Surgery to remove the whole breast is called a mastectomy. One breast may be removed (single or unilateral mastectomy) or both breasts (double or bilateral mastectomy).
When is a mastectomy recommended?
A mastectomy may be recommended if:
- there is cancer in more than one area of the breast
- the cancer is large compared with the size of the breast
- it is difficult to get a clear margin around the tumour
- you have inflammatory breast cancer
- you have had radiation therapy to the same breast before and so cannot have it again
- you have the BRCA1 or BRCA2 gene mutation.
If the cancer has come back, or there is a new cancer in the same breast, you may still be able to keep your breast. Or you may choose to have a mastectomy, even if you have a small cancer. Talk to your doctor. You don’t usually need radiation therapy after a mastectomy
What are skin-sparing or nipple-sparing mastectomies?
Having a mastectomy can be confronting but there are several options for your breast and chest appearance (see page 37). In some cases, the surgeon may be able to do a skin-sparing or nipple-sparing mastectomy, where more of the skin (with or without the nipple) is kept. Talk to your surgeon about whether this is an option. If you have a reconstruction, and are able to have a skin-sparing or nipple-sparing mastectomy, they can sometimes be done at the same time.
What are your options if you don’t have a reconstruction?
If you decide not to have a reconstruction, you will have a flat closure. You can also have an immaculate or aesthetic flat closure, a procedure where the skin is smoothed out. If you want to, you can then also wear a soft breast shape (form) in a special bra while you heal. Breast Cancer Network Australia (BCNA) provides a free bra and soft form. Speak to your breast care nurse for details. After you have healed, if you want to, you can be fitted for a permanent 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, or another rare breast cancer gene mutation, this does increase the risk of developing another breast cancer, so you may choose to have a double mastectomy (bilateral mastectomy) to remove both breasts.
Deciding whether to have a double mastectomy is a complex decision. It’s best to talk with your treatment team about the risks and benefits before making a final decision.
→ READ MORE: Breast reconstruction
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Dr Diana Adams, Medical Oncologist, Macarthur Cancer Therapy Centre, NSW; Prof Bruce Mann, Specialist Breast Surgeon and Director, Breast Cancer Services, The Royal Melbourne and The Royal Women’s Hospitals, VIC; Dr Shagun Aggarwal, Specialist Plastic and Reconstructive Surgeon, Prince of Wales, Sydney Children’s and Royal Hospital for Women, NSW; Andrea Concannon, consumer; Jenny Gilchrist, Nurse Practitioner Breast Oncology, Macquarie University Hospital, NSW; Monica Graham, 13 11 20 Consultant, Cancer Council WA; Natasha Keir, Nurse Practitioner Breast Oncology, GenesisCare, QLD; Dr Bronwyn Kennedy, Breast Physician, Chris O’Brien Lifehouse and Westmead Breast Cancer Institute, NSW; Lisa Montgomery, consumer; A/Prof Sanjay Warrier, Specialist Breast Surgeon, Chris O’Brien Lifehouse, NSW; Dr Janice Yeh, Radiation Oncologist, Peter MacCallum Cancer Centre, VIC.
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