Surgery is usually the first form of treatment that a man with breast cancer will have. Men have much less breast tissue than women and so it is usually necessary to remove all of their breast tissue and the nipple on the affected side (a mastectomy). When a woman is diagnosed with breast cancer it is sometimes possible for her to have a lumpectomy rather than a mastectomy but this is less often possible for men. Rarely a small part of the chest muscle is also removed during surgery if this has been affected by the cancer or if the lump is very close to the muscle. The surgeon also usually removes lymph glands (nodes) from under the arm to check whether any cancer cells have spread from the breast tissue. If the pre-operative scan shows the lymph gland appear normal, a technique called sentinel lymph node biopsy is used to take one or two lymph nodes to test whether the cancer has spread. If it is known that the cancer has spread to the lymph nodes, and this has been confirmed by a biopsy of a node in the armpit, then all of the nodes in that region will be removed - an axillary node or node sample or node clearance. This helps the doctors to decide whether any other treatment is needed after surgery. The size, grade and oestrogen receptor status of the tumour also help to determine what treatment should be offered. A sentinel node biopsy can reduce the chances of arm stiffness and swelling of the arm after surgery (see Lymphoedema). More information sources are available in our resources section.
Here men describe their experiences of having a mastectomy. Many men spoke of feeling nervous in the lead up to their surgery. Robert B said it was ‘probably the worst time knowing it was ahead of me and just wanting to get it over with’. Steve said that, although he was a bit nervous before his operation, he knew he was in the hands of professionals and that the mastectomy was a fairly straightforward operation.
In preparation for their operation, men met the anaesthetist, they were x-rayed, they had their chest and armpit shaved, and their operation site drawn on their chest by their surgeon. Some men said that the use of humour had helped them to cope with feeling nervous in the lead up to their operation.
Tom recalled how, before going into theatre for his mastectomy, he and the hospital staff had laughed at his compression socks being too long for him.
Tom recalled how, before going into theatre for his mastectomy, he and the hospital staff had laughed at his compression socks being too long for him.
Age at interview: 71
Sex: Male
Age at diagnosis: 70
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I could remember the times going in, ten past one. I can remember them laughing about my socks because the socks apparently go by your calf measurement and I finished up with socks about four inches too long because I’ve got really sturdy calves… short, fat and hairy. I could… waggling about like that when I was on the [unclear] anaesthetist, “Look at that”. I says, “when you stick the needle in, don’t stick it in the spare end of my sock like, I want it in me, not that”. Of course, by then I was half way under because he’d…
Yeah he’d started, yeah.
... [overtalk] you still making them laugh about your socks, the way you were waggling about and you were half under. I say, well, you know, no good being miserable, is there?
It is common to be asked to wear compressions socks during surgery to prevent complications.
After their operation, several men said they were relieved that it was over and many were surprised at how well they felt. Some said they experienced no, or very little, pain immediately after their surgery and they were able to move their arms much more than they had expected they would be able to. Others spoke about their pain management. Tim talked about how his pain had been managed very well by a morphine pump which he controlled himself. Morphine can make some people feel sick but this can usually be controlled by anti-sickness medication. However, Bill decided to stop taking the morphine because he felt the pain was more manageable than the nausea.
David could not believe how well he felt when he came round after his mastectomy. He had no pain and felt that a load was lifted off his mind after the operation.
David could not believe how well he felt when he came round after his mastectomy. He had no pain and felt that a load was lifted off his mind after the operation.
Age at interview: 57
Sex: Male
Age at diagnosis: 52
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So you look forward to this date and see how you’re going, and thinking you’re gonna go on a cancer ward but you’re just on a general surgeon ward and… I turns up for the hospital appointment, the operation was about 4pm and [wife] came to see me at 6 and I was just as right as a bobbin. Couldn’t believe how, how well, I felt, you know, you’ve lost all this side of your body and no pain, nothing. Just obviously coming round from the anaesthetic, but felt fine. Absolutely brilliant. [wife] was amazed and, you know, how well I looked. “You look really well” so I said “yeah, I feel really good.” And it were just like yeah, it’s happened, I’ve got rid, you know? A load’s lifted off your mind, really. I’ve come through the other side. Silly, in’t it, what you think? Anyway… get the hospital, the nurses and doctors said “what kind of painkillers do you want?” I said “well, what can I have?” They said “well, you can have anything from paracetamol to morphine, depending how bad the pain is.” I said well, actually, I’m not in any pain, which is unbelievable to think. As I say, you’ve lost all this side and you think there’s no pain. Obviously it’s in, you know, bandages and whatever else that you don’t really know, until they took the bandages off and sorta looking and you’re thinking .. they put a zip in, cos it’s just like, you see this staples from there and they disappear under your arm.
They actually said, “Yeah, we’ve got everthing, but we’ve had to take half your pec muscle, half the muscle, and I think it was about sixteen nodes, you know, which is strange, but they were all clear, so .. which was good, a good thing.
Ben describes what it was like immediately after his operation. He was able to raise his arms straight up very soon after his mastectomy.
