Mastectomy is one of the most common surgical procedures used in the management of breast cancer. However, it is often not knowledge of how the operation is performed, its different forms, and what happens afterward can help people face this experience with a little more peace of mind.
What is a mastectomy?
A mastectomy is the surgical removal* of all the breast tissue from one breast. It can be unilateral (one breast) or bilateral (both breasts), and is performed in two main situations:
For treatment: when breast cancer cannot be treated with breast-conserving surgery (tumor removal), especially in the case of a large tumour, several tumours or a Contraindication to radiotherapy.
For prevention: for women with a high-risk genetic mutation (BRCA1, BRCA2) who wish to significantly reduce their risk of developing cancer.
* Surgical removal: a medical term used to describe the surgical removal of an organ or Fabric.
The different types of mastectomy
Standard total mastectomy
It involves the complete removal of breast gland tissue, the areola-nipple pad (ANP), and an ellipse of Skin. This is the standard historical technique, especially indicated when the Skin or nipple is affected.
Mastectomy with skin preservation (skin-sparing mastectomy, SSM)
This technique preserves the Skin Envelope of the breast while removing all the gland tissue and the areola-nipple pad. It is particularly suitable for immediate breast reconstruction and may provide better aesthetic Results. According to the 2023 Recommendations: from the National Comprehensive Cancer Network (NCCN), SSM is safe for patients with early-stage invasive cancer or carcinoma in situ, when imaging shows no Skin or nipple involvement.1
Mastectomy with nipple preservation (nipple-sparing mastectomy, NSM)
NSM goes further by also preserving the areola-nipple pad, as well as the Skin Envelope. The Objective is to remove all the gland tissue while improving the appearance of the reconstructed breast. The cancer Security of NSM is now well established: local and regional recurrence rates at the level of the ANP are low, Between 0 and 3.7%. This technique is indicated for invasive cancers and DCIS that require a mastectomy, as well as risk-reducing mastectomies.2
Preventive removal of the other breast
Some patients with cancer in one breast choose to have the other breast removed, even if it is not affected. This may be done to achieve symmetry or reduce their Risk of recurrence in the other breast. A systematic review published in 2024 compiled the available data on clinical outcomes and patient-reported results in this situation.3
The operation, step by step
A mastectomy is performed under general anaesthesia. The length of the operation depends on the technique chosen and whether immediate reconstruction is carried out: around 1 hour and 30 minutes for a simple mastectomy, up to 4 to 6 hours when reconstruction using the patient’s own tissue* is performed during the same operation.4
* a reconstruction technique that uses the patient’s own Fabrics rather than an artificial implant to rebuild the BREAST
Pre-operative assessment
Mammogram, breast MRI, blood tests, anaesthesia consultation, and a discussion between several healthcare professionals to choose the right technique for each patient.
General anaesthesia
The procedure takes place under general anaesthesia. The patient lies on her Back, with her Arm out on the operated Side to make access to the armpit easier.
Incision and dissection
The surgeon makes an incision in the skin (around the areola, horizontal or angled, depending on the technique). They then separate and fully remove the glandular tissue, which is detached from the muscle layers underneath.
Lymph node removal or sentinel lymph node
At the same time, the Axillary lymph nodes are examined. The sentinel lymph node technique — less invasive — is now preferred when the lymph nodes show no clinical signs before the operation.
Bleeding control and drainage
One or two drains are placed to remove fluids after surgery. The incision is then closed with stitches.
Reconstruction (if immediate)
If immediate reconstruction has been planned, it is done during the same operation: placement of an implant, an expander, or tissue from the patient’s own body (DIEP, TRAM).
Sentinel lymph node: first Lymph node that drains the Tumour. Its analysis during Surgery can show if the cancer has spread to the lymphatic system, without removing the Total number of axillary lymph nodes.
Focus: axillary surgery in 2024
For several years, axillary surgery has become less extensive. For patients with early-stage cancer and clinically negative lymph nodes, sentinel lymph node biopsy alone is now the standard. This greatly reduces the Risk of lymphoedema and Other complications. Complete axillary dissection is no longer systematic. For patients with a small cancer (<2 cm) and no abnormal findings during the clinical examination, it may even be avoided completely.5
Breast reconstruction: immediate or delayed?
Breast reconstruction can be offered to all patients after mastectomy. It can be done immediately during the same operation, or later, after treatments.
Immediate reconstruction
Immediate reconstruction has the advantage of requiring only one anaesthetic and avoiding life without a breast after the operation. A systematic review of 229 primary studies (Medline, Embase, Cochrane, up to August 2024) concludes that immediate reconstruction is linked to better Quality of life in the Short and moderate term compared with delayed reconstruction.6 A retrospective Study of 646 patients (median follow-up of 72 months) shows that immediate reconstruction is linked to a slightly longer time Between Surgery and additional chemotherapy (14 days compared with 11 days after matching). This difference is statistically significant but not clinically significant. Immediate reconstruction also has no effect on the time before radiotherapy after mastectomy or on survival Without local, regional or systemic recurrence.7
Delayed reconstruction
Delayed reconstruction is sometimes recommended when radiotherapy Following surgery is needed. Studies generally recommend delaying reconstruction for at least 3 to 6 months after the End of radiotherapy to avoid the period of acute radiation damage.6
Reconstruction techniques
There are two main approaches:
Implant reconstruction: placement of a breast implant (saline or silicone), sometimes preceded by a skin expander that is gradually inflated to prepare the area. This is the most common technique.
