Your doctor may recommend removing one or both of your breasts to treat or prevent breast cancer. At the Abramson Cancer Center, our multidisciplinary breast cancer surgery team includes breast surgeons, plastic surgeons and genetic counselors. We will explain your options, answer your questions and help you decide if a mastectomy is the best choice for you.
What Is a Mastectomy?
A mastectomy is a surgical procedure that removes the breast tissue to treat breast cancer. This surgery is often recommended for patients that have more high-risk or late-stage breast cancer diagnoses. Mastectomies may be unilateral (single mastectomy), in which one breast is removed, or bilateral (double mastectomy), in which both breasts are removed. Mastectomies differ from lumpectomy procedures in that the entire affected area of the breast as well as all of the surrounding breast tissue is removed, whereas lumpectomies are only a partial removal.
We may use mastectomy for many reasons, including:
- Large or vast tumors: Tumors that are large in size or cancer located throughout the breast cannot be treated with lumpectomy, which only removes part of the breast.
- High-risk cancer: Mastectomy may be recommended as a preventative measure for patients at a considerable risk for developing new or recurring breast cancer.
- Personal reasons: Patients may have a personal preference for mastectomy over breast conserving surgery.
What is a risk-reducing prophylactic mastectomy?
A risk-reducing (or prophylactic) mastectomy is the surgical removal of one or both breasts to reduce the risk of developing breast cancer. Some people with a high risk of developing breast cancer, such as those who have a BRCA gene mutation, choose this risk-reducing procedure. Studies have shown that this procedure lowers the lifetime breast cancer risk by at least 90 percent in women with BRCA1 and BRCA2 gene mutations. This type of surgery is a very personal decision, and we recommend you fully explore all your options with your care team. If you’re considering a prophylactic mastectomy, you may also find it helpful to consult with a breast surgical oncologist and plastic surgeon to learn about your surgical options including breast reconstruction or aesthetic flat closure.
At Penn Medicine, we work as a collaborative, multi-specialty team to provide the individualized care based on your diagnosis and preferences. Our high-volume practice ensures the best clinical and aesthetic outcomes available.
We encourage all women who are considering a prophylactic mastectomy to discuss this with their doctors and loved ones. It’s important to take the time you need to make a thoughtful decision.
You may be considering a prophylactic mastectomy if:
- You’ve tested positive for a BRCA1, BRCA2, PALB2, CDH1, PTEN, or TP53 gene mutation, which increase the risk of breast cancer.
- You have had radiation therapy to the chest before age 30, which increases the risk of breast cancer throughout your life.
- You have a personal history of breast cancer, making you more likely to develop a new cancer in the opposite breast than someone who has never had breast cancer.
- You have a strong family history of breast cancer: More than one relative — including your mother, sister, or daughter — has had breast cancer, especially before age 50.
Types of Mastectomy Procedures
We use mastectomies to treat all types of breast cancer. Penn Plastic Surgery Performs the highest volume of tissue based breast reconstruction in the world and the highest volume implant based reconstruction in the region. Our surgeons have pioneered minimally invasive techniques that simultaneously enhance aesthetics and minimize recovery. For early-stage cancer, mastectomy is an alternative to treatment with lumpectomy plus radiation therapy. For more advanced or recurrent cancer, mastectomy is often the best or only surgical option. For men with breast cancer, mastectomy is often the best treatment, because most tumors in men occur beneath the nipple.
Our surgeons perform mastectomies with or without breast reconstruction. The types of mastectomies we offer include:
Total (Simple) Mastectomy
A total mastectomy is when the entire breast is removed, including surrounding breast tissue, nipple, areola, fascia of the main chest muscle, and the skin. This procedure is also known as a simple mastectomy, done without breast reconstruction, and patients are generally able to go home on the same day as surgery.
Breast surgeons typically remove lymph nodes during the procedure as well, unless the surgery is to prevent breast cancer from developing. This surgery is used to treat early forms of breast cancer, such as ductal carcinoma in situ (DCIS), as well as invasive cancer.
Skin-Sparing Mastectomy
During a skin-sparing mastectomy, all elements of a total mastectomy are removed except for the skin covering the breast. This type of mastectomy involves immediate post-op breast reconstruction to minimize the appearance of surgical scars.
Nipple-Sparing Mastectomy
Nipple-sparing mastectomies remove breast tissue, but preserve the nipple, areola, and skin. Like its skin-sparing counterpart, breast reconstruction is performed immediately after. This surgery is only an option when cancer is not detected in the tissue underneath the nipple.
Modified Radical Mastectomy
A modified radical mastectomy involves the removal of the breast tissue and all lymph nodes. We use this procedure mostly for patients with advanced or aggressive breast cancer. Removing the lymph nodes allows us to determine whether cancer has spread beyond the breast.
