Mastectomy - How a mastectomy is performed

There are several different types of mastectomy, depending on the areas that are removed.

Some of the main types of mastectomy include:

• standard mastectomy – all the breast tissue and most of the skin covering it is removed
• skin-sparing mastectomy – all of the breast tissue is removed including the nipple, but most of the skin covering the breast is left
• subcutaneous mastectomy – a skin-sparing mastectomy where the nipple is not removed
• radical mastectomy – when all of the breast tissue is removed, plus the skin covering it, the two muscles behind the breast and the lymph nodes in the armpit, but this is now only carried out rarely 
• modified radical mastectomy – a radical mastectomy where the large muscle behind the breast (the larger of the two pectoral muscles) is left in place

Removing the breast tissue

All mastectomies are performed under general anaesthetic, which means you will be asleep during the operation and will not feel any pain or discomfort. However, you will feel sore when you wake up after the operation, which usually takes between one and two hours.

During the operation, a diagonal or horizontal cut is made across your breast so the breast tissue can be removed. The amount of skin removed will depend on the type of mastectomy you are having. The surgeon will usually leave one or two drainage tubes in place to stop fluid building up in the breast space.

Lymph nodes 

In some cases, surgery may be carried out on the lymph nodes at the same time as the mastectomy. Lymph nodes are small, oval-shaped tissues that remove unwanted bacteria and particles from your body. They are part of the immune system (the body's natural defence against infection and illness).

It is possible for breast cancer to spread to the lymph nodes under your arm. If this is the case, most or all of your lymph nodes may be removed at the same time as your mastectomy.

It is standard practice for all removed tissue to be sent to a laboratory to be examined. Your surgeon will explain the reasons for this before your operation, as well as any further treatment you may need if your lymph nodes are affected.

Once the procedure is complete, stitches will be used to close the wound.

Read about recovering from a mastectomy.

Breast reconstruction

Breast reconstruction is a procedure that involves making a new breast to replace the tissue removed during a mastectomy. The new breast can be created using: 

• a silicone implant
• tissue from another part of your body, such as your abdomen or back
• a combination of both of these

The aim is to create a shape that matches the removed breast or breasts.

Breast reconstruction can often be carried out at the same time as a mastectomy. Alternatively, the surgery can be performed at a later date. Some people decide not to have breast reconstruction at all. It is your decision and your specialist will discuss the options with you.

Read more about breast reconstruction.

Endoscopic mastectomy

The National Institute for Health and Care Excellence (NICE) has published guidance on endoscopic mastectomies.

This is surgery to remove the breast using a small cut in the armpit or around the edge of the nipple. An endoscope (a long, thin, flexible tube with a light source and camera at one end) is used along with special tools to remove the breast tissue.

NICE found there is currently not enough evidence to confirm the safety and effectiveness of endoscopic mastectomies. Therefore, this type of surgery is not routinely used.

Endoscopic mastectomies may be carried out as part of medical research (clinical trials), but only in units that specialise in breast cancer management and by surgeons trained in both breast cancer surgery and endoscopy.

Read more about endoscopies and clinical trials.