Ben describes what it was like immediately after his operation. He was able to raise his arms straight up very soon after his mastectomy.
Age at interview: 68
Sex: Male
Age at diagnosis: 63
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I was admitted into hospital and had the operation and from there I remember going down and them putting a needle in me and I thought I was going to, the usual thing, I was gonna be… count to three and you’ll be gone, and I said, “Have I got a…?” and I was gone. So I didn’t get to one, two or three, and so I went down and I remember waking up on the ward because I was first in, I had been told I was first in, I woke up and raised my head and had a look and I couldn’t see anybody else awake and there was a whole ward full of people that had been operated on that morning and eventually they came round and sort of dealt with me and helped me, and from there I was then taken back to this little small unit where there was I think four people in this little unit, and stayed in there and was… I’d been given two bags, bags for blood and residue, to be taken, and then my wife came in and sort of greeted my son and my wife and… I was able, even then I’d been told that the first thing ladies, or you should try and do is raise your arms and I was able to do that and there was ladies that couldn’t do it and I was able to raise my arms straight up straight away, so I kept doing that and then trying to do all the exercises that I’d been told to do at that particular time.
Bill talked about waking up after his mastectomy feeling very cold and in pain. The morphine that he took made him feel nauseous.
Bill talked about waking up after his mastectomy feeling very cold and in pain. The morphine that he took made him feel nauseous.
Age at interview: 54
Sex: Male
Age at diagnosis: 46
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But the next thing, I do remember going to the anaesthetist, speaking with me and the cannula in my hand was already in my hand, and the next thing I remember waking up and I was absolutely freezing cold, I was very cold, in the recovery room. And I was aware of a big pressure bandage across my chest. And they put a, one of these- obviously a silver foil thing on me, and blew a heater into me to heat me up. And then they took me, once I was over that part, they took me back to the oncology unit in a single room, and hooked me up to different machines, and my arm seemed full of things. And I dozed in and out, people came to see me and I can’t remember much about that. And when I did come to a bit, they explained to me that I had this pain, pump thing, pain relief that I- if I was in pain then I could press this pump.
And I was in pain and I pressed the pump and it didn’t seem to work. And I told her that, and of course all this plumbing in my hand and I remember it was left hand, something was wrong and it wasn’t working anyway. So they had to realign all this stuff. And then it did work, but for me the morphine was… relief from the pain but it made me very nauseous. And I have this dislike of vomiting, so I resisted vomiting for a long time, and then I decided I wasn’t going to have any more of the morphine. And I asked them to take it away then. Because the threat of vomiting was more horrible to me than the pain I think.
Breast cancer surgery is now usually done as a day case or with just an overnight stay. The length of time that the men stayed in hospital following their surgery varied from as little as one night to seven nights. Most men described having drains attached to their bodies (chest and/or underarm) and a few said this had been the most uncomfortable aspect of their surgery. Several described not being allowed home from hospital until the fluid in their drain was clear. Some went home with their drains still attached and a few talked about it taking a long time for all the fluid to finally drain away.
Bill said that his drains were removed several days after his surgery. He describes it as a 'very strange feeling'.
Bill said that his drains were removed several days after his surgery. He describes it as a 'very strange feeling'.
Age at interview: 54
Sex: Male
Age at diagnosis: 46
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Anyway, the- the drains in my chest and arm began to run clear, after four days, Tuesday, Wednesday, Thursday, Friday… Saturday still draining a bit, and they said to me that I would be allowed home on the Sunday if the drains remained clear for that day. So in fact they did remain clear and they- I always remember, it was very strange feeling, having the drains taken away, cause you could feel them coming out. Ooh! Anyway, they took the drains out and gave me another dressing, put another dressing on the scar, and sent me home.
For most men the operation and recovery were straight forward. However, a few did experience complications after their surgery. For example, one man who was diabetic had to have the clips on his wound redone because they were taken out too soon. Another, Steve, developed a post-operative infection.
Steve developed an infection about a month after his mastectomy. He felt quite unwell, but the infection was quickly diagnosed and treated with antibiotics.
Steve developed an infection about a month after his mastectomy. He felt quite unwell, but the infection was quickly diagnosed and treated with antibiotics.
Age at interview: 58
Sex: Male
Age at diagnosis: 58
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And then it was just the road to recovery then, over a period of weeks. I did have an infection in the drain, that did cause me a bit of problems, I was quite unwell for a fortnight with that.
So was that pretty much immediately after you got home?
No, no, no, no. That was possibly about the fourth week? Because with the drain you have a certain amount of fluid every day, and hopefully it’s supposed to get less and less, to a point where you don’t need the bag, collection bag any more. And after the first two days I was doing it all myself, although the community nurse was coming to see me to check on the wound. There were no problems with it, it wasn’t seeping, everything was right, the stitches were right, everything was quite good. So I was getting more and more confident every day that, yeah. I didn’t have any worries, until I started getting unwell with the drain, that was really the only issue I had with the whole procedure.
So how did that manifest itself then?
