Introduction
A mastectomy is a major surgical procedure performed to remove all breast tissue from a breast as a primary treatment or preventive measure for breast cancer. For patients diagnosed with breast cancer, a mastectomy aims to eliminate the cancerous cells and prevent the disease from spreading. For individuals with a very high genetic risk of developing breast cancer (such as those with BRCA1 or BRCA2 gene mutations), a prophylactic (preventive) mastectomy can drastically reduce their risk. Depending on the stage of cancer and the patient’s choices regarding breast reconstruction, different types of mastectomies exist, ranging from a simple mastectomy (removing breast tissue, nipple, and areola) to a modified radical mastectomy (removing breast tissue, nipple, areola, and axillary lymph nodes).

Surgical Procedure
A mastectomy is performed in a hospital under general anesthesia. The surgeon makes an elliptical incision around the breast. The skin is lifted, and the underlying breast tissue is carefully separated from the chest wall muscles and removed.
In a skin-sparing mastectomy, most of the skin over the breast is preserved to accommodate immediate breast reconstruction. In a nipple-sparing mastectomy, the nipple and areola are also preserved. If lymph nodes need to be checked or removed, the surgeon makes an additional incision under the arm (axillary lymph node dissection) or removes just the first few nodes to which cancer would likely spread (sentinel lymph node biopsy).
Once the tissue is removed, the surgeon may place one or two surgical drains—thin plastic tubes—under the skin to remove excess fluid and blood that accumulates during healing. The incision is then closed with sutures and covered with a dressing.

Surgical Risks
Standard surgical risks include adverse reactions to general anesthesia, bleeding, and the risk of blood clots.

General Complications
Common complications associated with a mastectomy include:
– Pain, tenderness, and a feeling of tightness in the chest wall and armpit.
– Swelling (edema) at the surgical site.
– Numbness or a tingling sensation in the chest, armpit, or upper arm due to severed nerves. This can be temporary or permanent.
– Accumulation of clear fluid in the wound (seroma) or blood (hematoma), which may need to be drained.

Rare but Serious Complications
– Infection of the surgical wound, which can delay healing and compromise breast reconstruction.
– Lymphedema: A chronic condition causing significant swelling in the arm on the side of the surgery due to the removal of or damage to lymph nodes.
– Necrosis (tissue death) of the skin flaps used to close the wound, which may require further surgery.

Pre-operative Preparation
– Consultations: Extensive discussions with a breast surgeon and a plastic surgeon (if reconstruction is planned) to decide on the type of mastectomy and reconstruction timing.
– Medical Tests: Mammograms, MRIs, blood tests, and an ECG are standard.
– Medication Management: Stop taking blood-thinning medications, aspirin, and certain supplements at least a week before surgery.
– Fasting: No food or drink for 8 to 12 hours prior to the procedure.

Post-operative Care
Patients usually stay in the hospital for 1 to 3 days, longer if simultaneous breast reconstruction was performed. Pain management is provided via IV initially and then oral medications. Nurses will teach the patient how to manage and empty the surgical drains, measure the fluid output, and record it. These drains are typically removed at a follow-up appointment 1 to 2 weeks later.

Wound Care
– Keep the dressings clean and dry. You will receive specific instructions on when you can shower (usually after the drains are removed or with special waterproof dressings).
– Empty the surgical drains 2 to 3 times a day and strip the tubing to prevent blockages.
– Inspect the incision site daily for signs of infection (excessive redness, heat, swelling, or foul-smelling discharge).
– Wear a supportive, soft, wire-free surgical bra or camisole.

Diet
– Resume a normal, healthy diet. Focus on high-protein foods (lean meats, beans, eggs) to promote tissue healing.
– Stay well-hydrated and eat high-fiber foods to prevent constipation caused by pain medications.

Post-discharge Notes
Recovery from a mastectomy takes several weeks. It is normal to feel fatigued.
– Avoid lifting anything heavier than 5 pounds and avoid repetitive arm movements (like vacuuming or scrubbing) for 4 to 6 weeks.
– Perform specific arm and shoulder exercises prescribed by your physical therapist to prevent stiffness and regain range of motion.
– Contact your healthcare team immediately if you develop a fever, severe pain, excessive swelling in the arm or hand, or if the wound edges separate. Attend all oncology and surgical follow-up appointments.