Bilateral (double) mastectomy
During this operation, also called a bilateral mastectomy, the surgeon removes both breasts. We use double mastectomies to treat advanced cancer. Patients who have an elevated risk of breast cancer may opt to have a double mastectomy as a risk reduction procedure as part of their personalized cancer risk management program. For some patients, this type of mastectomy can be nipple sparing.
Contralateral mastectomy
Removal of the healthy breast in people who have cancer of the other breast.
Goldilocks mastectomy
A skin-sparing technique performed after a mastectomy to remove unhealthy breast tissue. The remaining fatty tissue and skin are formed into a breast mound that gives some shape and definition to the breast.
Breast reconstruction
Penn offers all options for breast reconstruction after mastectomy. Our highly skilled surgeons are experts in even the most complex cases. Learn more about breast reconstruction surgery options.
How Is a Mastectomy Performed?
Our surgical team helps you prepare for surgery and answers any questions you may have. We coordinate pre-surgery appointments including consultations with the breast surgeon and plastic surgeon, if you plan to have breast reconstruction.
The surgery is performed using general anesthesia. During the procedure, your breast surgeon will:
- Make an incision around your breast and remove breast tissue for review by a pathologist
- Possibly remove lymph nodes for further investigation by a pathologist
- Work in conjunction with a plastic surgeon whenever possible to perform breast reconstruction during the mastectomy
- Close the incision and place temporary drains (plastic tubes) to remove any fluid build-up near the surgery site
What to Expect from Mastectomy Recovery
After a mastectomy, our team will monitor your heart rate, blood pressure, and other vital signs while the anesthesia wears off to ensure no complications from receiving the anesthetic. Many patients who undergo a mastectomy will return home within a day of surgery, but the hospital stay may be extended if the choice to have breast reconstruction at the same time is made. You may experience some discomfort in your chest, armpit and shoulder for a few days following surgery.
Full recovery should take approximately four weeks. Before you head home, we will walk you through the recovery instructions and offer guidance on when you can begin to wear a bra or prosthesis. We coordinate a follow-up visit with your surgeon. At that time, we will remove any drains, check the incisions and review the pathology report.
Breast Reconstruction After Mastectomy
Breast reconstruction is a surgical procedure that restores the appearance of one or both breasts following mastectomy. Plastic surgeons reconstruct the breasts using either breast implants, the patient’s own tissue (typically removed from the lower abdomen) or a combination of the two methods.
We perform the highest volume of breast reconstructions in the nation. Our expert plastic surgeons can reconstruct your breasts at the same time as your mastectomy or at a later time. We will guide you through all your reconstruction options, so that you can make an informed decision. Learn more about breast reconstruction at Penn Medicine.
Mastectomy: Why Choose the Abramson Cancer Center?
At Penn Medicine, mastectomies involve a team of experts through our Breast Cancer Program. From preoperative education to post-surgical support, we offer compassionate care and advanced expertise every step of the way. The benefits of surgery at the Abramson Cancer Center include:
- Expert surgeons: Our specialized breast surgeons perform mastectomy to fit your body and needs. If you desire a reconstruction, our plastic surgeons expertly restore your appearance.
- Latest surgical techniques: We perform the latest breast cancer surgeries. Our clinical trials provide access to promising new mastectomy techniques such as robotic nipple sparing surgery.
- Risk evaluation and counseling: Our cancer risk experts at MacDonald Cancer Risk Evaluation Center determine your risk of breast cancer. If you have a high risk of hereditary breast cancer, the Basser Center for BRCA offers specialized guidance and support.
- Specialty boutiques: Our cancer center boutiques, located at two Penn Medicine hospitals, offer products and services designed for breast cancer patients. We provide bra fittings and intimate apparel to help you feel confident and comfortable after mastectomy.
Additional Resources:
Basser Center for BRCA – learn more about BRCA gene mutations, risk-reducing strategies, and research opportunities.
MAPS Clinic – a home for patients with non-genetic causes of elevated breast cancer risk, our management, assessment, prevention, and surveillance (MAPS) clinic is staffed by a surgical provider who can calculate your lifetime risk, order and follow annual MRIs, and help you decide if chemoprevention (or medication to decrease your risk of future breast cancer) is right for you.
Penn Breast Surgery – our team of breast surgical oncologists include renowned clinicians and researchers who care for patients with a range of breast abnormalities from high-risk lesions to cancer.
Penn Plastic Surgery – our team of skilled plastic surgeons perform a high volume of breast reconstruction procedures, among the most in the nation annually, with a highly published success rate.
PennBRA - an educational portal dedicated to educating patients diagnosed with breasts cancer about their options for reconstruction. It is an up-to-date resource focusing on the pre- and post- operative course associated with breast reconstruction featuring pictures of diverse patients who have received their care at Penn.
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