Mastectomy Surgery - Types, Procedure Indications, Recovery & Cost

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What is Mastectomy Surgery and its purpose?

Mastectomy meaning


Mastectomy is a surgical process that removes the entire tissue from a breast as a part of prevention or treatment for breast cancer. It is also effective in preventing the recurrence of breast cancer.


Initially, the standard treatment for breast cancer was a radical mastectomy, which included the removal of the entire breast, lymph nodes in the underarm, and portions of the chest muscles behind the breast. The selection of the type of mastectomy depends on age, general health, size, grade, and stage of the tumour, the tumour’s hormone receptor status, and involvement of lymph nodes.


However, medical innovation has increased patients' alternatives more than ever. Many patients now have access to breast conserving surgery (BCS or lumpectomy) which require less surgical intervention over Mastectomy procedure.

What is Mastectomy Surgery | Radical mastectomy surgery in India

What kind of breast cancer requires a mastectomy surgery?

  • Early-stage breast cancer (Stage I and II).
  • Locally advanced (Stage III) and inflammatory breast cancer after chemotherapy.
  • Ductal carcinoma in situ (DCIS), or non-invasive breast cancer.
  • Paget's disease of the breast
  • Recurrent breast cancer (locally)

Indications of Mastectomy Surgery

  • Patient who cannot undergo radiation treatment or has had breast radiation therapy before. 
  • The patient had previously undergone breast conserving surgery with re-excision(s) that did not result in the complete removal of the cancer. 
  • Multicentric breast cancer in different breast quadrants of the same breast that are too far apart to be removed at the same time without significantly altering the breast's appearance.
  • In some cases, women with an extremely high risk of developing a second breast cancer will opt for a double mastectomy (the removal of both breasts).
  • Presence of a tumour larger than 5cm (2 inches) in size. 
  • Presence of BRCA mutation (gene mutation) may result in a patient developing cancer more than once (on the same or different breast).
  • When a breast-conserving surgery (lumpectomy), which removes only the tumour portion of the breast, and cannot be used to treat the patient.
  • Patients who are sensitive to radiation therapy's side effects and have a serious connective tissue disease such as scleroderma or lupus.
  • If a patient prefers to choose more extensive surgery over breast conserving surgery (BCS).

Types of Mastectomy Surgery

Depending on the surgical technique used and the amount of breast tissue removed, mastectomy surgery can be classified into:

  1. Total mastectomy (simple mastectomy)
  2. Double mastectomy (bilateral mastectomy)
  3. Skin-sparing mastectomy
  4. Nipple-sparing mastectomy
  5. Modified radical mastectomy
  6. Radical mastectomy
  7. Extended radical mastectomy

1. Total mastectomy or Simple mastectomy

In this procedure, the breast cancer surgeon removes the entire breast, including the nipple, areola, fascia (covering) of the pectoralis major muscle and skin. A few underarm lymph nodes might be removed as part of a sentinel lymph node biopsy, depending on the patient’s situation.

2. Double mastectomy or Bilateral mastectomy

A double mastectomy, or bilateral mastectomy, is one in which both breasts are removed. Women with a BRCA (BRCA1 and BRCA2) gene mutation, who have an extremely high risk of developing breast cancer, may undergo a double mastectomy as a preventative measure.

3. Skin sparing mastectomy

The skin of the breasts is not removed during a skin-sparing mastectomy, but the breast tissue (same as in terms of the amount of breast tissue that is removed during a simple mastectomy), nipple and areola are removed. It is also possible to perform a sentinel lymph node biopsy. After a mastectomy, breast reconstruction can be done the same day using implants or donor tissue from other parts of the body. Skin-sparing mastectomy can be an effective treatment option when the tumour is small or moderate in size and close to the skin's surface.

4. Nipple sparing mastectomy

It is similar to skin-sparing mastectomy, but only the breast tissue is removed (and not the skin, nipple, or areola).

5. Modified radical mastectomy

The entire breast is removed, similar to a total mastectomy. Some of the lymph nodes under the arm (axillary lymph nodes) are also removed as breast cancer often spreads to these lymph nodes and then it spreads to other parts of the body.

