Q: What are the pros and cons of a mastectomy?

Pros It can lower your risk of dying from breast cancer by removing the tumor and cancer cells in nearby tissue. If you’re at very high risk of developing breast cancer, a preventive (prophylactic) or risk-reducing mastectomy that removes both breasts can dramatically reduce your risk of developing the disease. Current mastectomy techniques can usually spare the nipples and much of the skin, making breast reconstruction results look more natural. Cons Having a mastectomy doesn’t stop the spread of breast cancer that has already metastasized and spread into your lymphatic system. It also doesn’t reduce your risk of developing another type of cancer elsewhere in your body in the future. While the experience is unique to each patient, the permanent loss of a breast (or both breasts) is emotionally and psychologically challenging. Many women struggle with an adjustment in body image and identity. Recovery can take four to six weeks—even longer, if reconstructive surgery is done at the same time.

Q: How much does a mastectomy cost?

Thanks to the Women’s Health and Cancer Rights Act of 1998 , private health insurance and Medicare are legally required to cover lumpectomy, mastectomy, and reconstructive surgeries for breast cancer patients. Policies about covering prophylactic surgery (to prevent future breast cancer) vary. Even when they have insurance coverage, most patients still have to pay a portion of the cost out of pocket. How much you'll have to pay will depend on your deductible. Consult your insurance provider to understand the specifics of your policy.

Q: When can you have a lumpectomy instead of mastectomy?

A lumpectomy , sometimes called a partial mastectomy , is a breast-conserving surgery that removes only the cancerous tissue. According to BreastCancer.org , a lumpectomy followed by radiation therapy can be as effective as a mastectomy at treating tumors that are under four centimeters, in only one area of the breast, and with clean margins (no cancer cell spread in the surrounding tissues). Dr. Anne Peled , a plastic surgeon in San Francisco specializing in breast reconstruction, says that lumpectomies now account for the majority of breast cancer surgeries in the U.S. She points out that they offer the benefit of broader reconstruction options—from fat transfer, to fill in a divot, to a breast lift that can leave breasts looking better than before.

Question 1

What is a mastectomy?

Accepted Answer

A mastectomy is a surgical procedure that removes one or both breasts, usually to treat or prevent breast cancer. Depending on the location and size of the cancer or your preferences, it may involve the removal of your nipples or lymph nodes in your underarm area, though nipple-sparing mastectomies are becoming increasingly common.

When it’s done for FTM chest masculinization surgery, a mastectomy is often called “top surgery.”

Your doctor may recommend a mastectomy if:

Your tumor is more than two inches across or large for your breast size.
You have two or more tumors in different areas of your breast.
You have inflammatory breast cancer.
You wouldn’t be able to have radiation treatment after a lumpectomy (though you may still need radiation after a mastectomy, depending on the size of your tumor and whether cancer cells were found in your lymph nodes).

You may also choose to have a prophylactic mastectomy preventively—to remove one or both breasts and reduce your cancer risk—if you have a family history of breast cancer or carry a BRCA1 or BRCA2 gene mutation, which puts you at high risk of developing the disease. A prophylactic mastectomy can usually be done simultaneously with breast reconstruction.

Mastectomy is a major surgery, performed under general anesthesia.

Question 2

What are the pros and cons of a mastectomy?

Accepted Answer

Pros

It can lower your risk of dying from breast cancer by removing the tumor and cancer cells in nearby tissue.
If you’re at very high risk of developing breast cancer, a preventive (prophylactic) or risk-reducing mastectomy that removes both breasts can dramatically reduce your risk of developing the disease.
Current mastectomy techniques can usually spare the nipples and much of the skin, making breast reconstruction results look more natural.

Cons

Having a mastectomy doesn’t stop the spread of breast cancer that has already metastasized and spread into your lymphatic system. It also doesn’t reduce your risk of developing another type of cancer elsewhere in your body in the future.
While the experience is unique to each patient, the permanent loss of a breast (or both breasts) is emotionally and psychologically challenging. Many women struggle with an adjustment in body image and identity.
Recovery can take four to six weeks—even longer, if reconstructive surgery is done at the same time.

