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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.

 

Describes the shock she felt about having a mastectomy.

Describes the shock she felt about having a mastectomy.

Age at interview: 41
Sex: Female
Age at diagnosis: 39
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I left the hospital and returned for the 29th November, which was a very short period of time.

In the interim I had been told that there was no way that they could save my breast, that the tumour was quite large for a breast tumour, it was 5.2cms, that there was dottings about the back of the breast, so it just was impossible to save it.

So it was decided on a radical mastectomy.

I had that on the morning of 29th November with 15 lymph glands removed from under my right arm, along with the breast. I returned, I recovered rather quickly.

It was a shock because then I was confronted with the fact that I really was, I was disfigured at this stage. And even though they did everything in their power to try to prepare me for that it still is a shock.
 
 

Explains why she accepted that a mastectomy was the best option for her.

Explains why she accepted that a mastectomy was the best option for her.

Age at interview: 57
Sex: Female
Age at diagnosis: 55
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So anyway, so I visited hospital and I requested the doctors. And I said, well it's better because I had cancer in the front part of my breast, very in the nipple, right. So I thought it's very easy if they just, you know, operate on that part of me. But the doctor didn't agree.

The doctor said' "No, if we do that it may be 75% assurance, so mastectomy is the best thing." 

I wasn't happy with the mastectomy but anyway in the end I had to agree because my doctor also said it's better if you go ahead with the mastectomy. So I was very hesitant to have, you know, the whole breast removed.

Anyway, so I had a mastectomy and I stayed in hospital I think eight to nine days.

 

Tess preferred to have a mastectomy rather than a lumpectomy. She felt relieved after surgery and...

Tess preferred to have a mastectomy rather than a lumpectomy. She felt relieved after surgery and...

Age at interview: 38
Sex: Female
Age at diagnosis: 33
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I found out that the lump seemed to be not too big, but when I had the mammogram there was an area of calcification so they thought, having first of all thought I was going to have a lumpectomy, it then became a mastectomy. But actually psychologically I felt better with that. I think I felt that I would rather get rid of the whole breast. I didn’t like the idea of them having to monitor it and feel for lumps and, you know I didn’t, I was quite, again it was a moment when I felt much better; that I had, after the mastectomy, I felt quite relieved. I felt like something had been lifted from me and taken away from me. And this lump which I’d been living with and feeling, and even though I had had to persuade myself not to feel it or touch it even, because it was just, it would give me a kind of whole, it just felt horrible. I felt that when it was gone and my breast had gone it just felt so much better. And the doctors and the care I had was just, they were just brilliant.

So I had that I suppose in two weeks maybe after the first diagnosis. And then I had the lymph nodes biopsied at the same time and they all came back negative, so again that was a moment of just feeling hopeful that it didn’t all have to be negative.

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.

 

Explains that she had a mastectomy 18 years ago, and this was her only treatment.

Explains that she had a mastectomy 18 years ago, and this was her only treatment.

Age at interview: 67
Sex: Female
Age at diagnosis: 49
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The doctor was extremely good in explaining what was going to be done. How I'd have a mastectomy. And I said I was going on holiday the following week, could I leave it until after the holiday and he said' "Oh no, you must go into hospital tomorrow." So in actual fact I went in the next day. I also had the operation the day after.

And I think it was, it was definitely less than a fortnight from finding the lump to having it removed. So it was very good. I was then worried that it had gone into the lymph nodes. I don't know why but I always thought if it's gone into the lymph nodes, that's it. And it was four days before they checked up on that and said no it hadn't spread.

Which I must admit I felt then, up to then I felt very much as though it was a death sentence. But knowing it hadn't gone into the lymph nodes I felt a lot better about it.

And I didn't have to, at that time (because this all happened when I was 49, which was actually 18 years ago now) and I didn't have any treatment afterwards.

I was actually in hospital for ten days, they kept me in for ten days which is much longer than you would be in hospital nowadays.

But when I came out I had, I was teaching at the time and I had, it came up to the summer holidays fairly soon after that so that I had really nearly three months with no work 

And then I did go back to work in the September. And I had no after effects at all. I really kept very fit indeed. 
 

Some women discussed their experiences of double or bilateral mastectomies.

 

Explains why she opted for a second mastectomy.

Explains why she opted for a second mastectomy.

Age at interview: 49
Sex: Female
Age at diagnosis: 30
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So I had actually asked three years before' "Couldn't I just have another mastectomy?" Because I was just not happy with that breast. I was, I had no confidence. I was frightened of it basically. Because you know I was afraid it was going to let me down.