6. Radical mastectomy

In Radical mastectomy, the pectoral (chest wall) muscles under the breast, along with the axillary (underarm) lymph nodes, nipple, areola, and the overlying skin will be removed in this process. If the tumour has spread into the pectoral muscles, this procedure may be necessary. This procedure used to be quite common, but now that less invasive procedures (modified radical mastectomy) have proven to be effective with fewer side effects, they are being preferred.

7. Extended radical mastectomy

Extended radical mastectomy was the most extensive procedure used to treat breast cancer as a primary treatment. It is the combination of full-thickness parasternal chest wall excision and removal of internal mammary nodes with a classic radical mastectomy. By eliminating all lymphatic drainage channels in the breast region, this procedure aims to eradicate the cancer and prevent its spread.

What to expect before a mastectomy surgery?

The primary care physician or nurse will inform the patient regarding when the patient needs to check into the hospital. The surgeon will be explaining the procedure to the patient and an inform consent form will be provided to sign, allowing the surgeon to proceed with the surgery. The patient should make sure to read the form thoroughly and clarify any questions before signing.


The surgeon will be asking a few basic questions about the patient’s health condition. A physical examination, blood tests and other surgery related tests will also be performed. This is done so that the surgeon knows the patient is in good or favourable condition before performing the operation. 


As a part of surgery preparation, the patient will be informed to abstain from eating and drinking for a specified period of time (8 to 12 hours) and to follow the specific instructions of the surgeon.


The patient needs to inform the surgeon related to:

  • Pregnancy status (pregnant or expecting to be).
  • Any known allergies to drugs, latex, tape, or anaesthesia (local and general).
  • Family history of bleeding disorders.
  • Intake of medications, including over-the-counter, vitamins, herbs, and other dietary supplements. If the patient is currently on hormone replacement therapy and/or blood thinning agents, or anticoagulants, or any other medications (prescribed), that could affect the patient’s blood clotting procedure. These medications should be stopped before surgery or as per the surgeon’s or concerned physician’s (who prescribed) advice.
  • If it is planned to have reconstructive surgery along with mastectomy, it should be discussed with the surgeon and plastic surgeon prior to mastectomy surgery.


If the patient had planned for radiation therapy after surgery, the patient should schedule an appointment with a radiation oncologist before the surgery to weigh the pros and cons of radiation therapy and find out how it will affect the patient’s breast reconstruction options after undergoing surgery.


Depending on the patient’s specific health situation, the surgeon might give other specific instructions to follow.

What happens during a mastectomy surgery?

A mastectomy procedure typically requires a hospital stay and usually carried out while the patient is under general anaesthesia and completely unconscious.


When no reconstruction is involved, a mastectomy can be performed in one to three hours. A double mastectomy will require more time in surgery and may necessitate an extra day stay in the hospital. After a mastectomy, if the patient (women) opts for breast reconstruction surgery, which is a long procedure, it can add a few more days to the patient’s recovery time in the hospital.


Generally, a mastectomy follows this process:

  • The patient will be provided with a gown to change the dress. 
  • The patient will be inserting with an intravenous line into the arm or hand, through which medications and sedative will be administered.
  • The patient will be made to lie on their back on the operating table. During surgery, the patient’s vital signs (heart rate, blood pressure, breathing rate, and blood oxygen level) will be monitored.
  • A sterile solution will be used to clean the area of the operated skin.
  • The surgeon starts the procedure by making an elliptical incision around the patient’s breast. Depending on the type of mastectomy, a specific incision type may be used. 
  • Breast tissue and other breast features will be removed as well, depending on the surgical method chosen. After the breast or breast tissue has been removed, the lymph nodes may also be taken out.
  • The removed tissue and lymph nodes will be sent for laboratory analysis for the examination. The plastic surgeon will be coordinating with the breast surgeon, if the patient’s breast reconstruction has been scheduled along with mastectomy. 
  • Temporary tissue expanders are one of the breast reconstructions options where it will form a new breast mound. Temporary tissue expanders may be placed in the chest to support the breast skin for women who will undergo radiation therapy after surgery. 
  • The surgeon will be inserting one or more tiny plastic tubes (mastectomy drains) at the site of breast removal. Any fluids that build up after surgery can be drained away through these tubes, where they are stitched into place and the ends are connected to a drainage bag.
  • The surgical area will be closed with stitches or adhesive strips and the area will be covered with a sterile bandage or dressing.

What to expect after a mastectomy surgery??