Question 3

How much does a mastectomy cost?

Accepted Answer

Thanks to the Women’s Health and Cancer Rights Act of 1998, private health insurance and Medicare are legally required to cover lumpectomy, mastectomy, and reconstructive surgeries for breast cancer patients. Policies about covering prophylactic surgery (to prevent future breast cancer) vary.

Even when they have insurance coverage, most patients still have to pay a portion of the cost out of pocket. How much you'll have to pay will depend on your deductible.

Consult your insurance provider to understand the specifics of your policy.

Question 4

What are the types of mastectomy?

Accepted Answer

There are several mastectomy procedure options. An experienced breast surgeon will recommend the best one for you based on your age, overall health, and menopause status as well as the tumor size, your cancer stage and grade, your hormone receptor status, how far the cancer has spread, and whether lymph nodes are involved.

A skin-sparing mastectomy removes all breast tissue, the nipple, and the areola while saving most of your skin. It’s a good option if you plan to get breast reconstruction, either during the same procedure or in the future, because your surgeon can use the breast skin as an envelope for a reconstructed breast.
A nipple-sparing mastectomy removes all breast tissue but leaves intact the nipple, the areola, and most of the skin. It’s a common choice for women having a preventive procedure, and it’s becoming more common for cancer patients as well. Keeping your nipple has obvious upsides—like more natural-looking reconstruction possibilities and more sensation. According to a 2017 safety study, the recurrence rate of breast cancer is no higher after a nipple-sparing mastectomy than after a standard (or total) mastectomy.
A total, standard, or simple mastectomy removes the entire breast, including the nipple, the areola, and most of the skin. It’s become less common in recent years because of the difficulties it poses during reconstruction, but it can be a good choice for patients who want to “go flat,” with no plans to reconstruct. It may also be necessary for patients with advanced breast cancer.
A modified radical mastectomy takes the same approach as a total mastectomy plus removes some of the chest muscle lining and some (or many) axillary lymph nodes in the underarm area. This option is likely going to be recommended only for more aggressive types of cancer. The number of lymph nodes that need to be removed will be determined during a sentinel node biopsy, a procedure that determines if your cancer has spread beyond a primary tumor and into your lymphatic system.
This procedure takes its name from the radical mastectomy—a surgery that typically isn’t done anymore. It’s like the modified version but also involves removing all lymph nodes in the armpit as well as the chest wall muscles under your breast.

“It is important to discuss with both your breast surgeon and your plastic surgeon whether you would benefit from possibly having both breasts removed (bilateral or double mastectomy) or if you want to only remove one breast (unilateral mastectomy),” says Dr. Lisa F. Schneider, a New York City plastic surgeon who focuses on reconstructive procedures. “Having one breast versus two breasts removed (unilateral versus bilateral mastectomy) can affect the result, including symmetry and what options are available for reconstruction.”

Undergoing a unilateral (one-sided) mastectomy can still leave you at risk for developing breast cancer on the other side, so some women choose to have a double mastectomy even if they have cancer in only one breast. If you choose a lateral mastectomy, a yearly mammogram of the remaining breast is still recommended.

Related: I Had a Preventive Double Mastectomy When I Learned I Had the BRCA2 Gene Mutation

Question 5

When can you have a lumpectomy instead of mastectomy?

Accepted Answer

A lumpectomy, sometimes called a partial mastectomy, is a breast-conserving surgery that removes only the cancerous tissue. According to BreastCancer.org, a lumpectomy followed by radiation therapy can be as effective as a mastectomy at treating tumors that are under four centimeters, in only one area of the breast, and with clean margins (no cancer cell spread in the surrounding tissues).

Dr. Anne Peled, a plastic surgeon in San Francisco specializing in breast reconstruction, says that lumpectomies now account for the majority of breast cancer surgeries in the U.S. She points out that they offer the benefit of broader reconstruction options—from fat transfer, to fill in a divot, to a breast lift that can leave breasts looking better than before.

