Surgery to remove the whole breast is called a mastectomy or single mastectomy. Removal of both breasts is called a bilateral mastectomy.
A mastectomy may be recommended if:
- you have the BRCA1 or BRCA2 gene mutation
- there is cancer in more than one area of the breast
- the cancer is large compared to the size of the breast
- you have had radiation therapy to the same breast before and so cannot have it again
- it’s difficult to get a clear margin around the tumour
- you have inflammatory breast cancer
- cancer has come back or you have a new cancer in the same breast.
You may prefer to have a mastectomy instead of breast-conserving surgery – even if you have a very small cancer. You won’t usually be given radiation therapy after a mastectomy, though it may be offered in some situations.
The nipple is usually removed in a mastectomy. In some cases, the surgeon may perform a skin-sparing or nipple-sparing mastectomy. This means that more of the normal skin – with or without the nipple – is kept. If you have decided to have a reconstruction, and can have a skin-sparing or nipple-sparing mastectomy, the reconstruction is usually done at the same time.
If you don’t have a reconstruction, you have the option of wearing a soft breast form with a specially designed bra while your surgical wound heals. Breast Cancer Network Australia provides a free bra and temporary soft form. To order a kit, speak to your breast care nurse. After the wound has healed and the area is comfortable, you can then be fitted for a permanent breast prosthesis.
What about the other breast?
If you need a mastectomy because of cancer in one breast, you may think it’s safer to have the other breast removed as well. For most people, the risk of getting cancer in the other breast is low.
If you have the BRCA1 or BRCA2 gene mutation, this does increase the risk of developing another breast cancer, so your surgeon may recommend a double mastectomy (bilateral mastectomy) to remove both breasts.
Whether to have a double mastectomy is a complex decision and it’s best to talk with your treatment team about the risks and benefits. Then you can make a final decision once you are informed about all your options.
→ READ MORE: Breast reconstruction
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A/Prof Elisabeth Elder, Specialist Breast Surgeon, Westmead Breast Cancer Institute and The University of Sydney, NSW; Collette Butler, Clinical Nurse Consultant and McGrath Breast Care Nurse, Cancer Support Centre, Launceston, TAS; Tania Cercone, Consumer; Kate Cox, 13 11 20 Consultant, Cancer Council SA; Dr Marcus Dreosti, Radiation Oncologist and Medical Director, GenesisCare, SA; Dr Susan Fraser, Breast Physician, Cairns Hospital and Marlin Coast Surgery Cairns, QLD; Dr Hilda High, Genetic Oncologist, Sydney Cancer Genetics, NSW; Prof David W Kissane AC, Chair of Palliative Medicine Research, The University of Notre Dame Australia, and St Vincent’s Hospital Sydney, NSW; Prof Sherene Loi, Medical Oncologist, Peter MacCallum Cancer Centre, VIC; Dr W Kevin Patterson, Medical Oncologist, Adelaide Oncology and Haematology, SA; Angela Thomas, Consumer; Iwa Yeung, Physiotherapist, Princess Alexandra Hospital, QLD.
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