For women with larger breasts who are diagnosed with breast cancer, surgery can present a particular challenge.

Removing the tumour with adequate margins from a larger breast can be technically straightforward, but doing so while achieving a good cosmetic result and avoiding significant asymmetry with the opposite breast requires careful planning and specialist skill.

Therapeutic mammoplasty is an oncoplastic technique that addresses this challenge directly. It uses the established patterns of breast reduction surgery to remove the tumour along with a generous surrounding margin of tissue, simultaneously reshaping and lifting the breast into a more natural, elevated position. The result is a single operation that achieves both the cancer surgery and the breast reshaping together, rather than as separate procedures.

At Breast & Surgical Oncology at The Poche Centre, therapeutic mammoplasty is one of the most commonly performed oncoplastic procedures in our practice. It is a particular strength of our team, and all three of our specialist breast surgeons have dedicated training in the full range of reduction mammoplasty patterns used in its execution.

What Is Therapeutic Mammoplasty?

Therapeutic mammoplasty is a form of oncoplastic breast-conserving surgery in which a reduction mammoplasty technique is used to excise the tumour and reshape the breast in the same operation. Rather than cutting out the tumour through a small targeted incision and closing the wound, the surgeon uses a breast reduction pattern to remove a larger segment of breast tissue incorporating the tumour, then reshapes the remaining tissue and repositions the nipple-areola complex.

The word "therapeutic" distinguishes this from cosmetic breast reduction, where the motivation is purely aesthetic or symptomatic. In therapeutic mammoplasty, the primary purpose is the safe and complete removal of a breast cancer, with the reduction and reshaping achieving the functional goal of managing the resulting defect and the practical benefit of reducing breast size.

In the same operation, the non-cancer breast is typically reduced and lifted to match the treated side, restoring symmetry and producing a balanced, well-shaped outcome on both sides simultaneously.

Types of Mastectomy

Mastectomy is not a single operation — it describes a family of procedures, each with specific indications, incision placements, and implications for reconstruction. Understanding the differences helps you have a more informed conversation with your surgeon.

Total (Simple) Mastectomy

A total mastectomy removes all breast tissue, the nipple-areola complex, and the overlying skin through an elliptical incision across the breast. It is the standard approach when reconstruction is not planned or when the skin and nipple cannot be preserved due to the proximity of the cancer to these structures.

The resulting scar runs horizontally across the chest wall. A flat chest wall closure, without reconstruction, is a completely valid outcome that some women actively choose — an increasing number of patients choose a flat closure following mastectomy and do not wish to undergo reconstruction, and this is fully supported by our team.

Skin-Sparing Mastectomy

A skin-sparing mastectomy preserves the majority of the breast skin envelope — the skin of the breast mound — while removing all underlying breast tissue and the nipple-areola complex. An incision is made around the areola to allow removal of the nipple and the breast tissue beneath, with only a small amount of additional skin removed if needed.

Preserving the skin envelope creates the most natural framework for immediate breast reconstruction, as the reconstructed breast sits within the patient's own skin and produces a superior cosmetic outcome compared to reconstruction after a conventional mastectomy with less skin preservation. Skin-sparing mastectomy is one of the most commonly performed mastectomy types in our practice when reconstruction is planned.

Nipple-Sparing Mastectomy

A nipple-sparing mastectomy preserves the entire breast skin envelope including the nipple and areola, removing only the breast tissue from beneath the intact skin. The incision is typically placed in the inframammary fold (the crease beneath the breast), along the lateral border of the breast, or around the areola — all positions that are relatively inconspicuous after healing.

Nipple-sparing mastectomy produces the most aesthetically natural result, particularly when combined with immediate implant or autologous (own tissue) reconstruction, as the reconstruction is achieved beneath the patient's own skin and nipple. It is not suitable for all patients — the nipple skin must be free of cancer cells, and the tumour should not be immediately beneath the nipple. Patient anatomy, including breast size and degree of ptosis (drooping), also affects suitability. When the conditions are right, however, nipple-sparing mastectomy with immediate reconstruction produces results that are genuinely transformative for many patients.

Risk-Reducing (Prophylactic) Mastectomy

For women who carry a high-risk gene mutation — such as BRCA1, BRCA2, or PALB2 — but have not yet been diagnosed with breast cancer, a risk-reducing (prophylactic) mastectomy is a surgical option that reduces the lifetime risk of breast cancer by approximately 95%. It is a deeply personal decision that is never taken lightly, and our team provides careful, unhurried counselling to help patients and their families work through whether and when this is the right path.