Autologous reconstruction: use of the patient’s own tissue (a DIEP flap using abdominal skin and fat, or a TRAM flap). It provides a natural-looking result but involves a longer Surgery and an additional scar at the donor site.8
Hospital stay usually lasts 2 to 5 days, depending on the technique used and the patient’s general condition. Drains are removed during a consultation a few days after discharge.
Returning to normal activities is gradual: movements of the Arm on the operated Side are limited during the first weeks, and physiotherapy is often prescribed to prevent stiffness and lymph-related complications.
Returning to a sedentary job is usually possible after 3 to 6 weeks. Intense Physical activities are not recommended for 6 to 8 weeks.
Possible complications
Like any surgical procedure, mastectomy can lead to complications: a bruise with bleeding, wound infection, lymphoedema of the Arm (especially after lymph node removal under the arm), skin tissue damage (more common after NSM in people who smoke or have Obesity), or problems linked to the implant. These risks are assessed and discussed individually with the surgical team before the procedure.
Key points to remember
Mastectomy is a well-established procedure, carried out by specialised teams as part of Multidisciplinary management. Surgical techniques have evolved significantly fits better to the context in recent years — mastectomy that preserves the Skin or nipple, less extensive underarm Surgery, and immediate reconstruction making it possible to balance cancer control with patients’ quality of life.
Each situation is unique: the type of mastectomy offered depends on the characteristics of the tumor, the patient’s Profile and their wishes about reconstruction. The Decision is always made by a multidisciplinary team and after a detailed discussion with the patient.
1. Seth I, Xie Y, Lim B, Rozen WM, Hunter-Smith DJ. Defining skin-sparing mastectomy surgical techniques: a narrative review. Ann Breast Surg. 2024;8:20. https://abs.amegroups.org/article/view/8074/html
2. Manrique OJ, Banuelos J, Abu-Ghname A, et al. Techniques for Success in Nipple-Sparing Mastectomy and Immediate Reconstruction. Plast Reconstr Surg Glob Open. 2024. PMCID: PMC12194029. https://pmc.ncbi.nlm.nih.gov/articles/PMC12194029
3. Griffin C, Fairhurst K, Stables I, Brunsden S, Potter S. Outcomes of Women Undergoing Mastectomy for Unilateral Breast Cancer Who Elect to Undergo Contralateral Mastectomy for Symmetry: A Systematic Review. Ann Surg Oncol. 2024 Jan;31(1):303-315. doi: 10.1245/s10434-023-14294-6. PMID: 37749407.
4. De Vita R, Buccheri EM, Villanucci A, Pozzi M. Mastectomy with one-stage or two-stage reconstruction in breast cancer: analysis of early outcomes and patient's satisfaction. Updates Surg. 2023;75(3):783–791. PMCID: PMC9834349. https://pmc.ncbi.nlm.nih.gov/articles/PMC9834349
5. Heidinger M, Weber WP. Axillary Surgery for Breast Cancer in 2024. Cancers (Basel). 2024 Apr 23;16(9):1623. doi: 10.3390/cancers16091623. PMCID: PMC11083357. https://pmc.ncbi.nlm.nih.gov/articles/PMC11083357
6. Ontario Health (Cancer Care Ontario). Postmastectomy Breast Reconstruction in Patients with No-Metastatic Breast Cancer: A Systematic Review. 2024. PMCID: PMC12025830. https://pmc.ncbi.nlm.nih.gov/articles/PMC12025830
7. Baek SH, Bae SJ, Yoon CI, Park SE, Cha CH, Ahn SG, Kim YS, Roh TS, Jeong J. Immediate Breast Reconstruction Does Not Have a Clinically Significant Impact on Adjuvant Treatment Delay and Subsequent Survival Outcomes. J Breast Cancer. 2019 Mar;22(1):109-119. doi: 10.4048/jbc.2019.22.e7. PMID: 30941238; PMCID: PMC6438834.
8. Vrdoljak DV, Vukovic V, Filipcic IS, et al. Impact of Immediate and Delayed Breast Reconstruction on Quality of Life of Breast Cancer Patients. Int J Environ Res Public Health. 2022;19(14):8546. doi: 10.3390/ijerph19148546. PMCID: PMC9323042.
Regaining self-confidence after a mastectomy is a challenge for many women. This ordeal can profoundly affect self-esteem and body image. However, it is possible to regain emotional balance.
When we talk about “breast cancer”, we often think of it as one single disease. In fact, there are several types. They differ in their origin, their biological behavior and their response to treatments. Understanding these differences helps explain why two patients can receive very different treatments for the same diagnosis.
Every year, nearly 2.3 million women worldwide are diagnosed with breast cancer, making it the most common cancer in women globally ¹. It is a cancer with a good prognosis: detected at an early stage, the 5-year survival rate exceeds 88%². This figure is a reminder of how individual vigilance can make a real difference, no matter where you live.
