Surgery for breast cancer in men
In this section, we explain the different operations that may be used to remove the cancer, ways of checking and removing lymph nodes in the armpit, and what happens after surgery.
Removing the breast tissueBack to top
Men generally have only a small amount of breast tissue, so an operation to remove breast cancer usually involves taking away all of the breast tissue and the nipple in the affected breast. This operation is called a mastectomy. There are different types of mastectomy.
This removes all of the breast tissue, nipple and, usually, some lymph nodes in the armpit.
Modified radical mastectomy
This removes all the breast tissue, the nipple and all of the lymph nodes in the armpit (axilla). It may also be referred to as a total mastectomy and axillary dissection (or clearance).
A wide local excision or lumpectomy may sometimes be possible. This removes only the cancer with some surrounding normal tissue. For some men this may mean that they keep their nipple.
After a lumpectomy, the pathologist examines the tissue that’s been removed to see if there is an area or margin of normal cells around the cancer. This is called a clear margin.
If the margins are clear, you won’t need any more surgery to the breast. If there are still cancerous cells at the edge of the removed breast tissue, you’ll need another operation to remove more tissue. This reduces the chance of the cancer coming back in the future. If taking away more tissue is unlikely to remove all the cancer cells, doctors usually suggest a mastectomy.
Before your operation, make sure that you have fully discussed with your surgeon what the surgery involves.
Checking and removing the lymph nodes in the armpitBack to top
Your surgeon may remove some or all of the lymph nodes in your armpit to check if there are any cancer cells there.
This provides more information about the stage of the cancer and helps your specialist decide if you need further treatment to reduce the risk of the cancer coming back.
There are different ways of checking and removing the lymph nodes. If the cancer is small and the ultrasound of the armpit was normal, you’ll usually have a procedure to check the lymph nodes called a sentinel lymph node biopsy.
If the ultrasound or FNA are positive, or if there’s a high risk the cancer has spread to the lymph nodes, you may have all the lymph nodes removed. This is called an axillary lymph node dissection.
Sentinel lymph node biopsy (SLNB)
The sentinel node or nodes (there may be more than one) is the first node(s) that lymph fluid from the breast drains to. So, if any cancer cells have spread, they’ll most likely to go to the sentinel node. An SLNB involves finding the sentinel node, removing it and then testing it for cancer cells. SLNB isn’t suitable for everyone - your surgeon will explain if it’s an option for you. If the sentinel node or nodes don’t contain cancer cells, you won’t need surgery to remove more lymph nodes.
A tiny amount of radioactive liquid is injected into the area around the nipple before the operation. During the operation, a blue dye is injected into the breast. After a few minutes the dye drains into the lymph nodes. The surgeon then uses a scanner to find the radioactive lymph node(s), and looks for the ones that are stained blue. The nodes that become blue or radioactive first are the sentinel nodes. Your surgeon removes these through a small cut (incision) in the skin. They are then examined under a microscope by a pathologist to see if they contain cancer cells.
If any of the nodes contain cancer cells, you’ll need an operation to remove all the lymph nodes (axillary lymph node dissection). Some men may have radiotherapy to the lymph nodes instead of surgery.
Removing some of the lymph nodes (sampling)
Sometimes four or more lymph nodes in the armpit are removed. This is called sampling and you may have it done with a blue dye injection (see above). If any nodes contain cancer cells, you’ll need another operation to remove all the lymph nodes or you may have them treated with radiotherapy.
Axillary lymph node dissection (ALND)
This procedure involves removing all the lymph nodes in the armpit. It provides information about the stage of the cancer and treats the area by removing lymph nodes that contain cancer cells. You won’t need radiotherapy to the nodes afterwards.
An ALND is usually done when:
- the ultrasound of the lymph nodes is abnormal and a fine needle aspiration (FNA) of the lymph nodes is positive
- the sentinel node biopsy or sampling shows there are cancer cells in the nodes.
There’s an increased risk of developing swelling of the arm called lymphoedema after ALND. You can read more in our section on lymphoedema.
Appearance of the chest after mastectomyBack to top
After breast surgery there will be a scar across your chest in line with where your nipple used to be. There will also be an indentation where the breast tissue has been removed.
The scar will be red at first, but this usually
I went on holiday last year and that’s the first time I’ve actually shown my body... you know because it was a nice hot day. But that’s the first. I’ve had to get my confidence back in that respect. But I don’t worry now.
fades to a silvery white line over a few weeks or months. It’s common to have some swelling around the operation site to begin with.
There are techniques for recreating the appearance of a nipple on the chest, which your surgeon or breast care nurse can discuss with you.
For some men this change in appearance won’t be a problem at all. But it can affect your confidence and how you feel about yourself as a man. You may worry that your partner will be put off by your scars or a change in how your body looks. If you’re feeling self-conscious about how you look, talking with your partner or specialist nurse about how you feel can help you regain some confidence.
You’ll be encouraged to start moving around as soon as possible after your operation. This can help reduce the risk of complications.
