Risks and complications of a breast removal (mastectomy)

The decision to undergo a mastectomy (medically known as Mastectomy or Mastectomy (as it is known) is one of the most life-changing moments in the lives of many female patients. It is often associated with breast cancer, but increasingly also with a prophylactic mastectomy, for example in cases where a BRCA gene mutation has been detected. Regardless of the reason, the procedure is not only a physical but also an emotional challenge.

In this article, we will not only examine the medical risks and complications associated with a mastectomy, but also explain the procedure, post-operative care, possible long-term effects and financial considerations.

Reasons for and methods of mastectomy – why the procedure is carried out

Preventative mastectomy – taking preventative action

A prophylactic mastectomy is primarily considered for women with a significantly increased genetic risk, such as those with a confirmed BRCA1 or BRCA2 mutation. In such cases, the risk of breast cancer can be significantly reduced. However, it is important to note that even this preventative measure is a major surgical procedure which must be carefully considered and discussed at length.

An overview of surgical methods – different techniques, different risks

Not every mastectomy is the same. The choice of procedure affects both the aesthetic outcome and the likelihood of certain complications.

Surgical technique	Brief description	Typical risks
Simple mastectomy	Removal of the entire breast gland, including the skin	Wound-healing disorders, seromas
Skin-sparing mastectomy	The skin is preserved, whilst the breast tissue is removed	Serum formation, risk of infection
Nipple-sparing mastectomy	The nipple is preserved	increased risk of necrosis
Mastectomy with reconstruction	Breast reconstruction using implants or the patient’s own tissue	additional risks such as capsular fibrosis

The more complex the technique, the more important the surgical team’s experience and close follow-up care become.

Preparing for the operation

Several preparatory steps are carried out before a mastectomy:

• a detailed consultation with a doctor,
• Imaging (e.g. MRI, ultrasound),
• Anaesthesia consultation,
• psycho-oncological counselling, if required,
• Assessment of comorbidities and medication.

During this stage, questions regarding potential risks, post-treatment care and the healing process are also discussed.

The operation itself: duration, anaesthesia and technique

A mastectomy is usually performed under General anaesthesia. Depending on the method used and whether a reconstruction is carried out at the same time, the procedure takes approximately 1.5 to 3 hours. An important part of the operation is the insertion of Drainage systems. These thin tubes drain wound fluid and are designed to reduce complications such as seromas or secondary bleeding.

Hospital stay following a mastectomy

After the operation, patients usually remain several days in hospital in hospital. During this time:

• Wound healing and drainage are monitored,
• Pain treated with medication,
• guided through their first movement exercises,
• monitored for any early complications.

A stay in hospital is a key part of ensuring safety following a mastectomy and lays the foundations for a recovery with as few complications as possible.

Early complications immediately following a mastectomy

In the first few days and weeks following the operation, the focus is on wound healing. Most early complications can be treated effectively if they are detected in good time.

An overview of common early risks

Complication	Explanation	Frequency
Haematoma / Secondary bleeding	Haematoma in the surgical area	occasionally
Wound infection	bacterial infection of the wound	rare
Impaired wound healing	delayed or impaired healing	more common in the presence of risk factors
Serom	Accumulation of wound fluid	very often

Seroma formation – one of the most common complications

A seroma is an accumulation of fluid in the surgical area and is one of the most common complications following a mastectomy. It occurs because the removal of tissue leaves cavities which fill with wound exudate.

Typical signs of a seroma:

• A feeling of tightness or pressure
• visible swelling
• occasional pain

Seromas are usually harmless, but often need to be drained by means of a puncture. Several punctures may be necessary, which can be distressing for many patients, although medically it is usually straightforward.

Sensory disturbances and numbness

Following a mastectomy, many patients report:

• Numbness in the chest area,
• Tingling or changes in skin sensation,
• reduced sensitivity to touch.

These sensory disturbances are caused by the severing of small skin nerves. In many cases, they improve within a few months, but may also persist permanently.

Necrosis associated with skin- or nipple-preserving procedures

In skin- or nipple-preserving mastectomies, there is an increased risk of necrosis, i.e. the death of parts of the skin or nipple. Risk factors include, amongst others:

• Smoking,
• Circulatory disorders,
• Diabetes,
• very thin skin flaps.

In severe cases, further surgery may be necessary.

Lymphoedema – a debilitating long-term consequence

If a lymph node (e.g. a sentinel lymph node) is also removed during a mastectomy, this may lead to lymphoedema. This causes lymph fluid to accumulate in the arm on the side where the operation was performed.

Typical symptoms:

• Swelling of the arm or hand
• Tightness
• reduced mobility

Lymphoedema is usually a chronic condition, but it can be managed effectively through physiotherapy, lymphatic drainage and compression therapy.

Psychological consequences and emotional distress

As well as the physical risks, the psychological impact of a mastectomy should not be underestimated. Depending on the reason for the mastectomy, many women affected experience:

• Changes in body image,
• Grief over the loss of a breast,
• Uncertainty regarding femininity and sexuality,
• Fear of complications or further procedures.

