Breast Cancer Surgery (Mastectomy)

Under general anaesthesia, the surgeon makes a horizontal elliptical incision across the chest from under the arm towards the breastbone (or a smaller incision for skin-/nipple-sparing approaches). The breast tissue is dissected off the underlying pectoralis major fascia and removed en bloc. A sentinel node biopsy or axillary clearance is performed through a separate axillary incision or the same incision. One or more closed-suction drains are placed before the skin is closed. If immediate reconstruction is planned, the plastic surgical team then proceeds with implant or autologous flap insertion.

1. 1Confirm diagnosis with image-guided core biopsy, breast MRI/staging imaging and multidisciplinary team plan.
2. 2Pre-operative bloods, ECG, anaesthetic review and discussion of reconstruction options.
3. 3Stop smoking 6-8 weeks before to optimise flap and wound healing.
4. 4Mark sentinel node with radioisotope or dye on the day of surgery.
5. 5Arrange post-discharge support, drain management training and post-mastectomy bra/prosthesis fitting.

1. 1Day 0-1: Hospital stay overnight with closed-suction drains; intravenous analgesia and shoulder exercises begin.
2. 2Days 1-7: Discharge with drains; daily wound and drain monitoring at home or in clinic.
3. 3Days 7-14: Drain removal once output is low; wound check by breast care nurse.
4. 4Weeks 2-3: Return to most usual activities; continue gentle shoulder rehabilitation.
5. 5Weeks 4-6: Full wound healing; oncology team reviews need for adjuvant chemotherapy, radiotherapy or endocrine therapy.
6. 6Months 3-12: Surveillance imaging, lymphoedema monitoring and any planned delayed reconstruction.