After having a mastectomy, depending on the type of mastectomy surgery and the involvement of the breast reconstruction process, the patient needs to stay for a few more days in the hospital. In some cases, chemotherapy or radiation therapy may be required after a mastectomy, which is further advised by the physician.

After the surgery, the patient can expect to:

  • The patient will be taken into a recovery room once their vital signs (heart rate, respiration rate, and blood pressure) are stabilised.
  • The patient might feel pain, a pinching sensation, and numbness at the underarm location after the removal of sedation. 
  • Depending on the type of surgery and the patient's condition, the patient has to stay in the hospital. The patient will have a scar at the mastectomy site and also have a pulling feeling near or under the arm after surgery.


The physician will provide specific instructions related to incision, drain care, signs of infection, and dressing at the time of discharge such as: 

  • When there is an infection at the site of the procedure, what should be done or to whom should be contacted?
  • How to replace a wet dressing with a clean one after having a bath?
  • When and how often must the drain be emptied per day, and how to do so?
  • When to start using the arm again and how to do arm exercises to prevent stiffness?
  • When to begin wearing inner garments (mastectomy bra) and the type of prosthesis to be used?
  • When to resume the old medication, which was stopped because of surgery and usage of medications for pain management and infection control?
  • Follow-up visits.

Breast Reconstruction after Mastectomy Procedure

Breast reconstruction surgery is an option for many women who undergo a mastectomy surgery (the surgical removal of a breast for the purpose of treating or preventing breast cancer). It can be done along with the mastectomy surgery (post-surgery) or later (delayed reconstruction) after the breast cancer treatment is over and the incisions from the mastectomy have healed. The breast reconstruction is majorly performed with nipple-sparing mastectomy, as the patient’s breast skin is saved in this process. 


Many different approaches exist for women who want to undergo breast reconstruction. Saline or silicone implants can be used to reconstruct the breasts. Autologous tissue reconstruction is another option where tissue is taken from another place in the patient’s body to form a breast shape. The tissue-based approaches include transverse rectus abdominis myocutaneous flap (TRAM), latissimus dorsi flap, and the deep inferior epigastric perforator flap (DIEP). When reconstructing the breast, the physician might sometimes use both implants and the patient's own tissue.


If the nipple and areola were removed during the mastectomy, they may be re-created on the reconstructed breast as a final step in breast reconstruction. In order to achieve symmetry between the breasts, breast reconstruction procedures may also be performed on the opposite breast.



The implants are placed in a two staged process:


Stage 1: After a mastectomy, the surgeon will insert a tissue expander under the patient's skin or directly into the chest muscle to help the patient regain breast volume. At periodic doctor's visits after the surgery, the expander is gradually filled with saline.


Stage 2: After 2 to 6 months of mastectomy, as soon as the chest tissue has healed and softened, the expander is taken out and an implant is replaced. In some cases, the implant will be placed while the patient is having mastectomy surgery without placing a tissue expander.

Arm care after lymph node removal

Radiation therapy for breast cancer frequently involves the removal of nearby axillary lymph nodes (either some or all). This disrupts the flow of lymph, which can lead to swelling. Injury to the patient's arm may put them at greater risk for infection. Having surgery near the armpit also increases the risk of developing a blood clot in the armpit veins.



After the removal of lymph nodes, there are ongoing precautions the patient must take for the rest of their life, such as: 

  • No injections or intravenous lines were inserted into the patient’s arm.
  • Patients should pay close attention to the guidance given regarding arm exercises.
  • When carrying heavy luggage, the patient should not strain their weaker arm or shoulder; instead, use both hands.
  • For lymphatic drainage, raise the affected arm so that the hand is above the elbow.
  • The patient should not step outside under the hot sun.
  • No blood pressure readings should be taken from the affected arms.
  • The patient should keep the affected arm free from harm, such as cuts and splinters and should also wear gloves before doing any work that could cause a cut, such as working with harsh chemicals like detergents or household cleaners.
  • The patient should avoid wearing tight clothing on the injured arm, such as elastic wristbands, tight watches, and other jewellery. 
  • Patients should shave their armpits with a clean razor.
  • The physician might give the patients other instructions, depending on their situation.

