It’s very scary to learn you have breast cancer. Certainly, you worry if this will lead to your death. But it’s also natural to worry about what treatments you will need, how you will tolerate them, and what your body will look like after treatment. If you have breast cancer, you may be considering a mastectomy (surgery to remove all or some of your breast tissue). Or if you have a high risk of breast cancer (e.g., have the BRCA1 or BRCA2 gene), you want to remove your breasts to avoid cancer. Although this blog provides tips for a smooth recovery from a mastectomy, it’s important to understand that mastectomy is only one of several treatment options for breast cancer.

What exactly is a mastectomy?

A mastectomy involves the removal of some or all of your breast’s tissue. In some cases, your doctor may also remove some or most of the lymph nodes in your armpit.

Importantly, a mastectomy may save you from undergoing radiation therapy, but not always.

There are several different types of mastectomies, based on how the surgery is done and how much tissue is removed, as follows:

Simple or total mastectomy.

This surgery involves the removal of the entire breast, including the nipple, areola, fascia (covering) of the pectoralis major muscle (main chest muscle), and skin. Your doctor may remove a few underarm lymph nodes (called sentinel lymph node biopsy) to test if your cancer has spread.

Modified radical mastectomy.

This procedure is similar to a simple mastectomy (as described above), plus the removal of 10-20 lymph nodes in the armpit, called an axillary lymph node dissection.

Generally, doctors recommend this surgery when the cancer has spread to the lymph nodes.

Radical mastectomy.

During a radical mastectomy, the surgeon removes everything removed during a modified radical mastectomy (as described above) plus the pectoral (chest wall) muscles under the breast. This operation might be done if the tumor is growing into the pectoral muscles.

Importantly, this procedure, which requires a more extended recuperation period, was once common but now is rarely performed.

Skin-sparing mastectomy.

This procedure involves the removal of breast tissue while keeping as much of the skin over the breast as possible. Surgeons only remove the breast tissue, nipple, and areola In this procedure, doctors use implants or tissue from other parts of your body to reconstruct your breast.

Many women prefer this approach because it leaves less scar tissue and allows a reconstructed breast to seem more natural. However, if you have a larger tumor, or a tumor close to the surface of your skin, this approach may not be an option.

Experts recommended that skin-sparing mastectomies be performed by a team of breast surgeons with a lot of experience in this procedure.

Nipple-sparing mastectomy.

In this procedure, a surgeon removes the breast tissue while keeping the nipple and areola intact. Additionally, surgeons often remove the breast tissue under the nipple and areola to check for cancer cells. If cancer is found in this tissue, the nipple and areola must be removed. Surgeons can usually perform a breast reconstruction immediately after this procedure.

Generally, surgeons perform this type of mastectomy for women with a small, early-stage cancer, more than 2cm away from the nipple and areola, with no signs of cancer in the skin or the nipple. For women with larger breasts, the nipple may look out of place after a breast reconstruction. Therefore, many doctors feel that this surgery is best done in women with small to medium sized breasts.

Unfortunately, after this surgery, your nipple tissue may shrink or become deformed due to a lack of blood. Additionally, because the nerves are also cut, you may have little or no feeling in your nipple. And although this procedure leaves fewer visible scars, some breast tissue may get left behind, which can increase the risk of cancer recurring.

As with a skin-sparing mastectomy, experts also recommended this type of mastectomy be done by a team of breast surgeons with a lot of experience with this procedure.

Double mastectomy.

When doctors remove both breasts, it is called a double (or bilateral) mastectomy. If you have a high risk of breast cancer, such as having a BRCA gene mutation, you may consider a double mastectomy. Interestingly, most double mastectomies are simple mastectomies, but some may be nipple-sparing.

Will a mastectomy keep you healthy?

If you have early-stage cancer, you may have the option to choose between a mastectomy and breast-conserving surgery (BCS) which is sometimes called a lumpectomy or a partial mastectomy depending on how much tissue is removed.

Importantly, in most cases, mastectomy does not give you any better chance of long-term survival compared to breast-conserving surgery (BCS). In fact, studies of thousands of women over 20+ years show that when BCS is done along with radiation, the outcome is the same as having a mastectomy.

