Mastectomy

What it is

Mastectomy is surgery to remove a whole breast, and it may involve 1 or both breasts depending on the reason for surgery. It is most often used to treat breast cancer, but it can also be done to lower future breast cancer risk in people at very high inherited risk. In plain terms, a mastectomy removes breast tissue; some operations also remove the nipple, areola, skin, or underarm lymph nodes, while newer approaches may preserve skin or the nipple when this is oncologically safe.

Mastectomy is not one single operation. The exact type depends on the cancer stage, tumour location, prior treatment, breast size, whether lymph nodes need surgery, and whether reconstruction is planned.

Type	What is removed	Common situation
Total or simple mastectomy	Whole breast, usually including nipple-areola and skin	Many early breast cancers, DCIS, risk-reducing surgery
Modified radical mastectomy	Whole breast plus axillary lymph node dissection	When more extensive underarm node surgery is needed
Skin-sparing mastectomy	Breast tissue, nipple, areola; most skin kept	Often used when immediate reconstruction is planned
Nipple-sparing mastectomy	Breast tissue removed; most skin, nipple, and areola kept	Selected patients when cancer is not close to nipple/skin
Bilateral mastectomy	Both breasts removed	Risk reduction or cancer in both breasts

A mastectomy is different from a lumpectomy, also called breast-conserving surgery, which removes the cancer and a rim of normal tissue rather than the whole breast.

How it works

The goal of mastectomy is local control: removing breast tissue that contains cancer, precancerous change such as ductal carcinoma in situ, or tissue at very high future risk of developing cancer. During the operation, the surgeon makes an incision and removes the planned amount of tissue. If lymph node staging is needed, a sentinel lymph node biopsy or a larger axillary lymph node dissection may be done during the same surgery.

What is preserved matters because it affects appearance, reconstruction options, and sometimes recovery. Skin-sparing and nipple-sparing techniques were developed to improve cosmetic outcomes without compromising cancer treatment in carefully selected patients. These approaches are usually paired with immediate reconstruction using an implant or the patient's own tissue, though some people choose delayed reconstruction or no reconstruction at all. Another option is aesthetic flat closure.

Mastectomy may be done after neoadjuvant treatment, meaning chemotherapy or other systemic treatment given before surgery to shrink or control the cancer. This is common in locally advanced or inflammatory breast cancer. In other cases, surgery is the first major treatment.

Evidence and uses

Mastectomy is a standard treatment option for many people with breast cancer. It may be recommended for invasive breast cancer, ductal carcinoma in situ, recurrent cancer in a previously treated breast, multicentric disease with tumours in separate parts of the breast, or when breast-conserving surgery is unlikely to give a good oncologic or cosmetic result. It is also used as risk-reducing surgery in selected people with a very high inherited risk, such as some carriers of BRCA1 or BRCA2 variants.

For many early breast cancers, mastectomy and breast-conserving surgery followed by radiotherapy can offer similar long-term cancer outcomes. The choice is therefore not simply about "more surgery is better." It depends on tumour features, whether radiotherapy is suitable, patient preference, genetic risk, and access to reconstruction and follow-up. Some people still need radiotherapy after mastectomy, especially when there are larger tumours or involved lymph nodes.

In metastatic breast cancer, surgery to remove the breast tumour is more selective. Cochrane reviews note that surgery may help control disease in the breast, but the effect on overall survival is uncertain and depends on the clinical context. This is why treatment decisions in stage IV disease are usually made by a multidisciplinary team.

In India, mastectomy remains a common breast cancer operation, partly because many patients present with larger tumours or more advanced disease, and because access to radiotherapy and reconstruction can vary by region and hospital. Even so, the best operation is individualised. A breast surgeon will usually discuss whether breast-conserving surgery, mastectomy, immediate reconstruction, or flat closure is the best fit.

Safety and interactions

Mastectomy is major surgery, so risks should be discussed clearly before the operation. Short-term risks include bleeding, wound infection, fluid collection under the skin called seroma, delayed wound healing, pain, and complications related to anaesthesia. If lymph nodes are removed, there is a higher risk of arm swelling called lymphoedema, numbness, shoulder stiffness, and reduced range of motion.

Longer-term issues can include chest wall tightness, altered sensation or numbness, chronic pain, scar problems, body-image distress, and reconstruction-related complications such as implant infection, implant loss, flap failure, or the need for additional surgery. Preserving the nipple or skin is not suitable for everyone because cancer safety comes first.

Before surgery, tell your team about all medicines, supplements, and herbal products. Blood thinners, aspirin, some pain medicines, vitamin E, fish oil, and some herbal products may increase bleeding risk or interact with anaesthesia. Do not stop prescribed medicines on your own; ask the surgeon, anaesthetist, or pharmacist exactly what to continue and what to pause.

When to see a clinician

See a breast surgeon or oncologist if you have been diagnosed with breast cancer and want to understand whether mastectomy is recommended, optional, or avoidable. You should also seek review if you have a new breast lump, nipple discharge, skin changes, or a strong family history of breast or ovarian cancer, because these findings may change surgical planning.

After mastectomy, contact your care team urgently if you develop fever, increasing redness, pus, worsening swelling, heavy bleeding, severe pain not controlled by medicines, shortness of breath, or sudden arm swelling. Early physiotherapy advice can help with shoulder movement and recovery, especially if lymph node surgery was done.

Limitations and open questions

Mastectomy lowers the amount of breast tissue left behind, but it does not guarantee that breast cancer can never return. Small amounts of breast tissue can remain, and recurrence can still occur in the chest wall, skin, lymph nodes, or elsewhere in the body. It also does not remove the need for other treatments such as chemotherapy, endocrine therapy, HER2-targeted therapy, or radiotherapy when those are indicated.

Evidence continues to evolve on which patients benefit most from nipple-sparing approaches, how to reduce chronic pain and lymphoedema, and when surgery helps in metastatic disease. Reconstruction outcomes also vary by smoking status, diabetes, prior radiation, body habitus, and surgical expertise. Because of these trade-offs, the best mastectomy decision is usually made after discussion with a multidisciplinary team that includes a breast surgeon, medical oncologist, radiation oncologist, and, when relevant, a plastic surgeon.