Complications of mastectomy surgery

Possible complications of mastectomy surgery include:

  • Temporary breast swelling
  • Pain in the breasts 
  • Wound infection or bleeding
  • Formation of scar tissue at the wound site (incision)
  • Arm swelling (lymphedema) after lymph node removal 
  • Shoulder stiffness and pain 
  • Surgical site blood clot formation (hematoma)
  • After modified radical mastectomy or breast conserving surgery, the breast may contain clear fluid (seroma) in the dead space of the post-mastectomy skin flap, axilla, or breast.
  • Suffering from depression and a feeling of loss of sexual identity.
  • Risk of local recurrence (5-10%), incisional dog ears and mastectomy skin flap necrosis for total mastectomy.

Mastectomy vs Lumpectomy | Difference between lumpectomy and mastectomy

A lumpectomy, followed by radiation therapy, is an option for breast cancer patients who don't want to have both breasts amputated (mastectomy).

Elements Mastectomy Lumpectomy
Definition The surgeon removes the entire breast tissue and possibly a few lymph nodes under the arm. Mastectomy is more invasive. The only part of the breast that has cancer and a small amount of healthy tissue around it are removed by the surgeon. When compared to mastectomy, lumpectomy is less invasive.
Local recurrence Low chances of local reoccurrences. Higher risk of developing a local recurrence of the cancer after surgery.
Radiation therapy Radiation therapy is not mandatory following mastectomy surgery. Patient need to have radiation therapy (5 or 6 weeks) post lumpectomy for five days a week. In the event of a recurrence (same cancer, or of a new cancer) in the same breast after lumpectomy, further radiation would be harmful.
Safety Presence of post-surgery side effects and a longer recovery time. Compared to mastectomy, it has a short recovery time with fewer post-surgery side effects.
Indication Early-stage breast cancer (Stage I and II), Locally advanced (Stage III) and inflammatory breast cancer after chemotherapy, Ductal carcinoma in situ (DCIS), or non-invasive breast cancer and Paget's disease Benign breast lumps, such as fibroadenoma or phyllodes, Depending on the size of the lesion, ductal carcinoma in situ or invasive breast cancer that can be treated without removing the breast.

  • Is a mastectomy painful?

    Yes, some women experience prolonged nerve (neuropathic) pain after having breast cancer surgery due to nerve damage in the chest wall, armpit, and/or arm that does not resolve over time following a mastectomy. Chronic pain following a mastectomy may be more likely in women who:

    • At a young age at the time of surgery
    • Had breast pain prior to their surgery
    • Had a lot of anxiety or catastrophizing before surgery
    • Underwent axillary lymph node dissection rather than sentinel lymph node biopsy
    • Suffered from sudden, severe postmastectomy pain

  • Does a mastectomy prevent breast cancer?

    Yes, a prophylactic mastectomy or voluntary mastectomy (removal of one or both breasts for preventative reasons) surgery can lower the chances of getting breast cancer. However, there will be a 10% possible risk of developing breast cancer despite the procedure. This is due to the fact that, even after a mastectomy, all the breast cells cannot be removed and the left behind cells might mutate (develop to become cancerous).


  • How long does pain last after double mastectomy?

    Patients will have post-surgery pain related to nerves (neuropathic) as it damages nerves present in the armpit and chest, which is known as post mastectomy pain syndrome. This is the most common nerve injury in mastectomy, characterised by tingling in the chest wall, armpit, and/or arm which stays for a long time.

  • Can you get breast cancer after a mastectomy?

    Yes, in some cases, cancer treatments can shrink tumours to undetectable levels. These compromised cells may survive treatment and persist in the body. Before surgery, cancer cells can spread to neighbouring organs and systems, such as the lymph nodes and the blood. Recurrences of breast cancer typically occur locally within the first five years after a lumpectomy. Even if the cancer wasn't found in the axillary lymph nodes at the time of surgery, there is still a 6 percent chance of recurrence within the next five years. If cancer has spread to the axillary lymph nodes, there is a 25% chance that the cancer will return. In contrast, if radiation therapy is performed after a mastectomy, the risk is reduced to 6%, as radiation treatment can reduce the recurrence after a mastectomy.

Explore the mastectomy cost as per the types

How much does a mastectomy cost in India?

The average cost of mastectomy surgery in India is approximately Rs. 1,78,000 (one lakh seventy-eight thousand only). However, mastectomy cost in India may vary depending upon the different hospitals in different cities.