These psychological consequences of a mastectomy are very real and deserve just as much attention as physical complications. Psycho-oncological support can be an important part of aftercare.

Why preparation is crucial

Key measures to minimise risk prior to surgery

Giving up smoking – one of the most important factors

Nicotine impairs blood flow to the skin and significantly increases the risk of:

• Wound-healing disorders,
• Infections,
• Skin and nipple necrosis.

Recommendation: You must strictly avoid smoking for at least 4 weeks before and after the mastectomy.

Diet & Nutritional Status

Poor nutritional status – particularly protein deficiency – delays wound healing.

The following are important:

• adequate protein intake,
• stable iron and vitamin levels,
• Dietary supplements, under medical supervision where necessary.

Medication management

Blood-thinning medication (e.g. ASA) must be stopped in good time – always in consultation with the treating doctor.

Don’t underestimate the importance of mental preparation

Mental well-being also influences the healing process. Anxiety, uncertainty or a lack of information can exacerbate stress responses and have a negative impact on recovery.

The following are helpful:

• in-depth discussions with the treatment team,
• psycho-oncological counselling,
• realistic expectations regarding recovery, scarring and possible complications.

Note: Good preparation not only reduces medical risks, but also boosts one’s sense of control and security.

The first few days after the operation

Hospital stay & drains

Following a mastectomy, patients usually remain:

• 3–7 days’ hospital stay (depending on the course of the illness).

Drains are almost always inserted to drain wound fluid and prevent seromas.

Wound healing, stitches & scar care

Measure	Date and time
Pull the strings	after approx. 10–14 days
Showering	usually permitted after a few days
Scar care	once the wound has completely healed

Exercise, everyday life & sport

Arm and shoulder mobility

Early, guided movement is crucial for:

• Frozen shoulder,
• Lymphatic congestion,
• to prevent permanent restrictions on movement.

Physiotherapy is often an integral part of aftercare.

Sport and physical exertion

• light everyday activity: after a few days,
• Targeted training: subject to medical clearance,
• Strenuous exercise: usually only after 6–8 weeks.

Recovery time and long-term recovery

The recovery process following a mastectomy takes several months:

• physical recovery: approx. 6–12 weeks,
• Changes in sensitivity: months to years,
• Emotional processing: varies greatly from person to person.

It is precisely long-term complications such as lymphoedema, nerve pain or scarring problems that may only become apparent over time and sometimes require additional treatment or follow-up surgery.

• a total mastectomy,
• the hospital stay,
• Anaesthesia and surgical costs,
• Drainage and aftercare,
• Pain management,
• Medical aids (e.g. compression bra, temporary prosthesis),
• as well as, in many cases, breast reconstruction (either immediately or at a later date).

Important: Follow-up costs, such as the treatment of complications (e.g. infections, seromas or wound-healing disorders), are usually covered in these cases as well.

Preventative mastectomy: coverage of costs on a case-by-case basis

In the case of a prophylactic mastectomy – for example, to prevent cancer – the situation is more complex.

Costs for self-paying patients: transparency provides certainty

If the cost of a mastectomy is not covered by health insurance, the costs typically fall within the following range:

Performance	Approximate costs
Breast removal without reconstruction	approx. €4,000–6,000
Skin- or nipple-sparing mastectomy	usually higher
Breast reconstruction (implant or autologous tissue)	plus several thousand euros
Follow-up treatments / Corrections	individual

Please note: The actual costs depend, amongst other things, on:

• Surgical method,
• Clinic and practitioner,
• Length of stay,
• Course of complications,
• Combined with reconstruction.

Many clinics offer payment by instalments or financing options – it is advisable to clarify this at an early stage.

Don’t underestimate hidden costs

Regardless of whether costs are covered, additional expenses often arise, for example for:

• special bras or compression garments,
• Scar care products,
• Physiotherapy,
• psychological support,
• Absence from work or a prolonged period on sick leave.

Complications or the need for follow-up surgery in particular can significantly increase the financial burden – especially for patients paying out of their own pocket or undergoing cosmetic procedures.

Important questions to ask your health insurance provider or hospital

• What specific services are covered?
• Does the cover also apply to complications?
• Is a second operation included?
• What aftercare costs will I have to pay myself?

Coverage following a mastectomy: protection against unforeseen costs

A mastectomy is a major step – both physically and emotionally. Even when an operation goes perfectly, unexpected follow-up procedures or complications can occasionally arise.

This is exactly where 4beauty’s follow-up costs insurance comes in: it gives you the peace of mind to focus fully on your recovery and your new lease of life, without any additional financial worries.

Your benefits at a glance:

• Financial security: Coverage of the costs of any necessary follow-up treatment or medically recommended corrective surgery.
• A sense of reassurance: You can start treatment with peace of mind, as you have made provision for any potential follow-up costs.
• Flexibility: Insurance cover can be tailored to your individual needs, regardless of whether the operation is funded privately or through your health insurance scheme.
• Focus on healing and self-confidence: No additional worries; full focus on recovery, physical wellbeing and quality of life.

FAQ – Frequently asked questions about breast removal (mastectomy)