Moreover, although it’s natural to worry about breast cancer coming back, having a mastectomy instead of breast-conserving surgery plus radiation only lowers your risk of developing a second cancer in the same breast. Importantly, a mastectomy does not lower the chance of the cancer coming back in other parts of the body, including in your other breast.

Are you a good candidate for a mastectomy?

Generally, surgery is the primary recommended treatment if you have:

Infiltrating ductal carcinoma (IDC).
Infiltrating lobular carcinoma (ILC).
Triple negative breast cancer.
Inflammatory breast cancer.
Paget’s disease of the breast.
A proven high risk of breast cancer, such as a BRCA gene mutation.

Mastectomy might also be the first course of treatment for:

Ductal carcinoma in situ, also called DCIS or noninvasive breast cancer.
Stages 1 and 2 breast cancer, also called early-stage breast cancer.
Breast cancer that comes back after treatment, also called locally recurrent breast cancer.

Additionally, a doctor may recommend you have a mastectomy if you:

Cannot have radiation therapy.
Would prefer more extensive surgery instead of undergoing radiation therapy.
Previously received radiation therapy in your breast.
Have already had breast-conserving surgery that did not completely remove the cancer.
Have 2+ areas of cancer in different quadrants of the same breast that are not close enough to be removed together without dramatically changing the look of your breast.
Have a tumor larger than 5 cm (2 inches) across, or a tumor that is large relative to your breast size.
Are pregnant and would need radiation therapy while still pregnant.
Have a serious connective tissue disease such as scleroderma or lupus, which may make you especially sensitive to the side effects of radiation therapy.
Have inflammatory breast cancer.

Possible risks and side effects of a mastectomy.

Before deciding on a mastectomy, you should understand what challenges you may face during your recovery.

Certainly, all surgeries come with a risk for bleeding and infection at the surgery site, including mastectomies. Importantly, every patient has a different experience, and the side effects can depend on the type of mastectomy you have. Side effects can include:

Pain, tenderness, and/or swelling at the surgery site.
Buildup of blood (hematoma) or clear fluid (seroma) in the wound.
Limited arm or shoulder movement.
Numbness in the chest or upper arm.
Nerve pain (for example, burning or shooting pain) in the chest wall, armpit, and/or arm that doesn’t go away over time. This pain is often referred to as post-mastectomy pain syndrome or PMPS.
If the surgeon also removes the lymph nodes in your armpit, you may have other side effects, such as lymphedema (arm swelling due to a buildup of lymph fluid).

Additionally, you may experience breast skin necrosis which occurs from a lack of blood flow to the skin. Necrosis causes the affected area to wither and scab. Eventually the tissue can die.

Lastly, you may experience phantom breast pain – feeling pain in the removed breast due to a continuation of nerve signals sent to the area.

Choosing a surgeon and hospital for your mastectomy.

If you think you might want a mastectomy, the first task is choosing a surgeon and hospital. Try to find a doctor, and a hospital, with experience performing mastectomies for patients with a cancer like yours.

Finding the “right” surgeon and hospital can help you have a smooth recovery from a mastectomy.

You can either choose a hospital and then look for a doctor within the hospital’s network, or you can choose a doctor and then use the hospital with which he/she is affiliated.

Choosing a surgeon.

When meeting a potential surgeon, try to bring a trusted friend or family member to take notes, ask questions, and help you process the information discussed after the appointment. If you must go alone, record the appointment with your phone (ask first), so you don’t forget important information.

Ask as many questions as you need until you understand the information. And if a surgeon doesn’t seem like a good fit for you, look for another option.

Importantly, second or third opinions are always a good idea. Beware of doctors who discourage it!

What makes a doctor the “right” one?

Training and experience are both important. For a mastectomy, it’s best to use a surgeon who is either a board-certified breast surgeon or a board-certified general surgeon who specializes in breast procedures.

For reconstruction surgery, look for a plastic surgeon who specializes in breast reconstruction or aesthetic flap closure.

Of course, if you want breast reconstruction or an aesthetic flap closure performed immediately after your mastectomy, you’ll need a plastic surgeon and a breast surgeon who work at the same hospital.

And make sure any potential doctors and hospitals accept your insurance!