A mastectomy surgery cost in Hyderabad ranges vary from Rs. 1,25,000 to Rs. 1,58,000 (one lakh twenty-five thousand to one lakh fifty-eight thousand). However, cost of mastectomy surgery depends upon the multiple factors such as type of the breast cancer, selection of room for hospital stay and corporate, Central Government Health Scheme (CGHS), ESI, Employee And Journalist Health Scheme by Telangana State Government, EHS or insurance approval for cashless facility.

Frequently asked questions:

  • Is a mastectomy major surgery?

    Yes, a mastectomy is a major surgery in which one or both breasts are removed to treat cancer or to reduce the risk of breast cancer in a woman who is predisposed to the disease. Lymph nodes in the underarm may also be removed during a mastectomy. It usually involves a brief hospital stay followed by a longer healing phase that can last anywhere from a few weeks to several weeks, depending on the patient's condition.

  • Is radiation needed after mastectomy surgery?

    Yes, radiation therapy can also be used after a mastectomy. Radiation can eliminate any leftover cancer cells and reduce the likelihood of the disease reoccurring. Depending on the patient’s condition, the physician opt for radiotherapy such as:

     

    Lymph nodes with signs of breast cancer: If the patient underarm lymph nodes (axillary) test positive for cancer cells, that indicates, the disease has progressed beyond the breast.

     

    Large tumour size: As a general rule, the chance of recurrence for breast cancer increases when the tumour is larger than 2 inches (5 cm).


    Positive tissue margins: Tissue analysis is performed after breast tissue is removed to detect any remaining cancer cells in the margins of the tissue. There is a higher chance of cancer recurrence if the margins were extremely narrow or if they tested positive for cancer cells.

  • What is the breast reconstruction after mastectomy?

    Breast reconstruction surgery is an option for many women who undergo a mastectomy, the surgical removal of a breast for the purpose of treating or preventing breast cancer. There are a variety of approaches available to women who want to undergo breast reconstruction, such as


    • Implants (made of saline or silicone).
    • Autologous tissue reconstruction (tissue taken from another place in the patient’s body to form a breast shape). 
    • Pre-pectoral breast reconstruction, a novel and less painful breast implant procedure.

    In some cases, both implants and autologous tissue has been used for breast reconstruction.

  • What I wish I knew before mastectomy?

    The patient should know the following from the physician prior to mastectomy:

    • A detailed explanation of the surgical procedure, including risks, side effects, and complications associated with it.
    • What medications must be stopped and what diet must be followed prior to surgery
    • Estimated length of hospital stay. However, it might increase depending on the patient's condition post-surgery.

  • How to sleep with mastectomy drains?

    Most of the patient’s healing process happens during sleep. The patient should sleep on her back with her upper body elevated after a mastectomy or breast surgery, which is the ideal position to promote the healing process. This also helps to improve circulation and reduce post-surgery swelling. The patient can opt for a mastectomy pillow for additional comfort. These drains might be removed after 2 to 3 weeks(at the first follow-up exam).

  • What to wear after mastectomy without reconstruction?

    It depends on the type of mastectomy the surgeon operates on and the patient’s emotions towards the outcome of the surgery. The patient is not allowed to wear anything apart from a dressing band as the patient’s chest can be sore for the first few days’ post-surgery. If a patient had a total, double, radical, or modified radical mastectomies, which resulted in the complete removal of breast tissues, the patient may prefer to wear a cotton breast prosthesis (artificial breasts) that looks like a normal breast after the drains were removed.

  • How long after mastectomy can you lift your arms?

    Once the patient has recovered from surgery and is feeling well enough to move around, the patient can begin gentle exercises as per the physician’s or physiotherapists advise. The patient can start the exercises the day after the surgery. The patient should not engage in more strenuous exercise, such as housework or heavy lifting, until the physician provides a green call.

  • How to reduce fluid build-up after mastectomy

    The early complication of breast cancer surgery, whether it be a modified radical mastectomy (MRM) or breast conserving surgery (BCS), is the development of a seroma, which is a collection of serous fluid (clear body fluid) in the dead space (removal of tissue) of the skin flap, axilla, or breast. In order to prevent fluid build-up, the physician may recommend to wear a compression sleeve and usage of drains. 

