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Mastectomy

Mastectomy — surgical removal of all breast tissue in the treatment of breast cancer.

A surgical procedure used in the treatment of breast cancer in which all breast tissue is removed, together with the nipple, areola, and skin when necessary.

Indication

  • Multicentric breast cancer involving more than one area of the breast
  • Cases in which the tumor-to-breast ratio is too large for breast-conserving surgery
  • Patients who have previously received radiotherapy to the breast or who cannot receive radiotherapy
  • Risk-reducing (prophylactic) surgery in women carrying high genetic risk such as BRCA1/BRCA2 mutation
  • Inflammatory breast cancer and locally advanced breast cancer (after chemotherapy)
  • Cases in which positive surgical margins after breast-conserving surgery cannot be cleared by re-excision
  • Patient's informed preference together with oncologic suitability

Preparation

  • Suitability for general anesthesia is evaluated with blood tests, chest X-ray, and ECG
  • Imaging (mammography, ultrasound, MRI) and pathology reports are reviewed in a multidisciplinary council
  • Blood thinners, estrogen-containing medications, and herbal supplements are adjusted with physician approval
  • Smoking should be stopped at least 2-4 weeks before surgery to support wound healing
  • No solid food or liquid for at least 8 hours before the procedure

How it's performed

  1. The patient is positioned supine in the operating room and general anesthesia is administered
  2. Depending on the surgical type, a skin- and nipple-sparing or a classic elliptical skin incision is planned
  3. In modified radical mastectomy, the breast tissue and axillary (armpit) lymph nodes are removed together; in simple mastectomy, the axilla may be preserved
  4. In skin- and nipple-sparing techniques, reconstruction may be planned in the same session
  5. Tissue samples are sent to pathology, and a drain is placed
  6. The skin is closed in two layers and a pressure dressing is applied

Post-procedure

  • Hospital stay is generally 1-3 days
  • Drains are monitored daily and are removed when output drops below 30 ml
  • Heavy lifting and shoulder movements should be limited for the first 4-6 weeks
  • After the pathology report, chemotherapy, radiotherapy, and hormonal therapy are planned by the oncology council
  • Regular clinical examination, imaging, and lymphedema rehabilitation when needed are followed

Risks

  • Surgical site infection, bleeding, and hematoma
  • Seroma (fluid collection under the skin) — common but mostly temporary
  • Wound dehiscence and delayed healing (especially in patients who smoke or have diabetes)
  • Arm swelling (lymphedema) and limited shoulder movement in patients who undergo axillary surgery
  • Permanent sensory changes in the chest wall and, rarely, chronic pain

FAQ

Can the breast be reconstructed after mastectomy?

Yes. When the patient's oncologic situation allows, reconstruction can be planned with an implant or with the patient's own tissue, either in the same session or at a later time.

Should I have the other breast removed in unilateral cancer?

Surgery on the contralateral breast is recommended only in cases of high genetic risk or specific clinical conditions; the decision is made together with the patient after multidisciplinary evaluation.

When can I use my arm normally after surgery?

Light daily activities are usually resumed within 2-3 weeks; full range of motion and exercise are typically regained over 6-8 weeks with physiotherapy.

Is additional treatment always needed after mastectomy?

It is determined by the tumor stage, biological characteristics, and post-surgical pathology; some early-stage cases may not require additional treatment.