When looking for a surgeon, ask potential candidates the following questions:

How many surgeries like mine do you perform each year? (It’s important for a surgeon to have performed a minimum of 15 to 20 procedures per year.) How many have you done in your career?
What are your complication rates?
What is your 30-day mortality rate after surgeries? (This is the number of deaths that occurred within 30 days after surgery, either in or out of the hospital.)
How many mastectomies, reconstructions and/or aesthetic flap closures are performed in this hospital each year?

Importantly, ask to see before-and-after photos of their patients who had the same type of surgery you are considering. And ask if you can speak to any of their patients who underwent similar procedures to the type you may get.

For more tips on choosing a cancer doctor, read What Should You Do When You Get a Cancer Diagnosis?

Choosing a hospital.

When choosing a hospital, realize that hospital choice can significantly impact cancer survival rates. If possible, look for a hospital that is one of the National Cancer Institute’s 71 NCI-Designated Cancer Centers.

For tips on selecting a hospital, read How to Choose a Hospital for Cancer Treatment.

Should you have a mastectomy?

Deciding what type of cancer treatment you want is a very personal decision. Everyone is different and you must decide what feels right for you. Do not let someone make this decision for you. Instead, fully participate in the decision-making process with your doctor – and when possible, with loved ones. (For more information, read The Importance of Shared Decision-Making in Healthcare.)

Importantly, mastectomy is only one type of breast cancer treatment available. Don’t jump to this irreversible surgery without considering all your treatment options.

For instance, other options may include a lumpectomy (removal of a lump of breast tissue and a small amount of surrounding tissue), radiation, chemotherapy, or hormone therapy. For more information on cancer treatment options, conduct your own research on reputable websites and read the following posts:

Importantly, a mastectomy is major surgery that requires weeks or months to recover from. Generally, after a hospital stay of 1-2 nights, you can return home, but you may need help from a friend, family member, or paid caregiver. Most patients can return to regular activities in about 4 weeks. However, if you have breast reconstruction, your recovery will likely take longer.

Also, realize that in addition to a mastectomy, you may have to undergo additional treatments such as radiation therapy, chemotherapy, or hormone therapy. And you will likely need regular check-ups to detect any cancer recurrence.

Questions for your surgeon.

Before agreeing to a mastectomy, discuss the risks and benefits of each type of mastectomy with your doctor. Importantly, ask if you are a good candidate for a lumpectomy (which may require you to also undergo radiation therapy).

When talking to your doctor, don’t shy away from asking as many questions as you need to feel comfortable with your decision. And don’t hesitate to ask your doctor to explain anything you don’t fully understand.

The type of mastectomy recommended for you will depend on the extent of your cancer, the dimensions of your breast, and your overall health.

Questions to ask to help you decide if you want a mastectomy.

Ask the surgeon the following questions to help you decide which, if any, mastectomy is right for you:

Which type of mastectomy is recommended and why? Will my lymph nodes be removed?
What is the likelihood the cancer could come back?
What will my chest look like after the surgery?
Will I have surgical drains in place? If so, for how long?
Can I have breast reconstruction surgery? If so, would it be at the same time as the mastectomy or later?
What side effects can I expect? For how long?
How can I minimize the impact of the side effects?
How bad will the pain be? Will I need pain medications after the surgery? If so, what type and for how long?
Will I need antibiotics after the surgery? For how long?
If I will be getting a prosthesis, when and where should I get it? What type should I get?
Will I have any restrictions on my activities after surgery? If so, what and for how long?
How long will it take to recover? When can I go back to work?
Will I need help at home after surgery? If so, what kinds of tasks will I need help with and for how long?
What other treatments will I need?

Questions to ask about post-mastectomy care.

If you decide to move forward, a smooth recovery from a mastectomy will rely on your ability to understand and follow your doctor’s instructions for post-mastectomy care.

Therefore, ask your surgeon for instructions for post-surgical care – well before your surgery. Make sure you get information on the following items:

What should I do to manage pain and side effects? Will I need pain medication? If so, which medication, and how often, and for how long? Can I use an ice pack or heating pad?
How should I care for the wound and dressing?
What do I need to do to care for the surgical drain?
How will I know I’m developing a complication, like an infection or lymphedema (Swelling of the arm, after lymph nodes removal).
Under what circumstances should I call a doctor or nurse or go to the emergency room?
When can I bathe or shower?
When can I start using my arm again?
What arm exercises can I do to improve my range of motion in my shoulder and arm?
When can I wear a bra?
When do I need to come in for a follow-up appointment?
How long until I can start driving, working, exercising, taking care of my children, and doing household chores?

