Breast Cancer Surgery

Mastectomy

Mastectomy removes the whole breast. At Breastory, it is almost always discussed alongside reconstruction from the first consultation — the decision about whether, when, and how is yours to make with the full picture in front of you. Dr Fiona Tsang-Wright (GMC 4549831), Consultant Oncoplastic and Reconstructive Breast Surgeon, operates privately in London and Buckinghamshire at the Women's Health Centre – Harley Street, Women's Health Centre - King's Road, and The Chiltern Hospital, and as NHS Consultant at Bucks Breast Unit, Buckinghamshire Healthcare NHS Trust.

Decision 1
Type of mastectomy
Decision 2
Reconstruction approach
Decision 3
Timing of reconstruction

Quick answers

Can I have reconstruction at the same time?

Usually yes. Immediate reconstruction is discussed at your first consultation.

Will I need radiotherapy?

Most won't. It depends on the cancer, not the surgery type.

Can the nipple be preserved?

In suitable cases, yes. Nipple-sparing requires the cancer not to be close to the nipple.

What does 'going flat' mean?

Choosing no reconstruction — a flat, smooth chest wall. A valid choice with specific surgical technique.

01
Decision 1 of 3

Type of mastectomy

Standard
Simple (total) mastectomy

All breast tissue, together with the overlying skin and nipple, are removed. Used when reconstruction is not chosen, or where the cancer's position or skin involvement means the skin and nipple cannot be preserved.

Commonly chosen
Skin-sparing mastectomy

Breast tissue and nipple are removed through a small incision around the areola. Most of the skin envelope is preserved — creates a better result when immediate reconstruction is planned.

Where suitable
Nipple-sparing mastectomy

Breast tissue is removed; the skin envelope and nipple-areolar complex are both preserved. Offered when the cancer is not close to the nipple. Requires careful case selection.

Preventive
Risk-reducing mastectomy

Removal of healthy breast tissue to reduce future cancer risk in patients with a known genetic mutation (BRCA1 or BRCA2) or very high-risk family history. Usually skin-sparing or nipple-sparing with immediate reconstruction.

The type chosen depends on the cancer, your anatomy, and your preferences. This is a detailed conversation at consultation, with written information to take home — not a decision made on the day.

02
Decision 2 of 3

Reconstruction approach

Implant-based reconstruction

A silicone implant placed at the time of mastectomy, often with an acellular dermal matrix (ADM) to support the lower half.

  • Shorter recovery
  • No second surgical site
  • Same-day operation as mastectomy
Implants are devices and may need revision or replacement over time. The breast does not change with weight or age as natural tissue does.

Own-tissue reconstruction (DIEP flap)

Skin and fat from the lower abdomen used to form the new breast. Feels and ages like natural tissue. Coordinated with a plastic-surgery colleague from your first consultation.

  • Feels and ages like natural tissue
  • Not a device — no revision from device failure
Larger operation (6–8 hrs), longer recovery, and a second surgical site on the abdomen.

Going flat

Choosing no reconstruction — a smooth, flat chest wall. Sometimes called aesthetic flat closure. A valid choice, not an absence of decision.

  • No reconstruction recovery
  • Simpler long-term follow-up
Requires specific flat-closure technique — not the same as simply not having reconstruction.
03
Decision 3 of 3

Timing of reconstruction

Immediate reconstruction is done at the same operation as the mastectomy — you wake up with a reconstructed breast. Most patients without planned radiotherapy are candidates.

Delayed reconstruction is done months or years later, once adjuvant treatment (particularly radiotherapy) is complete. Radiotherapy can affect reconstruction outcomes — particularly implants — and in some cases a delayed approach gives a better long-term result. This is a case-by-case discussion.

At a glance

The operation

Anaesthetic General
Implant op time 1–3 hours
DIEP op time 6–8 hours
Implant stay 1–2 nights
DIEP stay 4–5 nights
Return to work 4–6 weeks
Full activity 3+ months
  • Anaesthetic: general anaesthetic.
  • Length of operation: typically 2–3 hours for mastectomy with implant-based reconstruction; 6–8 hours for mastectomy with DIEP reconstruction. Bilateral surgery, more complex reconstructions, or sentinel node biopsy can add time.
  • Hospital stay: typically 1–2 nights for mastectomy with implant-based reconstruction (some patients are now discharged the same day where suitable); usually 3–5 nights for mastectomy with DIEP reconstruction, depending on how flap monitoring and pain control are progressing.
  • Sentinel lymph node biopsy is usually done at the same operation: for invasive breast cancer to stage the axilla, and for DCIS being treated with mastectomy because once the breast is removed the lymphatic drainage is altered and a sentinel node biopsy cannot reliably be done later if invasive disease is found in the specimen.
  • Drains: typically 1–2 surgical drains for the first week or two after implant reconstruction; drains are removed once the daily output is low enough, so the exact day varies between patients. After DIEP reconstruction drains usually stay in a little longer, both at the breast site and at the abdominal donor site.
After surgery

