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The information on this page was reviewed and approved by
Maurie Markman, MD, President, Medicine & Science at CTCA.

This page was updated on August 13, 2021.

Double mastectomy

A double mastectomy—also known as a bilateral mastectomy—is exactly what it sounds like: a surgery in which both breasts are removed at the same time.

It’s major surgery that removes both breasts to remove cancer, or to reduce the risk of breast cancer in a woman who may be at high risk for the disease. It usually requires a short hospital stay and a longer recovery time that may take a few weeks to several weeks, depending on the circumstances.

Types

  • A simple mastectomy involves surgically removing the entire breast, including the skin, nipple and areola.
  • A modified radical mastectomy removes the entire breast and axillary lymph nodes under the arm.
  • A nipple-sparing mastectomy is a mastectomy procedure that saves a part of the breast. Both the skin and the nipple are preserved. This surgery is more likely to be an option if you have very early-stage cancer that is not located near the nipple or has affected the skin.
  • A radical mastectomy involves not only removing the entire breast and lymph nodes, but also the pectoral muscles that are located under the breast. This procedure is rarely done these days, except in the case of larger tumors growing into the pectoral muscles. The American Cancer Society notes that a modified radical mastectomy has been found to be as effective with fewer side effects.

An oncologist carefully evaluates a double mastectomy as a treatment option by comparing it to the benefits and risks of other breast-conserving surgeries.

Many people with early-stage cancer can choose between breast-conserving surgery or mastectomy. Studies show that, for them, opting for mastectomy or breast-conserving surgery plus radiation therapy has similar outcomes. That can vary based on a number of reasons that are specific to a woman’s own specific diagnosis and circumstances.

Breast reconstruction can be done at the same time as the mastectomy or at any later time. Many women also opt not to have reconstruction.

What to expect during surgery

You will receive general anesthesia before your surgery, so you’ll be asleep during the procedure. Unless you’ve decided on a nipple-sparing surgery, the surgeon will remove as much of the tissue as possible from both your breasts. This includes the skin, nipple and areola.

Sometimes that also includes the lymph nodes from under the arm. The doctor may also remove the pectoral muscles, located under the breasts.

As part of the surgery, the surgeon will remove breast tissue and insert one or two tubes for fluid to drain into from an attached soft-rubber ball.

Sometimes breast reconstruction is performed at the same time as mastectomy. Choices for reconstruction include breast reconstruction using breast implants or what’s known as tissue flap surgery, which reconstructs the breast by using muscle, fat and skin taken from other parts of the body.

At the end of the surgery, the area is closed with stitches.

A woman who has undergone a mastectomy typically stays in the hospital for one or two nights.

What to expect from recovery

You can expect temporary soreness in your chest, underarm and shoulder, as well as possible numbness across your chest that may be permanent.

The surgical drains that were inserted inside your breast area during surgery typically stay in for about one week to 10 days.

While recovering from surgery, most people have some pain. With a mastectomy, it can take three to four weeks to feel mostly normal. If you also have breast reconstruction, recovery can take six to eight weeks. For some procedures, it can take months before you can return to being fully active.

You'll likely receive a written list of instructions about post-surgical care that includes:

  • How to care for the surgery site and dressings
  • How to recognize signs of infection
  • Tips for bathing and showering after surgery
  • When you can use your arm again
  • Arm exercises to prevent stiffness
  • Restrictions on activity

Risk-reducing surgery explained

Prophylactic mastectomy (also known as risk-reducing surgery) is performed on women who don’t have breast cancer but who choose to have both breasts removed.

You might choose this option if your breast cancer risk is very high. According to the National Cancer Institute (NCI), double mastectomy lowers the risk of developing breast cancer by at least 90 percent for women with a strong family history and by about 95 percent if for those with a particular disease-causing mutation in the BRCA1 or BRCA2 genes.

High-risk gene mutations include:

  • BRCA1
  • BRCA2
  • PALB2
  • PTEN
  • TP53

This risk can be discovered through genetic testing. The lifetime risk of breast cancer for the average American woman is 12 percent.

All people have BRCA1 and BRCA2 genes, but only some people have the gene mutations linked to a higher cancer risk. According to NCI:

  • Someone with either a BRCA1 or BRCA2 gene mutation has a 50 percent chance of getting breast cancer by age 70, compared to a 7 percent chance among the general population in the United States.
  • Someone with either a BRCA1 or BRCA2 gene mutation has a 30 percent chance of having ovarian cancer by 70, compared to 1 percent of the general population.

In addition to the BRCA1 and BRCA2 gene mutations, an abnormality called a high-penetrance mutation in one of several other genes may also put you at high risk of breast cancer.

Some other reasons to consider a prophylactic mastectomy:

  • A strong history of breast cancer in your family
  • Radiation therapy to the chest before age 30
  • A previous breast cancer diagnosis in one breast
  • Lobular carcinoma in situ (LCIS), which characterized by abnormal cells in the lobules of the breast, plus a family history of breast cancer. Though LCIS is not cancer, women with the condition have an increased risk of developing invasive breast cancer.

A contralateral prophylactic mastectomy is the procedure when someone has cancer in one breast and opts to also remove the healthy breast.

You might choose this:

  • To ease worries about getting breast cancer again in either breast
  • Because you also have one of the inherited gene mutations that put you at greater risk

The benefit of having a contralateral prophylactic mastectomy is more likely for someone who has cancer and a higher genetic risk for cancer. The benefit is not as clear for those who don’t have those other risk factors.

A mastectomy is not considered an appropriate option for someone with average or slightly increased breast cancer risk because, like all surgeries, the procedure carries its own risks, including bleeding and infection at the surgery site.

Even a double mastectomy can’t remove all your breast cells, so some risk remains.

Another surgery that may reduce breast cancer risk for high-risk women is a bilateral prophylactic salpingo-oophorectomy. This involves removing both ovaries and fallopian tubes. According to NCI, this procedure may reduce the risk of ovarian cancer by about 90 percent, while also reducing the risk of breast cancer by about 50 percent for women at very high risk. Removing the ovaries may reduce the amount of estrogen produced in a premenopausal woman. This may slow the growth of some breast cancers.

Intensive screening options

Other options for reducing breast cancer risk besides surgery can include intensive screening. This might mean starting mammography at an earlier age (30 years old is recommended for those at high risk) or undergoing tests in addition to mammography.

  • Additional testing may include yearly MRIs, which may find cancers that are not detected in mammograms.
  • Your doctor may choose to stagger mammography and MRI every six months, so breast images are taken more frequently. This enhanced screening may help with early detection.

Some medicines may also help lower your risk. Some drugs that may reduce cancer risk include antiestrogens or aromatase inhibitors, such as tamoxifen, raloxifene and exemestane.

It’s not yet clear whether these drugs can be used to prevent breast cancer in women at very high risk. Tamoxifen may help lower risk of cancer in a second breast among BRCA1 and BRCA2 carriers who were previously diagnosed with cancer.