Should you have reconstructive surgery?

After a mastectomy, you may want breast reconstruction surgery to rebuild a breast mound. Although every case is different, most mastectomy patients can have reconstruction, either at the same time as your surgery or later.

The main types of breast reconstruction are:

Implants to replace all or some of your breast tissue.
Having a breast shape made from your own body tissue.
Using a combination of an implant and your own body tissue.

If you think you’d like reconstructive surgery, talk to your breast surgeon and to a plastic surgeon ahead of time to go over your options. And check with your insurance company regarding coverage for reconstruction.

Although many women choose reconstructive surgery, you may choose to wear a breast prosthesis under your clothes to mimic the look of breasts. Or you may decide to skip reconstructive surgery and instead “go flat”. If you want to have a tight, smooth, flat chest wall, ask your doctor to remove any extra fat, skin, and breast tissue.

When should you schedule your mastectomy?

In general, you should have your surgery for breast cancer between 31 – 90 days after your diagnosis. This gives you enough time for thorough testing and ample time to consider your treatment options.

Importantly, the time of day you choose for your mastectomy could impact your outcome. Unsurprisingly, mental and physical fatigue can negatively a doctor’s impact the ability to perform at one’s best and to make good decisions.

Therefore, schedule your surgery for as early in the day as possible.

For more information, read What is the Best Time of Day for Medical Care?

Tips for a smooth recovery from a mastectomy.

Recovering from mastectomy surgery can be difficult both physically and mentally challenging. Our tips below will help you have a smooth recovery from a mastectomy.

For a smooth recovery from a mastectomy: Prepare for your first few weeks.

Before your surgery, take the time to consider your post-surgical needs.

Importantly, realize you will likely have less movement and range of motion in your arm, including difficulty raising your arms above your head. Additionally, you will likely experience some pain, discomfort, and exhaustion.

Firstly, get the pain medications you will need when you get home from the hospital. If your doctor will not give you a prescription in advance, arrange for a friend or family member to get your medications for you while you are in the hospital.

Secondly, arrange for a ride home from the hospital. Ask your driver to have some pillows in the car for you to put under your seatbelt to minimize pressure on your surgical area.

Importantly, arrange for any help you will need after your surgery. For example, you may want help with showering (particularly if you have a drain), changing your clothes, childcare, laundry, cooking, and errands.

Before surgery, take the following steps to make your first weeks easier:

Buy the bandages you will need.
Gather clothes to wear in the first weeks. Soft, comfortable tops, pajamas, and robes – with buttons or zippers in the front – will make dressing easier. If you don’t have suitable clothes, search online for “post-mastectomy” clothes.
Put your frequently used items such as clothing, toiletries, dishes, and cutlery within easy reach.
Plan your food for the first few weeks. Cook and freeze some favorite meals before your surgery. And don’t shy away from asking friends and family to help you out by dropping off meals. Before your surgery, set up an account on either CaringBridge.org or LotsaHelpingHands.com to make it easy to organize help.
Use CaringBridge or LotsaHelpingHands to organize other kinds of help you will need in the first few weeks. For instance, you may want help with childcare, laundry, grocery shopping, or taking out the trash.
Find a comfortable chair to sleep in (you may find it difficult to lie down).
Get a notebook for tracking medications and for writing down questions to ask during follow-up appointments. Consider buying a ZaggoCare System – our tips and tools make it easier to manage a cancer journey.
Buy a wedge pillow to keep you comfortably propped up in bed or on the couch.
Make it easier to shower or bath by getting:
- A detachable showerhead (you may be able to easily swap out your shower head with one with a handheld wand).
- Dry shampoo.
- Cleansing wipes.
Buy items to manage surgical drains (if you will have them):
- A drain lanyard for the shower to keep surgical drains from dangling while showering. Search online for “drain lanyard for shower”.
- A surgical drain top with pockets designed to secure surgical drains. Search online for “tops with pockets for surgical drains”.

For a smooth recovery from a mastectomy: Follow postoperative instructions.

