What is a mastectomy?
A mastectomy removes breast tissue to treat or prevent breast cancer. It is recommended when lumpectomy is not suitable, for example, when the tumour is large relative to the breast, when multiple tumours are present, when margins cannot be cleared with conservation, or when the patient chooses it.
Modern mastectomy techniques are designed to preserve as much overlying skin as possible, which makes reconstruction easier and leads to better cosmetic outcomes. Not all mastectomies are the same, and the type recommended depends on your specific diagnosis.
Types of mastectomy
- Simple (total) mastectomy: Removes all breast tissue but not the lymph nodes or chest muscles. Often used for DCIS or as a risk-reducing procedure.
- Skin-sparing mastectomy: Removes breast tissue while preserving most of the overlying skin. The preserved skin is used for reconstruction, giving a more natural shape.
- Nipple-sparing mastectomy: Removes breast tissue while preserving the nipple-areola complex. Suitable for selected patients where the nipple is not involved by cancer. Gives the most natural appearance after reconstruction.
- Modified radical mastectomy: Removes the breast tissue along with the axillary (armpit) lymph nodes. Recommended when lymph node involvement is confirmed or likely.
- Goldilocks mastectomy: A technique that uses local breast tissue to provide some natural reconstruction at the time of mastectomy. Particularly suited for larger-breasted patients.
Who needs a mastectomy?
- Patients with large tumours relative to breast size where lumpectomy would leave a poor cosmetic result
- Multiple tumours in different areas of the breast
- Cases where clear margins cannot be achieved with conservation
- Inflammatory breast cancer
- Patients who choose mastectomy for personal reasons after being counselled about conservation
- BRCA-positive patients choosing prophylactic (risk-reducing) mastectomy
- Patients with locally recurrent breast cancer
What to expect
Consultation: Dr. Shruthi reviews your imaging, pathology, and clinical findings. She discusses the type of mastectomy appropriate for your case and what reconstruction options are available, before you decide anything.
Pre-operative preparation: Blood tests, chest X-ray, and anaesthesia review. If immediate reconstruction is planned, this is coordinated in advance.
Surgery: Mastectomy typically takes 1 to 3 hours under general anaesthesia. If reconstruction is performed simultaneously, the total time is longer. You will stay in hospital for 1 to 3 days.
Recovery: Most patients can return to light daily activities within 2 to 4 weeks. The drain (a small tube to remove fluid) is removed before or shortly after discharge. Full recovery takes 4 to 6 weeks, depending on whether reconstruction was performed.
Why breast-conserving alternatives should always be discussed first
Where clinically possible, Dr. Shruthi prefers breast-conserving approaches. A lumpectomy followed by radiation offers equivalent survival outcomes to mastectomy in many cases, while preserving the breast. She explains the evidence for this clearly during consultation.
If mastectomy is necessary, she plans reconstruction at the same time so the patient wakes up with a breast mound already formed, avoiding a two-stage process whenever possible.
Reconstruction options include implant-based reconstruction (sub-pectoral or pre-pectoral) and flap-based reconstruction including the Goldilocks technique and chest wall perforator flaps. Dr. Shruthi discusses all options at the pre-operative consultation.