What Happens When You Have A Mastectomy? 6 Questions, Answered

A mastectomy is the removal of a cancerous breast during surgery, right? Well, sort of. The word actually contains a lot of different aspects, from variations in breast surgery to what stages and types of cancers it's meant to treat. And that complexity needs to be unpacked, because Cancer Research UK estimates that a whopping 1 in 8 women worldwide will be diagnosed with breast cancer in their lifetimes, and chances are very strong that you'll know, or be, one of them. If it's going to be on the table for so many of us, we need to understand what happens when you get a mastectomy and how it works, rather than running scared.

I'm not going to lie: this is a discussion about surgery, so if you're squeamish, it may get a bit uncomfortable. Mastectomy usually isn't regarded as particularly challenging surgery for the body, though, and doesn't often require a long hospital stay, even if you've had the full enchilada (radical mastectomy with all the lymph nodes). It's important to be clear and real about the choices and diagnoses that lead to mastectomy for women, and what happens during and after the surgery, so that people don't go in scared or unprepared. It's a big deal, both psychologically and physically, but hopefully a bit of clear foreknowledge might help a bit with expectations and recovery.

If this is happening to you or somebody you know, or you're just curious about the ins and outs of the experience, this is your step-by-step guide to mastectomies. For further information and support, you'll need to consult your oncologist and surgical team.

1. How Do You Make The Decision To Have One?

A mastectomy isn't one unilateral procedure; it's actually got a lot of internal variation, and the particular type of mastectomy you'll have depends heavily on your specific circumstances and cancer prognosis — and it gets a lot more complex than just one breast or two. There are two types of partial mastectomy, which removes the tumor and some breast tissue but not the entire breast (lumpectomy and quadrantectomy), and you can have either a "total" mastectomy, which removes the breast and the nipples but leaves the lymph nodes, or a "radical" mastectomy, which takes away skin, underlying muscle and the lymph nodes as well.

The choice to have a mastectomy won't be a light one, and it doesn't necessarily have to be driven by a cancer diagnosis: preventative or prophylactic mastectomies, like the kind Angelina Jolie had, are done to prevent the likelihood of breast cancers in women who are particularly genetically vulnerable. (That's often the reasoning behind double mastectomies, particularly if one breast is already cancerous.) In most cases, if you have stage I or II cancer, breast-conserving surgery (which means stuff that will leave at least part of your breast behind) is preferred, but more complicated situations, like very big tumors, tumors that are likely to recur, or pregnancy, tend to lead to a mastectomy recommendation. If you have stage 3, which indicates the cancer has spread slightly, mastectomy will likely be on the table along with other therapies like radiation and chemotherapy.

2. What's The Procedure Like?

A mastectomy is performed under general anaesthetic, and requires hospital admission. You'll be awake while the markings are made on your breast to indicate what needs to be excised, and then put under anaesthetic for the procedure itself. What happens in the surgery itself depends on your particular mastectomy: if it's radical, the chest muscles and nodes will be taken out as well as the breast tissue. Depending on the extent of your surgery, you'll likely be in the hospital for three days or longer.

The surgeon may insert tubes into the wound to drain the fluid out shortly before stitching the wound and putting you in recovery; this is not unusual and doesn't mean anything alarming. Surgical drains are designed to prevent fluid build-up in the area where the tissue once was and avoid complications.

3. What Do Lymph Nodes Have To Do With It?

This is something that happens while you're having the mastectomy operation, if it's not entirely clear that the lymph nodes have any cancerous tissue in them. (If they do, they'll be removed as well.) In a simple mastectomy, the breast tissue will be removed, and then an assessment of your axillary lymph nodes, the glands across the pectoral muscle and near the armpit, where breast cancer is often likely to spread, will be done. It's a pretty simple operation: it means taking out a small selection of the nodes for dissection, to see if they have any indication of cancer in them. It's a just-in-case, while-we're-in-there scenario, done through a separate incision, that removes between five and 30 different nodes for analysis.

4. When Does Breast Reconstruction Happen?

If you've decided to have breast reconstruction to replace your removed breast or breasts, this can happen during the mastectomy surgery itself, after the tissue has been taken away. It doesn't have to, though; immediate reconstruction, as it's called, isn't your only option. You can also have breast reconstruction in stages, after any surgery and all your other therapy options, like chemotherapy, have been completed or present a good operating term. Generally speaking, it's recommended that if you're having chemo or radiation, that needs to be finished before you get a reconstruction.

If you are having immediate reconstruction, though, the plastic surgery team will move in once the surgeon's finished, and reconstruct the breast either using tissue from elsewhere in your body, an implant, or some combination of both. Reconstruction using your own skin and tissue is called tissue flap reconstruction, and either use material from your back or from your abdomen and bottom. And you can have the choice of a nipple reconstruction as well, if your nipple's also been removed.

5. What's Recovery Like?

As invasive surgery, recovery from a mastectomy isn't a vacation. You may only be in the hospital for a short time, but recovery itself is likely to take at least three to six weeks, and you'll be encouraged to avoid sports, heavy lifting, or driving for a while. If you have surgical drains, you'll be instructed on how to take care of them, as well as what to note in terms of infection and how to take your painkillers. If you had axillary lymph nodes removed, you'll be told how to watch out for lymphedema, or a swelling of fluid in the area where the nodes once were.

Psychological responses to mastectomy are complicated, but also pretty expected. Some care sites have details about the stages of grief that mastectomy patients go through for their original breasts, even if they've had reconstructions, and it's often recommended that therapy or talking to specialist cancer organizations about counselling can help.

6. What About Recurrence?

After a mastectomy, your health needs to be monitored for any signs that the cancer has come back (or "recurred"). They can recur in the original site, or turn up elsewhere, and if they're appearing post-mastectomy they'll most likely be treated with further surgery and radiation therapy. The usual procedure for women who've been treated in any way for breast cancer, whether it's mastectomy or something else, is to do extensive breast exams every month, attend follow-up appointments with doctors, and get regular mammograms.

If you or somebody in your family is contemplating or going through with a mastectomy, there are lots of places to look for information and support. The National Breast Cancer Foundation, Susan G. Komen, and The American Cancer Society are jam-packed with sources and FAQs, and places like Macmillan provide support for families and patients with cancer.

Images: Getty, Giphy