To have a smooth recovery, it’s important to follow the post-operative instructions given by your healthcare team. Although many doctors provide post-op instructions to patients right before discharge, ask your doctor for a copy of these instructions well before your surgery so you have plenty of time to prepare.

It’s essential that you keep the incision site clean and dry to prevent infection. Carefully follow your doctor’s instructions for washing the surgical site and changing the dressings. And tell your doctor if you notice any signs of infection, such as redness, increased swelling, or discharge from the incision site.

Additionally, follow your doctor’s recommendations for managing your pain and other side effects. Don’t hesitate to reach out to your nurse or doctor if you have questions or concerns.

Importantly, not following at-home care instructions could make it harder to recover and could lead to infections or worse.

For a smooth recovery from a mastectomy: Wear supportive garments.

Before your surgery, talk to your doctor about what type of supportive garment you will need to wear immediately after surgery. Invest in a comfortable, supportive bra designed for post-mastectomy patients. These bras can support and protect the surgical site while promoting healing. There are a variety of bras available for post-mastectomy, so look for one that meets your specific needs. The “right” bra will not only promote healing, but it will help you regain confidence in your new body.

Realize it will take time for the mastectomy site to heal before you can wear a “regular” bra again. If you had a mastectomy without breast reconstruction, you may want to buy implants – soft, flexible forms that you wear under your bra.

Tips for selecting your post-mastectomy bra:

Shopping for a mastectomy bra can be difficult, but it doesn’t have to be! Bringing a friend, and following our tips, may make the process easier.

Get a professional fitting from a mastectomy bra specialist who can help you find the right fit. Since your breast(s) likely changed in size and shape after a mastectomy, a specialist can find the best shape and support for you, taking into consideration your surgical scars, swelling, and remaining breast tissue.
If needed, buy a pocketed bra with discreet pockets to hold breast forms or prostheses securely in place. These pockets provide a natural look and feel, helping you maintain symmetry.
Buy a bra with soft, breathable fabric that won’t irritate sensitive post-surgery skin. Cotton, bamboo, or microfiber can reduce irritation and allow air to circulate. Additionally, breathable mesh panels or moisture-wicking fabrics will prevent sweat build-up.
Choose a bra with adjustable straps and multiple hook-and-eye closures that let you make adjustments as swelling decreases, improving the overall comfort.
Look for seamless and soft seams that will minimize friction and rubbing against sensitive skin, reducing the risk of irritation or chafing – particularly important for surgical sites and scar tissue. Avoid bras with rough edges, rough fabric, or decorative embellishments that can irritate sensitive skin.
Choose a supportive design with wide bands that will distribute weight across your chest, reducing pressure on the surgical site and providing all-day comfort. Additionally, high sides will hide scars and/or surgical sites.
Try different styles to find the bra that suits your body and shape. Consider your needs and daily activities when choosing styles that are right for you.
Take your time: Finding the perfect mastectomy bra requires trial and error, so don’t rush the process. Try different bras and evaluate your style as you go.

For a smooth recovery from a mastectomy: Seek emotional Support.

Don’t try to go through a mastectomy alone. Coping with the changes that come with a mastectomy can be emotionally and physically challenging. It’s essential to have a support system to help you through this time, so seek emotional support from friends and family.

However, it can also be exhausting to keep up with an onslaught of requests from friends who want updates or want to visit. To keep everyone updated on your health with minimal effort, consider sending out group emails or using an app such as CaringBridge. And feel free to say no to well-meaning friends if you’re not up for a visit.

You may also find it very helpful to join a support group of other patients who have undergone mastectomies. Support groups are a great way to connect with others who can understand your journey. You can honestly express your feelings and concerns and get tips from people who have had similar experiences. You will likely learn tips that can help you in your recovery from a mastectomy.

Realize these are other patients (or loved ones of patients) so you should not take their advice as medical advice. Before making changes in your treatment and/or recovery plan, talk to your doctor.

To find a support group, ask your doctor if your hospital has a support group. Additionally, there are many Facebook groups for people who have had mastectomies.

Also, you can connect with others through cancer associations, such as American Cancer Society’s Reach To Recovery program for breast cancer patients, National Breast Cancer Foundation’s Breast Cancer Support Group, the online community at BreastCancer.org.

For a smooth recovery from a mastectomy: Start with gentle movements.