So this time, with the pre-cancerous changes, I had the small area removed and that was just what they called atypical cells.

But in the middle of it was something they called, they called DCIS, or ductal carcinoma in situ, which a lot of people get diagnosed with on screening. And that is very early cancer changes. So this time they agreed that I could have a mastectomy.

So I had a second mastectomy just about a year ago. And I know that a lot of people would be horrified by that but for, that's my decision and I feel much safer.
 
 

Tess had a family history of breast cancer. Two years after her first mastectomy, she had a...

Tess had a family history of breast cancer. Two years after her first mastectomy, she had a...

Age at interview: 38
Sex: Female
Age at diagnosis: 33
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I’ve had a mastectomy and then I had actually another mastectomy and reconstruction a year when, about two years ago, which was again really I think brilliant for my kind of quality of life. And just feeling like a functional, I mean you know again its, but everyone’s very different.

And I think that it was a lot about getting rid of the other breast because there was, you know, because of my family history there were lots of genetic kind of queries. I had to have lots of possible genetic investigations, which were all, came back negative. But I think they still felt that I was at risk because of the early, the sort of early time I’d got breast cancer and my family history.

So I was quite keen to get rid of the other breast, and then the plastic surgeon said they could do some reconstruction at the same time and that was really, really good. And I then, I think they were amazing what they can do with what’s there.

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.

 

Describes how she felt before the operation.

Describes how she felt before the operation.

Age at interview: 47
Sex: Female
Age at diagnosis: 43
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I don't think the enormity of it all hit me until then.

They came to get me from the ward, wheeled me down and as they wheeled me into the room where they knock you out, the anaesthetic room, it just hit me what was going to happen.

And I just thought' "When I wake up from this I'm only going to have one breast." And I started crying and everybody was there, the surgeon was there as well, and they were, they were absolutely marvellous. And I just said, you know' "I think it's just hit me what's going on."

And the surgeon was just amazing. He reassured me, said that everything was going to be fine. They got me out as soon as they could. There was no pain. I wasn't even aware of what they were doing, they were just absolutely amazing.

And yeah that was when it hit me really.
 
 

Describes how she prepared herself physically for the surgery and how it helped to feel she was...

Describes how she prepared herself physically for the surgery and how it helped to feel she was...

Age at interview: 50
Sex: Female
Age at diagnosis: 48
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So besides that, then I had a mastectomy. So that would be a year last January. And that was alright.

During the time that I was waiting I was, I decided I'd need, I got myself as fit as possible. So I started all eating well and trying to keep fit, and trying to be as well as possible when I had my operation and whatever treatment was going to come. So I thought if I can get as fit as possible, then I'd maybe find it easier. And in fact I think that was helpful.

Well I already had been going to the gym but I made sure that I went to the gym regularly. I tried to go three times a week. And then I changed my, I tried to increase the amount of fruit and vegetables, cut down maybe on the fats. I started taking like multi-vitamins and minerals.

And I was already taking Evening Primrose Oil because I used to get sort of pre-menstrual things beforehand, so I was already taking that.

And just generally trying to look after myself.

 

Describes the procedure after the operation.

Describes the procedure after the operation.

Age at interview: 59
Sex: Female
Age at diagnosis: 56
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After surgery, I mean that is, it's not so much the pain, but you know it's the coming round, the wooziness. And the first time you need to get up to go and have a pee.

And of course you have to get the - oh that's right, my back, you know, trying to change position.

And the next thing of course you're conscious of is having two drains coming out of your side, and one drain is removed before the other.

The next day they took the first drain out and that is along where the breast was.

And I thought' "Well I'll watch this."

And I was absolutely horrified because it went on as it came out and it went on and it went on, because it's right along the incision, with little holes in of course so it can drain.

And that taught me a lesson - not to watch - because it was a most peculiar sensation.

But that was a relief.

But when you've got these bottles, and they have little Christmas bags, I think it had a snowman on it you know little carrier bags with these two bottles inside which you can carry around with you when you need to go to the bathroom.

 

Explains that after the operation she felt able to start to exercise the following day.

Explains that after the operation she felt able to start to exercise the following day.

Age at interview: 59
Sex: Female
Age at diagnosis: 58
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Then I went upstairs, back up to the ward, and the surgeons were waiting for me. So they asked me if I'm ready and they tried to tell me what they were going to do. So I told them' "Look you're doing your job, I'm doing mine. "You're going to take it off, just take it off. I don't want to know anything that you're going to do before."