Question 6

How should you choose your surgeons?

Accepted Answer

Ideally, breast cancer surgery is performed by a team that includes a general surgeon specializing in breast surgery and a plastic surgeon. The breast surgeon performs the mastectomy, and the plastic surgeon reconstructs the breast (as part of the same procedure—or months or even years later), if you opt for breast reconstruction.

“You want to make sure that you’re connected with a breast cancer surgeon you like and trust,” says Dr. Schneider. “Any surgeon who is operating on you (especially not in an emergency situation) should be someone you trust to make the right decisions when you are asleep.”

Your oncologist will likely refer you to a surgeon, but it’s also smart to verify that they’re a member of the American Society of Breast Surgeons. This organization promotes surgical training on the latest breast surgery techniques, including Hidden Scar surgeries that create better aesthetic outcomes.

Dr. Peled notes that before this technique was developed, “older surgical training really focused on just taking the tumor out, without thinking much about aesthetic scars.” She trains other surgeons on the Hidden Scar technique, seeing it as an essential part of cancer recovery. “We focus so much, as we should, on survival. But if you leave people with a scar that reminds them every day that they had cancer, we haven’t fully supported their survivorship,” she says.

When it comes to choosing a plastic surgeon, Dr. Schneider emphasizes finding a good fit. “For many patients, breast reconstruction is a journey and not a one-step process,” she says. “Make sure your plastic surgeon is a person you want to have on your team, especially if you come across any challenges.”

You absolutely can and should consult with multiple board-certified plastic surgeons before making your choice. Read patient reviews and check out real before and after photos in order to help inform your decision.

Learn more about choosing a plastic surgeon

Question 7

Should you pursue breast reconstruction after a mastectomy?

Accepted Answer

Many women also choose to get breast reconstruction, either simultaneously with their mastectomy (immediate reconstruction) or as a second operation later (delayed reconstruction), often after chemotherapy, radiation therapy, or hormone therapy. “There are pluses and minuses to each approach,” says Dr. Schneider. “In immediate reconstruction, when the patient goes to sleep, she has a breast. When she wakes up after surgery, she still has a breast, although it is now a reconstructed one. Psychologically, that can be helpful in terms of managing the sense of loss that comes with the mastectomy surgery and removal of the breast. In patients who undergo direct-to-implant or autologous (the body's own tissue) reconstruction, that single combined surgery may be the only one they need.” “However, it is important to note that for the majority of patients, at least one additional (typically outpatient) surgery is required, whether to exchange a temporary tissue expander for a more permanent breast implant, perform adjustments or revisions, or even just construct a new nipple.” Immediate reconstruction may be off the table for a number of reasons, says Dr. Schneider:

The patient may just want to initially focus on her cancer treatment and recovery or opt against reconstruction and later change her mind.
There may not be a reconstructive plastic surgeon available or nearby when the cancer surgery needs to take place.
If the patient has relatively advanced cancer or a cancer with certain biological characteristics, it may be life-saving to have the cancer surgery as soon as possible and start chemotherapy very quickly afterward.
Many patients require radiation after mastectomy surgery, which can change or harden a reconstructed breast, making it preferable to wait.

In cases where cancer treatment must take precedence, a hybrid option between immediate and delayed reconstruction may be considered. “I often recommend to patients to place a tissue expander or temporary implant at the time of the initial mastectomy,” says Dr. Schneider. “This gives the patient at least some breast, which is helpful psychologically and also preserves the skin envelope.”

Interestingly, according to 2014 research, 59% of women in urban areas and 71% of women in rural areas decide against reconstruction in favor of just “going flat” or wearing a breast prosthesis under their clothing. It’s possible that many of these women don’t have health insurance, don’t know that their insurance is legally obligated to cover breast restoration, or aren’t aware of their options. According to the BRAVE Coalition Foundation, fewer than 30% of women know their breast reconstruction options.