While you will need plenty of rest in the first days/weeks of recovery, your doctor may recommend gentle stretches and walking which can prevent stiffness and improve circulation.

Don’t overdo it in the early days of recovery!

For a smooth recovery from a mastectomy: Gradually increase your activity level.

Before your surgery, ask your doctor when and how you should start exercising. Generally, as you regain strength, you should slowly reintroduce exercise into your daily life, gradually increasing the intensity. Importantly, follow your doctor’s advice on lifting heavy objects or engaging in strenuous physical activity.

Additionally, talk to your doctor about participating in physical therapy for post-mastectomy patients. These programs – including exercises to improve range of motion, strength, and function in the arm and shoulder – can help with recovery from a mastectomy.

For a smooth recovery from a mastectomy: Eat well and stay hydrated.

Paying attention to what you eat before and after your surgery can help you in your recovery from a mastectomy. In fact, a healthy diet will provide nutrients to help you heal.

Nutritionists at Dana-Farber Cancer Center recommend you include the following foods both before and after your surgery:

Brightly colored fruits and vegetables like beets, squash, kale, cranberries, peaches, or kiwi.
Whole grains, like brown rice, quinoa and oatmeal.
Lean proteins, like beans, legumes, nuts, seeds, fish, poultry, eggs and low-fat dairy.
Healthy fats with monounsaturated and omega-3 fats, such as fish, olive oil, nuts, wheat germ, and avocado. Conversely, limit saturated fats and avoid trans-fats found in processed foods, deep-fried foods and margarine.

Drink lots of water!

Drinking water helps move cell-repairing nutrients and oxygen through the body, which can help you heal.

Fight off constipation.

After any surgery, patients commonly experience constipation due to a variety of factors, including narcotic pain relievers, general anesthesia, and fluid imbalance. Importantly, drinking plenty of water and eating a high-fiber diet – both before and after your surgery – can help you prevent constipation.

For a smooth recovery from a mastectomy: Manage chronic pain.

Although some pain is expected after surgery, for some patients, recovery from a mastectomy can involve pain that lasts longer 3+ months. Unfortunately, studies indicate that 40-60% of patients who undergo mastectomy develop chronic pain.

Studies show that patients with post-mastectomy pain have a significantly “worse quality of life with respect to physical well-being, physical autonomy, relationships, and psychological well-being”. Moreover, long-term pain can make it hard to work and can lead to depression. Interestingly, it’s not just mastectomy. Breast biopsy, lumpectomy, breast augmentation and breast reconstruction can also result in chronic breast and chest pain.

Unsurprisingly, chronic pain is most often felt in the areas of the chest wall, armpit, or arm. You may experience:

General pain or discomfort.
Numbness and tingling.
Shooting or prickling pain.
Burning sensation.
Phantom sensations around the surgical site.

Chronic pain after a mastectomy may be more common in people who:

Are younger at the time of surgery (generally defined as patients ≤40 years old).
Had breast pain before surgery.
Had high levels of anxiety or fixated on possible worst outcomes before their surgery.
Underwent axillary lymph node dissection (removal of 10-20 lymph nodes), as opposed to a sentinel lymph node biopsy (removal of a few lymph nodes).
Experienced acute, severe pain after the mastectomy.
Had radiation therapy following surgery.

Additionally, a 2018 survey found that people with a higher BMI (body mass index) reported higher levels of pain.

How can you manage chronic pain?

If you experience prolonged pain after your mastectomy, don’t try to “tough it out”. Instead, discuss treatment options with your doctor, including these potential options:

Over-the-counter or prescription medications.
Topical anesthetics.
Physical therapy.
Massage.
Acupuncture.
Relaxation techniques.

Conclusion.

A mastectomy is a serious surgery that can take weeks or months to recover from. But with proper planning and adherence to your doctor’s guidelines, you can have a smooth recovery from a mastectomy.

I wrote this article in collaboration with Karlee Smith who has crafted a collection of carefully designed clothing for mastectomy patients that blends style and function to provide support and confidence. From bras and camisoles to tops and dresses, each piece has useful features, like pockets for prosthetics, adjustable straps, and soft fabrics. Karlee’s website is a compassionate ally, providing resources, support, and a sense of community for people navigating life beyond mastectomy.

Tips for a Smooth Recovery from a Mastectomy