He says' "Are you sure?" I said' "Yes I'm sure. I don't want to know. Just when I wake up I know it won't be there." And they took me down. And then I had injections, and gas to put me to sleep. And then when I woke up I was in the recovery room.

And then, well my children were there with me, waiting for me to wake up. And then they took me back to the ward.

I didn't feel any pain until the next day when I felt, I started exercising, because one of my cousins had hers done and she sent me a leaflet with the exercises in it. So I started doing the exercises the very next morning. When the woman, the physiotherapist came, I was already sitting down there with my arms up and down, up and down. She said' "Oh good." So that was fun.

My grandchildren came to visit, my daughters-in-law, everybody my family. Some family I've got, they all came to visit.

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

 

Describes a complication she had after her operation.

Describes a complication she had after her operation.

Age at interview: 56
Sex: Female
Age at diagnosis: 55
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Now what happened then? Oh something I've forgotten.

When I went to see the consultant after I'd been discharged on the Thursday and he took off the fluid, he also said that I'd got a haematoma, which is a kind of a large blood clot.

So instead of being liquid it was actually solid. So he said' "The best thing to do is come in and we'll do an operation and sort of remove it." So, and he said' "Well come in this afternoon."

So there I was, back in the hospital again. They'd found a bed in a side room. And I was in overnight, and again it was the same procedure going through into the operating theatre.

"Which side is it?" Well it's pretty obvious because I mean it was black and blue with bruises. Anyway, that was alright.

They just did the operation. He said' "Oh, I'll do it through the same incision." Which made me sort of cringe a bit, but he did and it was alright and that was just unfortunate.
 

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.

 

Comments on the sense of loss that many women feel after having a mastectomy.

Comments on the sense of loss that many women feel after having a mastectomy.

Age at interview: 76
Sex: Female
Age at diagnosis: 52
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Well for a start I think, I mean I must say my husband was absolutely fantastic.

But you just can't, I mean you are disfigured in your eyes, which not everybody feels like that, but at that particular time it's a loss and you've got to mourn your loss. Because it's a loss of part of your body.

And let's face it there's so much in the papers, on the television, everywhere, about the body image and all the rest of it, that your body image has suddenly been taken away from you.

You don't want to go topless on a beach or something like that, but you haven't got the chance to do it now. Your right to decide has gone.
 

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.

 

Explains why she enjoyed her hospital experience.

Explains why she enjoyed her hospital experience.

Age at interview: 45
Sex: Female
Age at diagnosis: 44
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So there was myself and another lady having it done that evening and we got to be quite friendly. We used to go wandering all over the hospital and I must admit, this sounds awful, but I really enjoyed my time in hospital.

I had, this lady and myself, we became friends and we had a good time. We thoroughly enjoyed ourselves. We used to have cream cakes at midnight.

And one night we went down to the ground floor where they've got a machine that does chips and beef burgers, and we had that.

I mean it wasn't very nice but it was a little bit of an adventure for us I suppose. And I was fine, absolutely fine in the hospital.
 

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.

 

It can be difficult having treatment and looking after a new baby. At first Tess was also...

It can be difficult having treatment and looking after a new baby. At first Tess was also...

Age at interview: 38
Sex: Female
Age at diagnosis: 33
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I think also the other thing which my doctor said, which is very helpful, was you know, “Even if it doesn’t pose any extra risk to you or the baby, it’s a lot. It’s going to be a lot and, after all this treatment, you might not want a new baby.” And I think that was really helpful because it is a lot. You almost forget that having a new baby, it feels like such a positive thing, but actually it is hard work and it is again, you know, a lonely existence in a way when the baby’s very small. Even if...

Did you have a quite a bit of support, were you off work?

Yeah. Yeah I was off work, but I think even so, you do forget that there’s a lot of work to having a baby. It’s not all just a bunch of flowers and I think that was, I think him having said that, it’s just as well it’s almost there’s bits of reality, because you start, it becomes a bit like a fantasy in a way that you’re going to kind of come out of this with a baby and life’s going to be all beautiful and you know fine again. And actually I think there’s sort of the moments of realising that there’s a reality of another little person to look after. And that’s quite tricky.

And even just things like only having one breast and the fact that people kept asking me, in the hospital they kept coming and saying, “How are your breasts?” And in the end I just said, “I’ve only got one breast.” And she, you know, she just said, I mean they weren’t meaning to be insensitive, but you just felt that was just something that they wouldn’t even think to sort of correct themselves.

More experiences of mastectomy can be found in our DCIS section.

Last reviewed August 2018.
Last updated May 2015.


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