A mastectomy is a surgical procedure involving the removal of breast tissue, performed for breast cancer treatment or prevention. Understanding the potential changes to physical appearance following this surgery is a natural consideration.
Immediate Post-Surgical Appearance
Immediately following a mastectomy, the chest area will have surgical dressings or bandages covering incision sites. These dressings protect healing tissue and manage drainage. Bruising and swelling are common visual aspects in the surgical area.
The skin around the incision may appear discolored, ranging from purplish to yellowish hues, which gradually fade over several weeks. Surgical drains, often called Jackson-Pratt drains, are usually present. These small, clear tubes extend from the surgical site to a bulb-shaped reservoir, collecting fluid. This initial appearance is temporary as the body heals.
Appearance Without Reconstruction
For individuals who choose not to undergo breast reconstruction, the chest will typically have a “flat closure.” This involves the surgeon closing skin flaps directly over the chest wall, creating a smooth contour. The final appearance is usually a horizontal or diagonal scar where breast tissue once was.
The extent of tissue removal varies with mastectomy types, influencing the resulting flatness. A simple or total mastectomy primarily removes breast tissue, leaving a relatively flat chest. A modified radical mastectomy also removes some lymph nodes from the armpit, which may create a slightly different contour. The scar itself initially appears red or purple and may be raised, but over several months to a year, it typically flattens and fades to a lighter, less noticeable line. Aesthetic flat closure techniques remove excess skin and fat, tightening remaining tissue to create a taut, smooth chest wall without indentations.
Appearance With Reconstruction
Breast reconstruction aims to recreate a breast mound, using two primary methods. Implant-based reconstruction involves placing saline or silicone implants beneath the chest muscle or skin. Initially, tissue expanders may be used; these temporary, balloon-like implants are gradually filled with saline to stretch skin and muscle, creating space for a permanent implant. The reconstructed breast typically has a rounded appearance and projection, though its texture and feel may differ from natural breast tissue.
Autologous, or flap, reconstruction uses a woman’s own tissue from another part of the body, such as the abdomen, back, or thigh, to create a new breast. Procedures include the Deep Inferior Epigastric Perforator (DIEP) flap, which uses abdominal tissue, or the Latissimus Dorsi flap, which uses back muscle and skin. These reconstructed breasts often feel softer and more natural to the touch because they are made of living tissue. They also age and change with the body similarly to natural breast tissue.
To complete the reconstructed breast’s appearance, nipple and areola reconstruction can be performed. This often involves using local tissue rearrangement to create a projection resembling a nipple, followed by tattooing to simulate areola color and texture. Alternatively, 3D tattooing techniques can create a realistic nipple-areola complex directly on the skin. These final touches enhance the visual likeness of the reconstructed breast to a natural one.
Long-Term Visual Considerations
Over time, mastectomy scars, whether from flat closure or reconstruction, mature. Initially, scars can appear raised, red, or purple, but as healing progresses, they typically flatten, soften, and fade to a lighter color, often becoming a thin, silvery line. This process can take 12 to 18 months, with some changes continuing for up to two years. The final appearance of the scar is influenced by individual healing characteristics and surgical technique.
For women who have undergone a unilateral mastectomy, maintaining symmetry between the remaining breast and the treated side is a long-term consideration. Reconstructed breasts may not perfectly match the size, shape, or position of the natural breast. For those choosing flat closure, adapting to a single breast or a completely flat chest involves adjusting to a new body silhouette. External breast forms, also known as prostheses, offer a non-surgical option for a balanced look. These lightweight, silicone forms can be worn in specialized bras or clothing pockets, creating a symmetrical contour beneath garments.
In some instances, the removal of lymph nodes during a mastectomy can lead to lymphedema, a condition characterized by swelling, typically in the arm or hand on the affected side. Visually, lymphedema can cause the limb to appear enlarged or puffy, and the skin may develop a thickened or taut appearance. While lymphedema is a medical condition, its visual manifestation is a long-term aspect that some individuals may experience.