Having risk-reducing breast surgery

Treatment planning Back to top

Before you have surgery you’ll probably see a number of healthcare professionals. They work as part of a multidisciplinary team (MDT), which includes:

• A clinical geneticist/genetics counsellor who will be able to tell you about your risk of breast cancer and by how much this risk is likely to be reduced if you decide to have surgery.
• A consultant breast surgeon who will discuss the surgery and what it involves. Most breast surgeons who carry out risk-reducing breast surgery will see you in a breast clinic at least twice before you have to make a decision. They will answer your questions and discuss any anxieties.
• A clinical nurse specialist who will give you information and support during your treatment.
• A psychologist who your consultant may also refer you to, to help you think and talk through your feelings and expectations. They will be able to help you prepare for the surgery and for what to expect afterwards.
  Some women worry about being referred to a psychologist but it’s often a normal part of preparing for risk-reducing breast surgery.
• A plastic surgeon who you may see if you decide to have immediate reconstructive surgery. They will work alongside the breast surgeon during your operation. Some surgeons are trained in both breast surgery and plastic surgery. They are called oncoplastic surgeons.

Your consultant or nurse may be able to arrange for you to look at photographs of women who have already been operated on by your surgeon. They may also be able to put you in contact with other women who have had similar surgery.

You can contact Breast Cancer Care|, who may be able to put you in telephone contact with another woman who has had risk-reducing surgery.

The surgery Back to top

Risk-reducing mastectomy is major surgery involving a general anaesthetic. During the operation the surgeon removes both entire breasts with or without the skin and/or nipples. The lymph nodes and underlying muscles of the breasts are not removed.

Bilateral risk-reducing mastectomy without reconstruction takes about 2–3 hours. The operation takes longer if it also includes breast reconstruction.

Types of surgery Back to top

Different types of surgery can be used. You will be assessed by your breast surgeon who will then recommend the most appropriate operation for your situation. They will also give you more detailed information about the type of operation you will have.

Your surgeon may use slightly different terms to those used here.

Total mastectomy

Total mastectomy is also sometimes called a simple mastectomy. It involves removing as much of the breast tissue as possible. The nipple (which contains breast ducts), the areola (the coloured skin around the nipple) and about half of the skin covering the breasts is removed. It can’t be guaranteed that all the breast tissue has been removed, but only a very small amount will be left after this operation.

Skin-sparing mastectomy

This involves removing as much of the breast tissue as possible including the nipple and the areola. The skin covering the breast is not removed, and this helps to form the shape of the breast when reconstruction is done. With skin-sparing mastectomies the surgical cuts are usually shorter so the scars are more discreet. Many women who have risk-reducing surgery will be offered skin-sparing mastectomies.

Nipple-sparing (subcutaneous) mastectomy

This involves removing as much of the breast tissue as possible usually through a cut (incision) in the fold under the breast, leaving in place the skin, the nipple and the areola.

Nipple preservation

It may be possible to keep the nipple| . Your surgeon will discuss this with you before the operation. However, keeping the nipple and areola can sometimes mean that a small amount of breast tissue is left behind. There’s only a very small risk of cancer developing in this tissue but it’s important to discuss with your surgeon the risks and benefits of keeping the nipple and areola. Keeping the nipple is accepted by most surgeons as safe.

Tests on the removed breast tissue Back to top

After your surgery, samples of the breast tissue that has been removed are sent to a laboratory and examined under a microscope. This is to see if there are any changes in the cells that might be the early stages of cancer. If any cancerous changes are found, your doctors will talk to you about any treatment you might need.

After risk-reducing breast surgery Back to top

During the operation you will have a drip (infusion) into a vein in the back of your hand or in your arm. The drip is to keep you hydrated and will stay in for a short time after the operation. It will be removed when you’re able to drink enough.

If you’re also having reconstructive surgery using tissue flaps| you’ll also have a catheter to drain urine from your bladder. This will be taken out once you’re able to get up and move around.

Pain

After your operation you may have some pain and discomfort around the wound(s). This may continue for several weeks. You’ll be given painkillers and it’s important to take them regularly as prescribed. Let your nurses and the doctor know if you still have pain so that more effective painkillers can be given.

Some painkillers can cause constipation. Let your doctor know if you experience this. They will be able to prescribe medicines known as laxatives to help relieve constipation. Alternatively, you can buy laxatives from your local chemist. 

Wounds and drainage tubes

The mastectomy wound(s) will be covered by dressings. There will be a drainage tube or tubes coming out of the wound(s) attached to a small container to collect any excess blood or body fluid. This will be removed once the drainage has slowed, which is usually within a few days of the operation.

After a risk-reducing mastectomy (with or without reconstruction) the wounds should heal completely within six weeks of surgery.

Fluid can sometimes build up in the area around the wound after the drain has been removed. This is called a seroma. The fluid lessens with time and usually stops building up within a few weeks. It may need to be drained off with a fine needle and syringe by your nurse or doctor.

Time in hospital

After bilateral mastectomy with reconstruction you can usually expect to stay in hospital for a few days, but this may be longer depending on the type of reconstruction|. If you have bilateral mastectomy without reconstruction your stay in hospital may be shorter.

Your specialist team will be able to give you more information about how long you can expect to stay in hospital.

Recovery

This can take some time and will depend on the type of surgery you’ve had. Many women want to know when they can get back to doing everyday things like carrying the shopping or gardening.

This will vary depending on the type of surgery you’ve had and how you feel. It’s a good idea to discuss this with your surgeon or breast care nurse.

Numbness

After a mastectomy you’ll usually have some numbness or pins and needles across your chest/reconstructed breasts or underneath your upper arms.

These symptoms improve over months to years but it’s usual to have some permanent numbness. You’ll find that you will adjust to this over time.

Driving

It’s usually fine to start driving again when you feel that you could safely do an emergency stop or move the steering wheel around suddenly, if necessary. Some women find that this is possible within a few weeks of the surgery and others find that it takes longer.

Some insurance companies have specific guidelines about when you can drive again after an operation, so you should check this with your car insurance company.

Follow-up after risk-reducing breast surgery Back to top

After your surgery, you will have a follow-up appointment to check that your wounds have healed well and that your recovery is as expected. Your follow-up appointment will be a good time for you to talk to your hospital team about any concerns you may have.

You won’t need to have any further screening tests following risk-reducing breast surgery. However, you should still check your breast area regularly for any new lumps as there is still a very small risk you may develop breast cancer.

If you notice any lumps, or are concerned about anything else, you should contact your doctor or nurse for advice.