Risk-reducing mastectomy is typically performed as a bilateral procedure (both breasts), most commonly combined with immediate reconstruction. It can be performed as a skin-sparing or nipple-sparing procedure depending on individual circumstances and patient preference.

Bilateral Mastectomy

Some patients — whether for cancer reasons (bilateral breast cancer, or preference to remove both breasts at the time of treating one) or for risk-reduction purposes — choose to have both breasts removed. Bilateral mastectomy may be performed with immediate reconstruction on both sides simultaneously.

The decision to remove the unaffected breast in the context of a unilateral breast cancer should be carefully considered with your surgeon. For most women with average to moderately elevated risk in the opposite breast, the benefit of removing a healthy breast is modest and may not justify the additional surgical risk and recovery. However, for high-risk women or those with specific concerns, it is a reasonable and supported choice.

Planning Mastectomy — What Happens Before Surgery

The period between deciding on mastectomy and the day of surgery is an important time for planning, particularly if reconstruction is being considered.

Pre-operative appointments — you will have at least one pre-operative appointment with your surgeon to review the planned procedure, confirm your understanding and consent, and answer any remaining questions. If reconstruction is planned, your reconstruction planning will be finalised at this stage. Pre-operative photographs are typically taken for surgical planning and record purposes.

Discussing reconstruction — if you are considering breast reconstruction, the conversation about reconstruction options occurs before your mastectomy so that the most appropriate type of reconstruction can be planned and performed at the same time (immediate reconstruction). See our dedicated breast reconstruction page for a full overview of the options available.

Breast care nurse — your breast care nurse is actively involved in preparation for mastectomy, providing information, emotional support, and practical preparation. She can help answer questions about what to expect, what to bring to hospital, how to set up at home for recovery, and what support services are available.

What to arrange before surgery — depending on the complexity of the procedure and your home circumstances, you may benefit from arranging practical help at home for the first one to two weeks after surgery. Driving should not be planned for at least two weeks. If you have drains (see below), someone will need to be available to help you monitor them at home.

The Mastectomy Operation

Mastectomy is performed under general anaesthetic. The duration varies depending on the type of mastectomy and whether axillary surgery and/or reconstruction is performed simultaneously — from approximately one to two hours for a simple mastectomy without reconstruction, to four to six hours or more for complex immediate reconstruction procedures.

The surgical steps depend on the type of mastectomy planned, but in all cases the surgeon carefully dissects and removes all breast tissue from the overlying skin and the underlying chest wall muscles. The skin is preserved as much as appropriate for the planned procedure.

Axillary surgery — sentinel lymph node biopsy is performed simultaneously in almost all mastectomies for breast cancer, and axillary clearance is performed where indicated. A separate incision is not usually required for the sentinel node biopsy but may be needed if an axillary clearance is performed.

Surgical drains — one or two fine drainage tubes are placed beneath the skin at the conclusion of the procedure to remove fluid that accumulates in the surgical space during healing. Drains are managed at home after discharge, typically for five to ten days, and removed at your post-operative appointment when drainage has reduced to an acceptable level. Your breast care nurse will show you how to manage the drains before you go home.

Wound closure — the incision is closed with buried dissolving sutures and a waterproof dressing. You can shower with the dressing in place.

Immediate vs. Delayed Reconstruction

One of the most important decisions associated with mastectomy is whether to have breast reconstruction, and if so, when.

Immediate reast reconstruction — performed at the same time as the mastectomy, immediate reconstruction restores a breast shape when you wake from anaesthesia. It is the preferred approach for most patients who choose reconstruction, as it avoids the psychological and practical burden of living without a breast, is generally associated with better cosmetic outcomes (particularly when skin-sparing or nipple-sparing techniques are used), and does not delay adjuvant treatments in most cases.

Delayed breast reconstruction — reconstruction performed as a separate procedure after all other treatments (chemotherapy, radiotherapy) are complete. Delayed reconstruction used to be recommended when post-mastectomy radiotherapy is planned but with more modern approaches to breast cancer surgery recontruction can be performed with mastectomy.

Delayed reconstruction may be chosen by patients who prefer to complete cancer treatment before making decisions about reconstruction, or who need more time to process the diagnosis before committing to a reconstructive plan.

“No reconstruction” - flat closure chest wall reconstruction — some patients choose not to have breast reconstruction, either immediately or at all. This is a completely valid choice and is fully supported. External breast prostheses — worn in a bra — offer an excellent alternative that many women find comfortable and satisfying. Our team ensures every patient who chooses a flat closure has access to appropriate prosthesis advice and fitting support.

