ENIn Germany, a mastectomy, removing the whole breast, is far from necessary for every woman with breast cancer: it depends on the tumour’s size, position, type and biopsy, and is discussed with the patient, not announced. The word sounds like a verdict on the body; the first question is human: must the whole breast go?
Below: indications, types, lymph nodes, reconstruction, the hospital stay and after-care; for the wider picture, see breast cancer treatment in Germany.
When the breast is removed and when it is kept
The breast is kept if the tumour can be removed with clear margins without spoiling its shape, and radiotherapy can follow; otherwise, or by choice, it is removed. Tumour size relative to the breast matters. Survival after breast conservation plus radiotherapy at least equals mastectomy; a tumour board, not one surgeon, weighs the choice.
Mastectomy is needed when re-excision cannot remove the tumour and its intraductal part, in inflammatory cancer, when radiotherapy is needed but impossible, or at the informed woman’s request. Risk-reducing removal with a confirmed BRCA1 or BRCA2 mutation is a separate, personal decision: it lowers breast cancer risk, though longer survival is not sufficiently proven. It is made with a geneticist, other specialists and, if needed, a psycho-oncologist, no surgery being one option, never on forum advice.
Before surgery: biopsy histology with receptor and HER2 status, mammography, ultrasound of both armpits, breast ultrasound or MRI where needed, and biopsy of a suspicious node, as in the German S3 guideline on breast cancer, 2026 version.
The types of mastectomy
A mastectomy is simple, skin-sparing or nipple-sparing. A simple (total) one removes the gland with skin and nipple, used when skin cannot be kept, as in inflammatory cancer, or when a woman wants no reconstruction; the chest wall is then closed flat and neatly. Elsewhere, skin-sparing surgery increasingly replaces it.
Skin-sparing surgery keeps almost all the skin, nipple-sparing surgery also the nipple and areola, if margins are clear and the tissue under the nipple is tumour-free. It is planned with the reconstructive surgeon, since the incision shapes the result.
The sentinel node is the first lymph node draining the tumour; if it is clear, the others can stay. With normal-seeming nodes, sentinel biopsy is standard; full axillary dissection is a separate decision. More nodes removed means poorer arm drainage: in a 2013 meta-analysis of 72 studies, arm lymphoedema was about four times more common after full dissection than after sentinel biopsy, affecting almost one in five women.
Reconstruction: straight away or later
The breast can be rebuilt in the same operation, later or not at all. Immediate reconstruction spares a time without a breast; delayed does not hold up chemotherapy or radiotherapy. Radiotherapy raises implant complications, so an implant may only be a placeholder before own-tissue reconstruction; see breast cancer radiotherapy. Smoking, diabetes, excess weight and age count; the woman decides.
An implant often goes in two steps, an expander stretching the skin, then the permanent implant: smaller operations, more stages. An own-tissue flap from the abdomen or back means bigger surgery, several days in hospital and a donor-site scar, yet after two years women seem more often satisfied with it. More on breast surgery in Germany.
Agree details early: symmetry, sometimes by operating on the other breast; corrections, including with own fat; a nipple and areola months later, from skin or tattoo. Reconstruction usually takes several stages.
The hospital stay and recovery
The stay begins the day before or the morning of surgery, and recovery starts on the ward. Before sentinel biopsy, a weakly radioactive substance or blue dye marks the nodes. Surgery is under general anaesthesia; its length depends on the axillary surgery and any reconstruction. Pain relief comes in advance, and there is a dressing, sometimes a drain.
The stay is longer than after breast conservation, especially with immediate reconstruction; drains usually come out within days. Per the S3 guideline, shoulder physiotherapy starts within two weeks, mostly in hospital. Lymphoedema prevention starts there: use the arm normally, report swelling at once; drainage without swelling is not recommended.
The pathologist assesses tumour, margins and nodes, and the tumour board advises on chemotherapy, hormone therapy, radiotherapy or further surgery. So flying home before this decision is unwise.
Where it is done: partner departments
Mastectomy in Germany is done in breast centres like these AlenMed partners; see also breast cancer hospitals in Germany. In Munich, at the Rotkreuzklinikum’s gynaecology department, Professor Michael Braun, covering surgical and drug treatment of breast cancer, heads the interdisciplinary breast centre and Professor Martin Pölcher the gynaecological cancer centre.
In Frankfurt, Professor Marc Thill heads the Department of Gynaecology and Gynaecological Oncology of the Agaplesion Frankfurter Diakonie Kliniken: breast and gynaecological cancers, reconstructive breast surgery, DEGUM level II breast ultrasound and a Da Vinci robot for some gynaecological operations.
In Berlin: the Department of Gynaecology with Breast Centre at the Charité under Professor Jens-Uwe Blohmer. In Bonn: the senology department of the University Hospital Bonn under Professor Andree Faridi. These are examples, not a ranking: each case gets its own match.
Frequently asked questions
Can I decide against reconstruction?
Yes, a full option. The S3 guideline requires respecting a wish to go without reconstruction and closing the chest wall flat and neatly. A prosthesis can restore the shape under clothes, or a woman can live without one; reconstruction stays possible later.
Should the healthy breast be removed too?
Usually not. Without an inherited mutation or high familial risk, the S3 guideline advises against it: no benefit is proven. With a confirmed BRCA1 or BRCA2 mutation, removal lowers the risk there, but is decided with a geneticist, considering the tumour’s prognosis.
What if my arm swells after surgery?
Tell the doctor at once: lymphoedema is treatable, per the S3 guideline with complex decongestive therapy — skin care, manual lymphatic drainage, exercise and compression. Not every swelling is lymphoedema; wound fluid can briefly collect early on, even after sentinel biopsy alone.
How AlenMed organises treatment
Send biopsy histology with receptor and HER2 status, mammography, ultrasound or MRI on disc, discharge letters and treatment records. Two or three departments review them and reply with what they propose and in what order; for costs, see breast cancer treatment cost in Germany.
AlenMed has 86 partner hospitals in 38 cities and 345 doctors, with its office in Munich. A coordinator books appointments, interprets at consultations and the consent talk, helps with visa paperwork and collects the discharge letter with the treatment plan.
This material is for information only, not an offer; the extent of surgery is decided by a doctor at a face-to-face examination.
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