What is a mastectomy?
A mastectomy is a surgical procedure that removes the breast tissue to treat breast cancer. Mastectomies may be unilateral (single mastectomy), in which one breast is removed, or bilateral (double mastectomy), in which both breasts are removed. Mastectomies differ from lumpectomy procedures in that the entire affected area of the breast as well as all the surrounding breast tissue is removed, whereas lumpectomies are only a partial removal.
At Penn Medicine, breast surgeons work closely with plastic surgeons and other breast cancer specialists to create a surgical plan based on your diagnosis and goals. As part of a comprehensive cancer center with a dedicated breast cancer research program, we offer advanced surgical options and coordinated care throughout your treatment.
Types of mastectomy procedures
We use mastectomies to treat many types of breast cancer. For early-stage cancer, mastectomy is an alternative to treatment with lumpectomy plus radiation therapy. For more advanced or recurrent cancer, mastectomy is often the best or only surgical option. For people with male breast cancer, mastectomy is often the best treatment, because most tumors in men occur beneath the nipple.
Our surgeons perform mastectomies with or without breast reconstruction. The types of mastectomies we offer include:
A total mastectomy removes the entire breast, including the nipple, areola, and most breast tissue. This procedure is also known as a simple mastectomy. It may be performed with or without immediate breast reconstruction, and most people are able to go home the same day as surgery.
Breast surgeons typically remove lymph nodes during the procedure as well unless the surgery is to prevent breast cancer from developing. This surgery is used to treat early forms of breast cancer, such as ductal carcinoma in situ (DCIS), as well as invasive cancer.
During a skin-sparing mastectomy, all elements of a total mastectomy are removed except for the skin covering the breast. This type of mastectomy involves immediate post-op breast reconstruction to minimize the appearance of surgical scars.
Nipple-sparing mastectomies remove breast tissue, but preserve the nipple, areola, and skin. Like its skin-sparing counterpart, breast reconstruction is performed immediately after. This surgery is only an option when cancer is not detected in the tissue underneath the nipple.
A modified radical mastectomy involves the removal of the breast tissue and all lymph nodes. We use this procedure mostly for patients with advanced or aggressive breast cancer. Removing the lymph nodes allows us to determine whether cancer has spread beyond the breast.
During this operation, also called a bilateral mastectomy, the surgeon removes both breasts. We use double mastectomies to treat advanced cancer. Patients who have an elevated risk of breast cancer may opt to have a double mastectomy as a risk reduction procedure as part of their personalized cancer risk management program. For some patients, this type of mastectomy can be nipple sparing.
Who is a candidate for a mastectomy?
If you have a higher-risk or late-stage breast cancer diagnosis or an increased risk of developing breast cancer, your provider may recommend removing one or both of your breasts to treat or prevent breast cancer.
We may use mastectomy for many reasons, including:
- Large or widespread tumors: Tumors that are large in size or cancer located throughout the breast cannot be treated with lumpectomy, which only removes part of the breast.
- High-risk cancer: Mastectomy may be recommended as a preventative measure for patients at a considerable risk for developing new or recurring breast cancer.
- Personal reasons: Some people may have a personal preference for mastectomy over breast-conserving surgery.
Preparing for a mastectomy
Our surgical team helps you prepare for surgery and answers any questions you may have. We coordinate pre-surgery appointments including consultations with the breast surgeon and plastic surgeon, if you plan to have breast reconstruction.
What to expect during mastectomy surgery
The mastectomy surgery is performed using general anesthesia. During the procedure, your breast surgeon will:
- Make an incision around your breast and remove breast tissue for review by a pathologist
- Possibly remove lymph nodes for further investigation by a pathologist
- Work in conjunction with a plastic surgeon whenever possible to perform breast reconstruction during the mastectomy
- Close the incision and place temporary drains (plastic tubes) to remove any fluid buildup near the surgery site
What to expect from mastectomy recovery
After a mastectomy, our team will monitor your heart rate, blood pressure, and other vital signs while the anesthesia wears off to ensure no complications from receiving the anesthetic. Many patients who undergo a mastectomy will return home within a day of surgery, but the hospital stay may be extended if the choice to have breast reconstruction at the same time is made. You may experience some discomfort in your chest, armpit and shoulder for a few days following surgery.
Full recovery should take approximately four weeks. Before you head home, we will walk you through the recovery instructions and offer guidance on when you can begin to wear a bra or prosthesis. We coordinate a follow-up visit with your surgeon. At that time, we will remove any drains, check the incisions, and review the pathology report.
Breast reconstruction after mastectomy
Breast reconstruction is a surgical procedure that restores the appearance of one or both breasts following mastectomy. Plastic surgeons reconstruct the breasts using either breast implants, your own tissue (typically from the lower abdomen), or a combination of the two methods.
