Many women diagnosed with breast cancer may undergo a mastectomy, the removal of the breast, as part of treatment for breast cancer. It is important to know that there are different types of mastectomy. A total mastectomy, also called a simple mastectomy, is the surgical removal of the entire breast. In a simple mastectomy, the surgeon does not remove the lymph nodes under the arm (called axillary lymph nodes) and the muscle tissue beneath the breast. During a modified radical mastectomy, the surgeon removes the entire breast and the axillary lymph nodes. When the tumor is large and has spread to the muscles of the chest wall, a radical mastectomy, the most extensive type of mastectomy, may be necessary. This surgery involves the removal of the entire breast, the axillary lymph nodes, and the chest wall muscles beneath the breast.
What to expect after surgery
You may experience the following after a mastectomy:
- A bandage that covers the surgery site
- A drain from the breast and/or underarm that removes fluid and blood while the surgical site is healing. This drain will need proper care, which may include emptying it, measuring the amount of fluid collected, and reporting any problems to the doctor immediately.
- Possible numbness, pinching, swelling, or a pulling feeling beneath the arm closest to the affected breast, possibly due to damage to nerves in the region.
Side effects of mastectomy
You may also experience the following side effects after a mastectomy:
- Infection at the wound site
- Blood accumulation at the wound site
- Fluid accumulation at the wound site
The primary side effect after removal of the axillary lymph nodes is a chronic (long-term) condition called lymphedema , or swelling of the arm. This condition is a serious medical concern and can often be prevented. Report any signs of pain, swelling, or tightness in the arm to your doctor. Learn more about preventing lymphedema after breast cancer treatment .
The follow-up care you need after a mastectomy depends on your overall health and how much tissue the doctor removed. For example, a woman who has had a radical mastectomy may need more time to recover. It's important to review all follow-up care instructions with your doctors and caregivers. Be sure you understand instructions on the following topics:
- Wound and bandage care
- Drainage care
- Warning signs of infection
- When to call the doctor
- Nutritional needs during recovery
- Medications and pain control
- Activity restrictions
- Clothing restrictions (for example, when a bra or prosthesis can be worn)
Effects on body image and sexuality
In addition to the physical side effects of a mastectomy, many women also experience emotional changes. For example, a woman may feel differently about her body after a mastectomy. To many people, breasts symbolize femininity, sexuality, and nurturance. Some women may feel that losing a breast to cancer alters their identity as a woman. Furthermore, when a woman faces surgery that changes how her body looks, she may experience feelings of isolation, loss, and helplessness, along with feelings of anxiety, depression, and uncertainty caused by a diagnosis of breast cancer.
A woman may also worry about their physical and sexual attraction after a mastectomy, such as being accepted by her partner and concerned about still being able to sexually please her partner. In addition to these feelings of self-consciousness, some women experience weight gain, problems with breast sensitivity, joint pain, muscle stiffness, and chronic pain  in the chest and shoulders after surgeryâall of which may affect enjoyment in many different types of activities, including intimacy. It's important to note that breast cancer surgery does not physically decrease a woman's libido (sex drive) or ability to become aroused. In fact, women with early-stage breast cancer treatment often report the same quality of life one year after surgery as women who never had breast cancer.
Breast prosthesis and reconstruction
Women have various options for restoring the look and feel of a breast. One is the use of a breast prosthesis. Also called a breast form, a prosthesis is a natural-feeling artificial breast. It comes in a variety of shapes, sizes, colors, and textures and is made of silicone gel, foam, or fiberfill. A breast prosthesis can be custom-fitted or prefitted into a bra, undergarment, and bathing suit for instant, painless reshaping of the chest that resembles a natural breast. The prosthesis can be worn against the skin, inside the pocket of a mastectomy bra, mastectomy swimsuit, or other garment, or attached with an adhesive directly to the chest wall. Learn more about choosing a breast prosthesis .
Another option is breast reconstruction, a surgical option to rebuild and restore the appearance of a natural breast. Sometimes, a plastic surgeon can reconstruct the remaining tissue to resemble a natural breast, with or without rebuilding the nipple and areola (ring of darker skin that surrounds the nipple). Breast reconstructive surgery may be done at the time of mastectomy (called immediate reconstruction) or months or years later (called delayed reconstruction).
Reconstructive breast surgery is likely to scar the breast and may change the shape and size of the breasts. Restoring normal breast sensation is not possible with reconstructive surgery.
Choosing breast reconstructive surgery is a personal decision. Some women choose reconstructive surgery to re-establish breast symmetry, to regain normal breast contour, or to eliminate the need for a breast prosthesis. Discuss all options with your family, doctor, and surgical team before deciding on breast reconstructive surgery. Learn more about the different types of breast reconstruction surgery .
Recovering from breast cancer surgery requires a strong support system. Women should know they are not alone; other women have had similar experiences. Talking with other women, a counselor , or finding a support group  may help women in dealing with the physical and emotional effects of a mastectomy.