If you have a mastectomy you may have a drip (infusion) in your arm giving you fluids for a short time after the operation, usually until you are eating and drinking normally.
You’ll have a dressing covering your wound. This may be left undisturbed for the first couple of days. After this, you’ll usually have the dressings changed if there’s any leakage from the wound. If you had a small area of tissue removed, your wound will usually heal quickly and you can probably remove the dressings yourself at home. How long it takes to heal depends on the type of operation you had and how much tissue was removed.
You may have a long, thin plastic drainage tube attached to a bottle that fluid from the wound drains into. It’s usually removed a few days after the operation, but you may be sent home with the drain still in place.
Any wound drains will stay in place until they’ve stopped draining fluid. This may take 2–7 days. If you go home with your drain still in, it can be removed by a district nurse or practice nurse. Or you may be asked to go back to the hospital every few days to have it checked.
A wound infection can be a complication of surgery. Symptoms include redness, swelling, warmth or an increased discharge from the wound. Tell your nurse or doctor if you get any of these symptoms, even after you’ve left hospital.
Pain or soreness
For the first few days, you’ll probably have some pain or discomfort around your wound and under your arm if you’ve had the nodes removed. You’ll be given painkillers to take regularly until it settles down. If you still have pain, let your doctor or nurse know so they can prescribe stronger painkillers.
After a mastectomy you may have a PCA (patient-controlled analgesia) pump that you can press to give yourself painkillers for the first few days. It’s usually attached to your drip (infusion).
Usually any pain or discomfort goes away as the wound heals. Occasionally, some men continue to have pain in their breast and arm. Let your doctor know if this is a problem.
Fluid collecting around the wound (seroma)
The area around the wound will be bruised and there may be a build-up of fluid, making it swollen and puffy for a while.
This gradually disappears over a few weeks. Fluid can sometimes build up in the area around the wound (seroma). The fluid lessens 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.
Stiff shoulder or arm
If you had a mastectomy or the lymph nodes in your armpit have been removed, you may have pain or stiffness in the shoulder or arm.
Because of the recovery process, you have to do physio, you have to do exercises. You know, if I hadn’t done that, then I might possibly not be functioning like I am now.
It’s important to do the arm exercises you’ve been shown by the physiotherapist or breast care nurse. This improves your range of movement and reduces the risk of long-term problems with pain in your shoulder or arm. You should start the exercises the day after your operation. As you recover, you’ll be able to gradually do more and increase your range of movement. Breast Cancer Care can send you a leaflet that shows the exercises you can do.
Numbness and tingling in the upper arm
You may have numbness and tingling in your upper arm because nerves in the area have been injured during the operation. There’s a high risk of this happening after all the lymph nodes in the armpit have been removed. It may last for several months and can sometimes be permanent.
About 3–5 days after a mastectomy most men are able to go home. Before you leave hospital, you’ll be given an appointment to attend the outpatient clinic so that the surgeon can check the wound is healing properly. At the outpatient clinic you’ll also be told the stage of the cancer.
Your doctors will discuss with you any further treatment that you may need. This is a good time for you to talk to them about any problems or questions you have.
Rest and activity
When you get home, take things easy for a while. How you’ll feel depends on the operation you’ve had. It’s common to feel very tired, so try to have plenty of rest and eat a well-balanced diet. Although your physical recovery might be faster than you expected, you may feel emotionally exhausted.
It’s very important to carry on with the exercises you were shown in hospital. You’ll be advised not to lift or carry anything heavy, or to drive for a few weeks. Some insurance policies give specific time limits for not driving after surgery – so check this with your insurance company.
Try to do a bit more each day and rest in between so that you build up the amount that you do gradually. Most people are back to their usual level of activity after 3–6 months. But this will depend on many factors including what other treatments you’re having, as well as your age and general fitness.
Late effects of surgeryBack to top
Some men may have problems with the effects of surgery for some months or longer after their operation. There are usually things that can be done to improve this and things you can do to help yourself. Let your breast care nurse know if you experience any of the following late effects.
Some men have an uncomfortable sensation that feels like a tight cord running from their armpit to the back of their hand. This is called cording. It may develop weeks or months after surgery and is thought to be due to hardened lymph vessels. Sometimes it makes it difficult to move the arm, but it usually gets better gradually over a few months. Some men may need physiotherapy and massage to improve it.
Pain and changes in sensation
Sometimes men continue to have numbness and tingling in the upper arm, or pain because of injury to the nerves during surgery. It can often be treated using antidepressant drugs and anticonvulsants (drugs used to treat epilepsy).
Changes in arm/shoulder movement and strength
Problems with movement and strength usually improve after surgery, but some men continue to have problems. Carrying on with your exercises, even for a few years, may help reduce the risk of this happening. Your cancer specialist can arrange a referral to a physiotherapist and make sure your pain is controlled well with painkillers.
Surgery or radiotherapy to the lymph nodes in the armpit can sometimes lead to lymphoedema, which is a swelling of the arm on the affected side. Men who have all or a large number of lymph nodes in the armpit removed are more at risk, especially if they also have radiotherapy to the armpit.