We perform a high volume of breast reconstruction procedures each year. Our expert plastic surgeons can reconstruct your breasts at the same time as your mastectomy or later. We'll guide you through all your reconstruction options so that you can make an informed decision.
Support throughout your mastectomy care
At Penn Medicine, our breast cancer program provides expert surgical care along with the resources and support you may need before, during, and after mastectomy. Highlights of our program include:
- Expert surgeons: Our fellowship-trained breast surgeons tailor your surgery to your diagnosis and treatment goals. If you choose breast reconstruction, our plastic surgeons offer a range of reconstructive options to help restore the appearance of your breast.
- Advanced surgical techniques: We perform the latest breast cancer surgeries. Our clinical trials provide access to promising new mastectomy techniques like robotic nipple-sparing surgery.
- Risk evaluation and counseling: Our cancer risk experts at the MacDonald Cancer Risk Evaluation Center assess your risk of breast cancer. If you have a high risk of hereditary breast cancer, the Basser Center for BRCA offers specialized guidance and support.
- Support beyond surgery: Our cancer center boutiques, located at two Penn Medicine hospitals, offer products and services for people recovering from breast surgery, including bra fittings and post-surgical garments to help you feel comfortable and confident.
Rated “exceptional” by The National Cancer Institute
Penn Medicine’s Abramson Cancer Center is a world leader in cancer research, patient care, and education. Our status as a national leader in cancer care is reflected in our continuous designation as a Comprehensive Cancer Center by the National Cancer Institute (NCI) since 1973, one of 7 such centers in the United States. The ACC is also a member of the National Comprehensive Cancer Network, one of a select few cancer centers in the U.S., that are working to promote equitable access to high-quality, advanced cancer care.
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Patient stories
From survivor to inspiring others to exercise
Doris Piccinin uses her own firsthand experience as a breast cancer survivors to help other survivors. “I’m excited to see a lightbulb go on for people when they realize that not all physical activity is the same, and to see them recognize and understand the questions to ask when they’re having limitations. That’s where I gain my inspiration.”
Genetic knowledge helps catch cancer early
“I didn’t know about BRCA at all before my sister’s diagnosis—it was a total learning curve,” Trudy Orthey said. “If you know that your family carries this gene mutation, don’t be afraid to talk about it. I did and it saved my life. It also has a ripple effect to your family and future generations.”
A mom-inspired clinical trial journey to help others
“I wanted to participate in a clinical trial because I was inspired by my mom,” Kate Korson said. “I saw how brave she was and the success she had on a clinical trial. I felt like I received the best possible care by taking part in a clinical trial, and it feels good to know that I’m helping others by contributing to cancer research.”
Coming home to ‘Team Penn’: Kate’s Story
From the moment Kate Korson showed up at her first appointment wearing a Penn sweatshirt to symbolize she was on “Team Penn,” every one of her caregivers let her know they were on “Team Kate.” “Penn has now saved all three members of my family,” she said, after participating in a clinical trial.
Creating beauty out of a breast cancer journey
“Cancer isn’t just physically grueling. It mentally and emotionally tears you down,” Ginger Mimmo Rohlfing said of her experience navigating HER2-positive breast cancer, chemotherapy, mastectomy, and breast reconstruction surgery. Her paintings of leaf and petal patterns “were a metaphor for putting pieces of myself back together.”
A diagnosis that ripples through the family
“It’s harder to find out your sister has cancer and a BRCA mutation than to find out for yourself,” said Laura Temple. Testing and treatment have made all the difference for the three BRCA-positive sisters who are now breast cancer survivors. They are grateful for Susan Domchek, MD, answering questions about research that could benefit their children.
From patient to advocate, battling breast cancer and disparities
With her metastatic breast cancer under control, Jamil Rivers is looking out for other Black women. “We’re trying to help them understand what to anticipate, what questions to ask, and how to be advocates for themselves.”
Mother and daughter recover from surgery with home care
“I loved that I was able to do this right from the house, because otherwise we’d have to drive 40 minutes and then wait in a doctor’s office,” said Lauren Magaziner, who went first. Lauren and her mother, Robin, had preventive mastectomies a few weeks apart after learning they both carried a BRCA mutation.
Helping to stop cancer from coming back
“I often say Dr. DeMichele saved my life twice,” said Illeana Casiano-Vazquez. “Without this trial, I don’t know if I’d still be here. She really put herself at the center of what it is to be a breast cancer patient without any options, and I’m so thankful she didn’t give up.”
Volunteering to intercept cancer for future generations
“I'm convinced that I would have had breast cancer in my 40s as my mother, my grandmother, and my grandmother’s sister all did,” said Maggie Gaines. She is now part of an innovative clinical trial aiming to intercept hereditary cancers before they start.