In a 2015 review of common misconceptions about breast reconstruction, Dr. Schneider and coauthor Dr. Babak Mehrara concluded, “Breast reconstruction might not be the right choice for every patient, but every patient deserves to have a complete discussion before cancer treatment to make a fully informed decision. The more involved they are in the decision process, the more likely they are to be satisfied with postoperative outcomes.”

Related: 5 Things You Need to Know About Your Breast Reconstruction Options

Question 8

How long does it take to recover from a mastectomy?

Accepted Answer

It typically takes four to six weeks to recover from a mastectomy. Your recovery timeline and what you can expect will depend on the type of surgery you have.

You’ll be sore and feel numbness due to injury to the skin or muscles, so rest and take pain medication as needed, especially for the first few days afterward. Ice packs may help reduce swelling, but many doctors say to avoid them due to the risk of compromised blood flow. Defer to your surgeon’s recommendations.

Many surgeons recommend—and will show you—exercises to prevent arm and shoulder stiffness and avoid a pulling in of the chest muscles. You may be referred to a physical therapist, who can help you regain your full range of motion, and learn how to manage lymphedema (if you’ve had lymph nodes removed).

If surgical drains are placed, you’ll need to empty the collecting fluid a few times a day, noting how much is collected. Doctors on RealSelf say there’s nothing you can really do to reduce drainage, but contact your surgeon with any concerns. The drains will be removed by your doctor at a follow-up appointment.

Question 9

What are the risks and potential side effects of a mastectomy?

Accepted Answer

Risks and potential side effects associated with a mastectomy include bleeding, infection, and hematoma (buildup of blood at the surgical site) or seroma (buildup of clear plasma and inflammatory fluid) during recovery as well as phantom pain and hardness or tightness from scar tissue at the surgical site.

If lymph nodes are removed, there’s an additional risk of numbness in the area and swelling (lymphedema) in the arm.

Post-mastectomy pain syndrome, a chronic neuropathic pain disorder, can present as pain, numbness, or itchiness from nerve damage. It typically resolves on its own as nerves regrow, but uncomfortable sensations may persist.

Question 10

Sources & studies

Accepted Answer

“Hidden Scar Breast Cancer Surgery.” Hidden Scar, Stryker, 1 Feb. 2020.

“Mastectomy vs. Lumpectomy.” BreastCancer.org, 9 Mar. 2019.

Miller, Adela M., et al. “Breast Reconstruction Surgery for Mastectomy Hospital Inpatient and Ambulatory Settings, 2009–2014.” Healthcare Cost and Utilization Project, Oct. 2017.

Ambulatory Settings, 2009–2014.” HCUP Statistical Brief #228, Agency for Healthcare Research and Quality, October 2017.

“Non-Profit Breast Cancer Reconstruction—BRAVE Coalition Foundation.” BRAVE, BRAVE Coalition Foundation, 2020.

Schneider, Lisa F., and Babak J. Mehrara. “De-Mythifying Breast Reconstruction: A Review of Common Misconceptions about Breast Reconstruction.” Journal of the American College of Surgeons, vol. 220, no. 3, Mar. 2015.

Smith, Barbara L., et al. “Oncologic Safety of Nipple-Sparing Mastectomy in Women with Breast Cancer.” Journal of the American College of Surgeons, vol. 225, no. 3, Sept. 2017.

“The American Society of Breast Surgeons: ASBrS.” American Society of Breast Surgeons, 2020.

The Center for Consumer Information & Insurance Oversight. “Women's Health and Cancer Rights Act (WHCRA).” CMS, Centers for Medicare & Medicaid Services, 4 May 2013.

MASTECTOMY

Lisa F. Schneider, MD

Karyn Repinski

Lisa F. Schneider, MD

Karyn Repinski

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Lisa F. Schneider, MD

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Expanders making breasts farther apart (photo)

Areola Reduction & mastectomy - which approach is safer for nipple survival?

Very painful fibrocystic breasts - is mastectomy an option? Cost and insurance coverage are not an issue! I can self pay

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