Aesthetic flat closure is a term which is used to describe a smooth, even chest wall after mastectomy. It is a type of chest wall reconstruction, often performed bilaterally, where someone can choose to “go flat” after mastectomy. Our surgeons at Breast & Surgical Oncology strive to achieve a smooth even chest wall every time, regardless of whether the patient will wear a prosthesis or not.

Recovery After Mastectomy

Mastectomy recovery is more involved than recovery from lumpectomy, though most patients find it more manageable than they expected.

Hospital stay — a mastectomy without reconstruction typically requires one to two nights in hospital. Mastectomy with immediate implant-based reconstruction requires one to three nights; more complex procedures involving tissue flap reconstruction may require a longer stay, usually five days or more.

Pain management — pain after mastectomy is generally well controlled with regular oral analgesia — paracetamol and anti-inflammatories — in the days following surgery. Most patients do not require strong opioid medications beyond the immediate post-operative period. If reconstruction has been performed, pain management may be more complex and will be managed carefully by your surgical team.

Drains — you will go home with one or two surgical drains in place. These are simple to manage at home with the guidance provided by your nursing team. They are typically removed at your first post-operative appointment, usually seven to ten days after surgery. They can also be removed by specialist nurses involved in your care.

Arm and shoulder exercises — gentle arm and shoulder exercises should be started soon after surgery, as directed by your physiotherapist or breast care nurse. These are important for preventing stiffness and preserving shoulder function, particularly if axillary surgery has been performed.

Returning to normal activities — most patients can manage light daily activities within one to two weeks of a straightforward mastectomy. Driving can usually resume after two weeks, when comfortable arm movement is restored. Strenuous upper-body activity should be avoided for six to eight weeks, or longer if complex reconstruction has been performed.

Sensation changes — the skin of the chest wall after mastectomy will feel permanently numb or altered in sensation, as the skin nerves are divided during the procedure. This is an expected and permanent consequence of the surgery. The degree of sensation change varies between patients. After nipple-sparing mastectomy with reconstruction, some patients regain partial nipple sensation over time as nerve regeneration occurs, though this is not guaranteed.

Seroma — fluid accumulation (seroma) in the surgical space after drain removal is common and usually resolves on its own. If a seroma is large or uncomfortable, it can be drained with a fine needle at your post-operative appointment.

Lymphoedema — arm swelling due to disruption of lymphatic drainage is a risk when axillary surgery has been performed. The risk is significantly lower after sentinel node biopsy alone than after full axillary clearance. Lymphoedema is managed with compression garments and lymphatic massage; our team coordinates closely with specialist lymphoedema physiotherapists as part of follow-up care.

The Emotional Experience of Mastectomy

Having a breast or both breasts removed is a physically and emotionally significant experience. Even when mastectomy is the right clinical decision and a patient feels certain about their choice, the aftermath of surgery — the change to the body, the altered sensation, the adjustment to a new appearance — can bring a complex range of emotions.

Grief, loss, relief, pride, and anxiety can all coexist. There is no right way to feel, and there is no timeline for adjustment. Our breast care nurses are trained in supporting patients through this experience, and psychological support and counselling are actively available to every patient who would benefit.

We also strongly encourage patients to connect with peer support — speaking with someone who has been through mastectomy firsthand is something that many patients find more helpful than anything else. Breast Cancer Network Australia (BCNA) coordinates a peer support program that matches newly diagnosed patients with trained volunteer breast cancer survivors. The Mater Hospital also runs patient support groups which are available for our patients.

Risks and Complications

Mastectomy is a safe and well-established procedure. All risks will be discussed in detail with you before surgery. They include infection, bleeding or haematoma, seroma, wound healing issues,, shoulder stiffness, numbness of the chest wall and arm, lymphoedema (if axillary surgery is performed), and — where reconstruction is involved — reconstruction-specific risks including implant complications or flap-related issues that your surgeon will explain in detail.

Mastectomy at Breast & Surgical Oncology at The Poche Centre

Our surgeons perform the full range of mastectomy procedures at The Mater Hospital and North Shore Private Hospital (private patients) and Royal North Shore, Northern Beaches, and Hornsby Ku-ring-gai Hospitals (public patients). Our team's extensive experience in nipple-sparing and skin-sparing techniques, combined with our reconstructive expertise, means that whatever approach is right for you, we can deliver it to the highest standard.

If mastectomy has been recommended, or if you are weighing your surgical options, we welcome the opportunity to meet with you and ensure you have everything you need to make a fully informed decision.