Mastectomy: what happens, risks and recovery

The NHS describes surgery as usually the main treatment for breast cancer, with breast-conserving surgery and mastectomy as the two broad options. Which is advised depends on the size, type and position of the cancer and whether it has spread, and the specialist team talks this through with each person. A mastectomy is also sometimes chosen to lower risk, for people with a high risk of developing breast cancer.

Mastectomy is not automatically the more thorough choice. For many early cancers, removing only the cancer and then giving radiotherapy is an established alternative, and some people prefer to keep their breast. This is a decision to make with the surgeon and breast care nurse, and having time to think it over is reasonable.

After a mastectomy, reconstruction is an option, either at the same time or in a later operation, as the NHS notes. Some people prefer no reconstruction, and wear a prosthesis in the bra or go without. Each of these is a valid choice.

A health-check appointment usually takes place days to weeks beforehand and may include blood tests, X-rays or an ECG. The NHS says fasting is needed for up to six hours before surgery, and stopping smoking for weeks beforehand is advised. Compression stockings may be provided to reduce the chance of a clot in the leg.

It helps to think about practical matters early. Loose, front-fastening tops are easier in the first weeks, and a supportive non-wired bra is advised by one Bath trust leaflet. Many people also find it useful to meet a breast care nurse beforehand to talk about prostheses, arm exercises and what the scar will look like.

• Ask whether a temporary soft prosthesis is given before you leave hospital; the Worcestershire leaflet says one is provided.

• Plan help at home for lifting and housework in the early weeks.

• Take your regular medicines list so the team can advise which to continue.

Under general anaesthetic the surgeon makes a cut across the chest, often running towards the armpit, and removes the breast tissue. The NHS says the breast, nipple and skin are usually taken, and that the lymph nodes in the armpit may also be removed or sampled. In a nipple-sparing technique used with reconstruction the nipple can be kept.

The NHS gives about 90 minutes for a single mastectomy and about three hours for a double one. Worcestershire says most patients leave the same day or the next morning, while the NHS notes that people having reconstruction at the same time typically stay several days.

You may wake with drains, which are thin tubes that collect fluid and blood from the wound. They are temporary and, the NHS says, usually come out within days or weeks. Some people go home with a drain and have a district nurse or breast clinic check it.

The NHS lists wound bleeding, a collection of fluid called a seroma, infection, painful scarring, blood clots in the leg, numbness in the arm, a frozen shoulder and lymphoedema as possible complications, and does not give percentages. Worcestershire quotes the risk from general anaesthetic as 1 in 250,000, and notes that risk rises with age, with being overweight and with other health conditions.

A seroma is common and often settles. The Bath leaflet says fluid may need draining more than once and is not lymphoedema. Short shooting pains, altered feeling or numbness around the wound and armpit are described as common as nerves recover, and some change may be permanent. Phantom breast sensations can last a few months.

Emotional effects deserve a mention, too. Feelings of loss, anger or low mood are common after the operation, and the breast care nurses are there for that part of recovery as well as the physical part.

Worcestershire gives four to six weeks for full recovery, and the NHS says most routine activities return within three weeks, with the wound taking about six weeks to heal. Arm and shoulder exercises begin early and continue for weeks, which is explained further in the recovery timeline for this operation.

The Bath trust advises not driving for at least three weeks and being confident of an emergency stop; the NHS says to resume once wounds have healed and a seat belt is comfortable. Check your insurer's terms, and see the GOV.UK pages on surgery and driving.

The NHS advises contacting NHS 111 for sudden pain, swelling, bleeding from the wound or new arm numbness. Dial 999 for severe difficulty breathing, chest or upper back pain, a racing heart or collapse, which can signal a clot on the lung. For redness, heat or a new discharge from the wound, contact your breast care nurse or GP the same day.