may be necessary. This surgery involves the removal of the entire breast, the axillary lymph nodes, and the chest wall muscles beneath the breast.

Many women experience physical and emotional changes as result of a mastectomy. This is the first in a four-part series of articles designed to help women with breast cancer understand common issues faced after treatment.

Follow-up care

The necessary follow-up care after a mastectomy depends on a woman’s overall health and how much tissue the doctor removed. For example, a woman who has had a radical mastectomy may need more time to recover. It is important to review all follow-up care instructions with your doctors and caregivers. Be sure you understand instructions on the following topics:

• Wound and bandage care
  
  
• Drainage care
  
  
• Warning signs of infection
  
  
• When to call the doctor
  
  
• Nutritional needs during recovery
  
  
• Medications and pain control
  
  
• Activity restrictions
  
  
• Clothing restrictions (for example, when a bra or prosthesis can be worn)

What to expect after surgery

In most cases, a woman can expect the following changes after a mastectomy:

• A bandage that covers the surgery site
  
  
• A drain from the breast or underarm that removes fluid and blood while the wound is healing. This drain will need proper care, which may include emptying it, measuring the amount of fluid collected, and reporting any problems to the doctor immediately.
  
  
• Some women may experience numbness, pinching, or a pulling feeling beneath the arm closest to the affected breast from damage to nerves under the arm.

Side effects of mastectomy

Some women experience the following side effects after a mastectomy:

• Infection at the wound site
  
  
• Blood accumulation at the wound site
  
  
• Fluid accumulation at the wound site

The primary side effect after removal of the axillary lymph nodes is a chronic (a disease or condition that persists or progresses over a long period of time) condition called lymphedema, or swelling of the arm. Lymphedema occurs in 15% of women who undergo mastectomy with removal of all the lymph nodes under the arm. This condition is a serious medical concern and can often be prevented. Report any signs of pain, swelling, or tightness in the arm to your doctor. To learn more about this condition, read the Cancer.Net Feature: After Treatment for Breast Cancer: Preventing Lymphedema.

Body image changes

Many women feel differently about their bodies after a mastectomy. A breast cancer diagnosis may already create feelings of anxiety, depression, and uncertainty, and when a woman faces disfiguring surgery, feelings of isolation, loss, and helplessness may also surface. To many people, breasts symbolize femininity, sexuality, and nurturance. Some women may feel that losing a breast to cancer also means they have lost their identity as a woman.

Sexual side effects of mastectomy

After breast cancer surgery, a woman’s feelings of being physically attractive may change. She may worry about being accepted by her partner and concerned about still being able to sexually please her partner. In addition to these feelings of self-consciousness, some women experience chronic pain in the chest and shoulders following radical surgery, weight gain, problems with breast sensitivity, joint pain, and muscle stiffness—all of which may hold back enjoyment in many different types of activities, including intimacy. It’s important to note that breast cancer surgery does not physically decrease a woman’s libido (sex drive) or ability to become aroused. In fact, women with early-stage breast cancer treatment often report the same quality of life one year following surgery as women who never had breast cancer.

Breast prostheses

A breast prosthesis, also called a breast form, is a natural-feeling artifical breast. It comes in a variety of shapes, sizes, colors, and textures and is made of silicone gel, foam, or fiberfill. A breast prosthesis can be custom-fitted or prefitted into a bra, undergarment, lingerie, and bathing suit for instant, painless reshaping of the chest that resembles a natural breast. The prosthesis can be worn against the skin, inside the pocket of a mastectomy bra or other garment, or attached with an adhesive directly to the chest wall. For more information, read the Cancer.Net Feature: After Treatment for Breast Cancer: Choosing a Breast Prosthesis.

Breast reconstruction

Breast reconstruction is a surgical option to rebuild and restore the appearance of a natural breast. Sometimes, a plastic surgeon can reconstruct the remaining tissue to resemble a natural breast, with or without rebuilding the nipple and areola (ring of darker skin that surrounds the nipple). Breast reconstructive surgery can be done at the time of mastectomy (immediate reconstruction) or months or years later (delayed reconstruction).

Reconstructive breast surgery may scar the breast or change the shape and size of the breasts. Restoring normal breast sensation is not possible with reconstructive surgery.

Choosing breast reconstructive surgery is a personal decision. Some women choose reconstructive surgery to re-establish breast symmetry, to regain normal breast contour, or to eliminate the need for a breast prosthesis. Discuss all options with your family, doctor, and surgical team before deciding on breast reconstructive surgery. To learn more about this surgery, read the Cancer.Net Feature: After Treatment for Breast Cancer: Breast Reconstruction.

Seeking support

Recovering from breast cancer surgery requires a strong support system. Women should know they are not alone; other women have had similar experiences. Talking with other women or finding a support group may help women in dealing with the physical and emotional effects of a mastectomy.

More Information

Body Image and Cancer

Body Image and Sexuality

What to Know: ASCO's Guideline on Follow-up Care for Breast Cancer