Breast Cancer in women

Mastectomy

A mastectomy involves removal of the whole breast and usually the nipple. A simple mastectomy removes only the breast tissue and nipple, while a radical mastectomy also removes the muscles on the chest wall. A radical mastectomy is almost never performed these days. The surgeon also usually removes lymph glands from under the arm to check whether any cancer cells have spread from the breast (sampling or sentinel lymph node biopsy). This helps doctors decide whether other treatment is needed.

Before the operation an ultrasound scan is taken under the arm (axilla) to see if the lymph nodes look clear of cancer. If it is suspected that there are cancer cells in the lymph nodes a biopsy or fine needle aspiration is done and sent to the laboratory for checking. In most cases where the ultrasound scan or the biopsy shows cancer cells the surgeon may want to remove all the lymph nodes in the armpit. This is called an axillary lymph node dissection (ALND) and is done at the same time as the breast conserving surgery. An ALND may also be done in a second operation if sampling or the sentinel lymph node biopsy in the original operation shows there are cancer cells in the lymph nodes. Whether to do a full ALND or just use radiotherapy after surgery if cancer is found in the lymph nodes is an area of clinical uncertainty and needs more investigation.

Sentinel lymph node biopsy is another way of checking just one or two of the lymph glands to see if they contain cancer. It involves injecting a tiny amount of radioactive liquid into the area of the cancer before the operation. The lymph nodes are then scanned to see which has taken up the radioactive liquid first. A blue dye is also injected into the area of the cancer during the operation. The dye stains the lymph nodes blue. The nodes that become blue or radioactive first are known as the sentinel nodes. The surgeon removes only the sentinel nodes so that they can be tested to see whether they contain cancer cells.  

Sentinel node biopsy reduces the chances of side effects such as arm stiffness and swelling (Lymphoedema) of the arm that can occur after sampling or ALND. It can also cause less pain and does not need a drain into the wound afterwards. In some hospitals, the surgeon can get the laboratory to check for cancer in the lymph nodes while the patient is still under anaesthetic the surgeon can then continue to remove all the other nodes if necessary and avoid a second operation.
Here women describe their experiences of having a mastectomy. Women used to stay in hospital for 7 to 10 days, but now it is usually a much shorter stay, of just 1 to 2 days. Women who are having reconstructive surgery at the same time as their mastectomy will usually stay in hospital for longer.

For some women a mastectomy is the best option, depending on the size of the tumour and the type of cancer. Some women explained why they were given a mastectomy and how they felt about it at the time.

One woman had Paget's disease (a rare form of cancer that affects the nipple) for which a mastectomy was the best option. Two women had inflammatory breast cancer, which is also less common, had mastectomies.

A few women had their mastectomies over 15 years ago, when breast conserving surgery/lumpectomies were less common, and were pleased with their operations and recovery.

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Some women discussed their experiences of double or bilateral mastectomies.

Some women described their feelings before having the operation, and one explained how she prepared herself physically for the surgery. Other women discussed aspects of the procedures involved e.g. having drains removed and post-operative exercises. Several women recommended taking painkillers whenever necessary, though one woman declined painkillers because she did not need them.

For many women the operation was straightforward. However, a few women experienced complications during or after surgery.

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Several women felt hungry after the operation or tired shortly afterwards. Many talked about how they felt about their changed body image (see 'Body image'). Some women felt a sense of loss as a result of their experience, and advised allowing time to recover physically and psychologically.

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Meeting other patients helped some women enjoy the hospital experience as well as share their concerns. The visitors, cards and flowers they had received were also considered supportive. Some women said that the hospital care that they had been given helped them to feel looked after and protected. Other women, however, were bored in hospital and eager to go home.

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At home, most women said they were careful not to lift anything heavy or over-exert themselves physically, including with housework. Some said they had a bit of pain or discomfort around their wound and under their arm to begin with, and took painkillers to ease it. Many said they had support from family until they felt able to do everything themselves again. Most women recovered well and were able to get on with life as normal. Some women, though, said they had problems with their arm, such as lymphoedema (see ‘Lymphoedema). Some younger women who had children to look after often found it tiring, especially at first.

More experiences of mastectomy can be found on the our DCIS section.

Last reviewed May 2015.
Last updated May 2015.

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