  • Why can't you take blood pressure on side of mastectomy?

    Regardless of the extent of lymph node excision, measuring blood pressure with a cuff on the ipsilateral arm (same side of the surgery) is a risk factor for the development of lymphedema following breast cancer therapy. The injury to lymphatic vessels is caused by the cuff's pressure, which in response causes the patient’s body to produce more lymph fluid.


  • When can I take a bath after mastectomy?

    It depends on the removal of drains. In general, the drains will be removed in the week of 2nd or 3rd post that, the patient can have a shower by taking special precautions in order to make sure that, the sutures are not disturbed.

  • Why can't you keep your nipples after a mastectomy?

    It depends on the patient’s condition and the type of surgery. In total, double, radical, modified radical and skin-sparing mastectomies, the surgeon removes the entire breast, including the nipple, whereas, in nipple-sparing mastectomy, only the breast tissue will be removed but not the nipples.

  • Can you get breast implants after mastectomy?

    Yes, breast implants can be inserted after mastectomy. In general, there are two procedures to insert the implants after mastectomy. Either by inserting a tissue expander at the time of mastectomy, followed by replacement with an implant after 2 to 6 months of surgery, or directly inserting an implant while the patient is having mastectomy surgery.

  • How to prevent lymphedema after mastectomy?

    Lymphedema could be prevented if the patient maintains a good skin care and regular exercise post mastectomy surgery. Availability of advances in lymph node surgery also resulted in a lower risk of lymphedema. However, there is no tried-and-true process or procedure to prevent lymphedema after a patient undergoes mastectomy.

  • Can you still breastfeed after nipple sparing mastectomy?

    Yes, breastfeeding is safe and encouraged by the physicians for mothers who have had breast or nipple surgery in the past. There is a minimum amount of colostrum (first milk).  that every postpartum woman is capable of producing. The antibodies in the mother's milk are passed on to the baby at each feeding, even if the mother only manages to produce a small amount of milk.

  • What to wear after mastectomy and reconstruction?

    Nipple reconstruction occurs after the chest has healed from reconstruction surgery and the breast mound has settled into place on the chest wall. In most cases, the new nipple is formed by cutting and repositioning tiny pieces of skin from the reconstructed breast to the nipple site, where they are then shaped into a new nipple. In some cases, women who choose not to undergo surgical nipple reconstruction may want to consult with a tattoo artist who specialises in 3-D nipple tattooing to have a realistic picture of a nipple created on the reconstructed breast which is generally called as mastectomy tattoos or nipple tattoos after mastectomy.

  • Can you have a mammogram after double mastectomy?

    No, in the case of double mastectomy, both breasts have been removed after the mastectomy surgery. Hence, there shouldn't be enough patient breast tissue to perform a mammogram, so the procedure should be unnecessary. However, the cancer may recur on the skin or chest wall on that side, but the physician can typically detect it either during a physical exam or a breast self-exam. 

  • What to expect after a double mastectomy with reconstruction?

    The patient will be experiencing temporary soreness in the chest, underarms and shoulder, as well as possible numbness across the chest that may be permanent. The surgical drains that were inserted inside the patient’s breast area during surgery typically stay in for about 14 to 21 days. If the patient also has breast reconstruction, mastectomy recovery can take around six to eight weeks.

  • Is hormone therapy necessary after double mastectomy?

    Yes, after surgery, hormone therapy is the treatment of choice for physicians because it helps to reduce the size of the tumour and, hence, it decreases the risk of reoccurrence post-surgery.

  • Does cording after mastectomy go away?

    Yes, most cases of cording can be cured in a matter of weeks or months with the help of physiotherapy and exercises. This condition typically starts within days or weeks after surgery following a lymph node dissection where the pain occurs in the patient’s armpit (axilla) when the patient’s arm is stretched and raised above shoulder level.

  • How do I empty my drain?

    In order to empty the drain, the patient needs to remove the fluid from the bulb, which collects the fluid that drains from a wound.

    • The patient needs to empty the drain every 8 hours once they are discharged and are at home.
    • After emptying, the patient should fill out the drainage record sheet, to help the caretaker team to keep track of the amount of drained fluid.
    • The fluid will be red at first, and over time the fluid will look like the colour of apple juice.
    • Small clots of blood or tissue may be seen in the drain – this is normal.