From: healthline.com
In this article, we’ll talk about when double mastectomy is a good option, different types of surgery, potential alternatives, and what you can expect recovery to be like.
Double mastectomy is the surgical removal of both breasts. The purpose is to:
- remove breast cancer
- reduce the risk of cancer for those who may be at high risk for breast cancer
- allow for symmetry
- avoid ongoing surveillance imaging if you’re at a high risk of breast cancer
Your doctor may recommend a double mastectomy if:
- You have breast cancer in both breasts: If the stage and characteristics do not make lumpectomy an option, you may have a double mastectomy.
- You have a high risk of contralateral breast cancer in the second breast: If you have cancer in one breast and have a very high risk of getting a second breast cancer in the remaining breast, you may choose a double mastectomy. A high risk includes having the BRCA1 or BRCA2 gene mutation, or a strong family history of breast cancer.
- You’re not at high risk for getting a second breast cancer, but you want to avoid worrying about the possibility: You may choose to have the second breast removed, as well as the one with cancer. The medical term for having a second healthy breast removed is contralateral prophylactic mastectomy (CPM). However, there’s no overall survival benefit for removing the contralateral breast, as breast cancers do not spread to the other breast.
- You want to reduce the risk of developing cancer in the future, even though you do not currently have breast cancer: A bilateral risk-reducing mastectomy is usually done only if you carry one of the genes linked to breast cancer risk, or you have a strong family history of breast cancer.
Are there benefits to having both breasts removed?
There may be some benefit to removing both breasts if you are at a very high risk of getting another breast cancer. (If you carry a BRCA gene mutation or have a strong family history of breast cancer, for example.)
The benefit is less clear for women who are not at high risk, as the risk of getting cancer in the other breast is usually lowTrusted Source, according to the American Cancer Society (ACS).
Even so, the number of women choosing CPMs tripled during the first decade of this century and is continuing to rise.
The American Society of Breast Surgeons (ASBrS)Trusted Source discourages CPMs for average-risk females with cancer in just one breast or for males with breast cancer. They point out that CPM surgeries have twice the complication rate as unilateral mastectomy, and the recovery time is longer.
The ASBrS recommends CPM as a good option to consider for female BRCA carriers and those with a strong family history of breast cancer. CPM is rarely a good choice for male cancer, even with the BRCA gene, they say.
Types of double mastectomy surgery include:
- Skin-sparing or nipple-sparing mastectomy: The surgeon removes the breast tissue but preserves the majority of the skin, and sometimes the nipple and areola for reconstruction.
- Simple (total) mastectomy: The surgeon removes the breast, areola, nipple, and most of the overlying skin. They may also remove the sentinel lymph nodes.
- Modified radical mastectomy: In this type, the surgeon removes the breast, areola, nipple, and most of the overlying skin. They also remove the lining over the chest muscles as well as the axillary lymph nodes under the arm.
- Radical mastectomy: This is the removal of the entire breast, areola, nipple, skin, chest muscles, and underarm lymph nodes. Doctors rarely perform this type.
Many people go home on the same day of the surgery, but some may have a short hospital stay of 1 to 2 days. You may need to stay in the hospital longer if your procedure is more complex, or if you also opt for immediate reconstructive surgery.
You also have an option for a delayed reconstruction or no reconstruction at all. The type of mastectomy you have will also impact when you can resume typical activities, which can be 4 to 6 weeks or more.
There are two stages to double mastectomy surgery. First, you’ll undergo the surgery itself. After the surgery, you’ll go home to recover. Read on to learn what to expect in each stage and how to prepare.
Preparing for surgery
Your doctor will explain the medical specifics. Here are some other things to consider in advance:
The drive home
After surgery, you’ll need someone to drive you home. The seat belt’s shoulder harness may hurt your sore chest. It can help to bring a small, soft pillow to place between your chest and the strap.
What you’ll wear
When you leave the hospital, you’ll still have drainage tubes in your chest. They’ll remain in place for at least a week or 2, maybe longer. Your chest and arms will be sore and stiff.
A post-mastectomy wardrobe typically involves soft, loose-fitting tops that are easy to put on and take off and ideally open at the front. That way, you avoid stretching your arms or pulling your shirt over your head. Specialty stores carry camisoles and tops with pockets for the drainage bulbs, or you can clip the bulb to your clothing. A large zip-up hoodie is a good option.
If you’re not having reconstruction and plan to wear prosthetics, hold off on buying mastectomy bras for now. Your size will change as your swelling goes down.
When you’re ready, a doctor will write a prescription for breast forms (prosthetics) and mastectomy bras, which may be covered by insurance.
What you’ll eat
You may not feel up to cooking after surgery, so consider preparing in advance if you can. Stock your kitchen, and if time permits, prepare a few meals for the freezer.
How you’ll nest
What helps you feel good? A thick novel, aromatherapy, your grandmother’s knitted blanket? Make sure it’s within easy reach of your favorite comfy chair or sofa.
Have a water bottle nearby so you can easily stay hydrated. Gather your essentials, such as your phone and charger, high protein snacks, and anything else you may need or want.
Asking for help
Your friends mean well when they say, “Let me know if I can do anything.” But don’t leave it to chance. Get your calendar out and get commitments ahead of time. Be sure to consider:
- babysitting
- transportation
- meals
- picking up prescription medications
Do you want to be left alone, or do you thrive on friends dropping by? Will there be holidays or special events during your recovery? Now’s the time to lay it all out and let people know what you need.
Have one family member or friend who can help send updates to your larger circle so that you don’t have to. Additionally, consider trying out a website or app for coordinating people who can help. One example is Caringbridge.org.
If you need more help
Make a list of organizations you can contact if needed. Consider babysitting, housecleaning services, and transportation.
The ACS provides a wealth of information on support programs and servicesTrusted Source in your area. A local support group may also be a good resource for information from others who have had similar experiences.
Managing your emotions
With or without reconstruction, having a double mastectomy can be an emotional experience. Know upfront that whatever feelings you have are valid. You’re allowed to have positive and negative emotions, and every type in between.
Don’t beat yourself up over any of them. They’re normal. Things won’t change overnight, so give yourself time to sort through it all.
The process of recovering from mastectomy is different for everyone. One reason it’s so variable is that not all mastectomies are the same.
There’s also an emotional component to mastectomy that may affect your recovery and change over time. Speak with your healthcare team about any distress that you may feel, especially if it interferes with your ability to take care of yourself or if it’s impacting your well-being.
Your cancer clinic may have professionals trained to support people with cancer about their emotional health.
What to know before leaving the hospital
After surgery, you’ll move to the recovery room, where nurses will monitor your vital signs. You’ll have a dressing and several drains coming out of your chest. You’ll likely receive pain medication, and your chest may feel numb.
You’ll be released for recovery at home or be transferred to a hospital room for the night. As sensation returns, you might feel pain and strange sensations in your chest and underarms.
You’ll receive instructions on:
- managing the drains
- noticing signs of infection, such as blood or fluid collection or lymphedema
- showering
- removing bandages
- taking medications
- stretching exercises for arms and shoulders
- returning for a follow-up appointment
- instructions about when you may return to normal activity
In your postsurgical recovery, it might be difficult to keep track of discharge instructions. You’ll probably get written instructions, too, but it’s a good idea to have someone else there to listen.
Barbara Jacoby is an award winning blogger that has contributed her writings to multiple online publications that have touched readers worldwide.