Recovery

Week 1
At home with drains

Limited arm movement on the operated side. Regular simple pain relief. Drains still in place.

Weeks 2–4
Increasing movement

Progressive arm range of movement with physiotherapy. Driving usually resumed at 3–4 weeks.

Weeks 4–6
Return to desk work

Most patients with desk-based work return. Physical work takes a little longer.

3 months
Full activity

Most patients back to full activity including exercise (implant-based). DIEP reconstruction typically needs an extra month or two for full abdominal recovery.

Follow-up appointments are at two weeks, six weeks, three months, six months, one year, and then annually.

What the operation does

A mastectomy removes the whole breast — the breast tissue, and, depending on the type of mastectomy, some or all of the overlying skin and nipple. It is used to treat breast cancer where breast-conserving surgery is not suitable or not preferred, and to reduce future risk in a small group of women at high inherited risk — for example those with a known BRCA1, BRCA2 or TP53 gene change, or a very strong family history assessed through a specialist genetics service (in line with NICE CG164).

At Breastory, mastectomy is almost always discussed alongside reconstruction from the first consultation. Whether reconstruction is chosen — and if so, what type — is your decision, informed by the clinical situation, your anatomy, and what matters most to you about the outcome.

Psychological and practical considerations

Mastectomy — with or without reconstruction — is a significant operation, and its impact is not only physical. Time is built into consultations to discuss what this means for you personally: body image, intimacy, clothing and swimwear, lymphoedema risk, bra fitting after surgery. You will also be offered contact with the breast-care nurses at your hospital, who provide practical and emotional support throughout the pathway.

If you would like to speak to a patient who has been through a similar operation, this can often be arranged through patient-support networks — ask Sarah or Nadiya, Dr Tsang-Wright’s PAs, or breast-care nurses.

Related: Breast cancer surgery overview · Wide local excision (lumpectomy) · Sentinel lymph node biopsy · DIEP flap glossary entry · Clinical philosophy

Common questions

Frequently asked questions

Will I need chemotherapy or radiotherapy after a mastectomy?
It depends on the cancer. Most patients who have a mastectomy do not need radiotherapy — one of the reasons mastectomy is chosen in some cases. Some do, particularly with larger tumours or significant lymph node involvement. Chemotherapy and hormone therapy are decided by the cancer's biology, not by the type of surgery.
Can I have immediate reconstruction if I need radiotherapy?
Often yes, but with important nuances. Radiotherapy affects reconstructed tissue — particularly implants — and in some cases a delayed reconstruction after radiotherapy is complete gives a better long-term result. This is a case-by-case discussion based on the likely need for radiotherapy, the type of reconstruction planned, and your preferences.
What is the difference between skin-sparing and nipple-sparing mastectomy?
A skin-sparing mastectomy preserves the breast skin envelope but removes the nipple. A nipple-sparing mastectomy preserves both the skin and the nipple-areolar complex. Nipple-sparing gives a more natural look when paired with immediate reconstruction but is only suitable when the cancer is not close to the nipple.
What is a risk-reducing mastectomy?
A mastectomy performed on healthy breast tissue to reduce the risk of developing breast cancer in the future. It is considered for patients with a high-risk genetic mutation (for example BRCA1 or BRCA2) or a very strong family history. The decision involves genetic counselling and a thorough discussion of the risk reduction achieved (typically around 90% or more for BRCA mutation carriers) versus the implications of surgery.
Will I lose sensation in the chest after a mastectomy?
Significant loss or change of sensation in the chest wall and — where preserved — the nipple is expected after mastectomy. Some sensation may return over months to years, but full pre-operative sensation typically does not. This is important to understand when considering nipple-sparing versus skin-sparing approaches, particularly for patients considering risk-reducing surgery.
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