I was getting a lot of pain, and I thought it was to do with the surgery, but it wasn’t, there was obviously, there was a bit of swelling under the arm, they put me on antibiotics, and that possibly kicked in after about a week, and I felt, I just felt very unwell. Difficult to explain what I felt like, but it, I knew something wasn’t right from the very, you know, from the beginning of the infection, there was something not right. And it was quickly diagnosed, I went in to the clinic and they checked it over, asked me to come back in a week after I’d been on antibiotics, and I was obviously getting better.
All of the men we interviewed had all of the breast tissue, the nipple and at least one lymph node removed during surgery, but a few men also had to have some of their chest muscle removed. Several men were surprised how long their scar was and, in some cases, how neat it was. Several talked about what it felt like to have their breast tissue and nipple removed (see also ‘
Effect of breast cancer on men’s body image’ and ‘
Reconstruction’).
Tim can feel his ribs in his chest since his surgery, which he said was as 'a funny feeling'. He has been left with a very neat scar.
Tim can feel his ribs in his chest since his surgery, which he said was as 'a funny feeling'. He has been left with a very neat scar.
Age at interview: 73
Sex: Male
Age at diagnosis: 60
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And the operation was very successful, the whole breast tissue, everything was taken away, in those days still they took all the lymph glands.
But, you know everything was removed, as far as we were aware at that time, and then I was told to report back later, you know the operation healed up very quickly actually, it was amazing how little pain there was, and in fact looking at me you would notice that I only have one nipple, but it doesn’t bother me in the least actually, it’s a very neat scar, but you can feel my ribs right there. It’s a funny feeling. And I had a bit of trouble with the muscle underneath my arm and its attachment for some time. Probably for about a year. If I used that arm too much, it was the base of the muscle, it used to get very sensitive, because it hadn’t got anything to hold onto. It used to hold on to this piece of muscle here. But it’s settled down more or less now, cause we’re talking twelve years ago now.
Bill described how he felt the first time he saw his chest with only one nipple. He was annoyed about losing his nipple even though it had been the only option he had.
Bill described how he felt the first time he saw his chest with only one nipple. He was annoyed about losing his nipple even though it had been the only option he had.
Age at interview: 54
Sex: Male
Age at diagnosis: 46
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And, after a few days, I think the operation was on the Tuesday, and I had drains in of course, two drains, one in my chest and one under my arm. The bandage had loosened a bit and I became very nosy and managed to ease it off mostly and, was just a huge scar right across my chest, which ended under my arm.
So was that a shock to see that or-?
I think I thought it was very... straight. The scar. I just seemed to miss my nipple, which was a huge miss, when you looked at one side and saw your nipple and you looked at the other one and it wasn’t there. And it seemed kind of stretched, the skin you know. And this big scar, big, big scar, which was very neat, that was the word. And I wasn’t, annoyed about the scar, I think I was more annoyed about the nipple disappearing.
Again had they explained in advance that that might happen or-?
Oh yes, that was the only option really, especially for men, who don’t have much breast tissue.
Most men made a complete recovery from their surgery. After surgery they were given exercises by the physiotherapist and most regained movement in their arm. However, some men were left with longer term symptoms such as stiffness, tenderness, aches, loss of strength and swelling (see ‘
Lymphoedema’).
Derek still experiences some stiffness under his arm, even some years after his surgery.
Derek still experiences some stiffness under his arm, even some years after his surgery.
Age at interview: 65
Sex: Male
Age at diagnosis: 57
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And how was your wound?
It was fine, yeah. I just didn’t realise how big or large it were or… were quite long. I didn’t realise that. I’ve not much recollection of that, of the operation or anything. I’ve not much… can’t really remember much about it. Obviously stiffness, I still get stiffness now after all this time because apparently when I go to the doctor’s to ask her about this, it was, it says it’s because of the depth of how far they’ve gone down through and my lymph glands here, I was very fortunate as well I didn’t get any bloating or nothing like that.
Steve described getting the movement back in his arm over the 6 months since his mastectomy. He still has a 'weird' sensation under his arm which feels a bit like sunburn.
Steve described getting the movement back in his arm over the 6 months since his mastectomy. He still has a 'weird' sensation under his arm which feels a bit like sunburn.
Age at interview: 58
Sex: Male
Age at diagnosis: 58
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I was told that obviously if I had any problems with the tissue area, that I should go back, but I haven’t. It’s still, it’s a funny sensation, for people who’ve not had surgery, it’s a little bit like having sunburn.
Right.
Not so much across the front of your chest, cos that’s healed really quickly, it’s where there isn’t any fat supportive tissue over the muscle in the underarm area, where they took the lymph, the second lymph node out – that is still quite a tender area. It’s not one that you would sort of want to touch a lot. But I’ve had physiotherapy, and apparently manipulating the small muscle on the breast helps with that. I’ve been doing that a lot. But I haven’t had any real pain. It’s more not being able to move your arm – you know, I have full rotation now, which I didn’t have before. Takes, you know, a couple of months for you to get that back, you know, about four months to get that back. But it’s a matter of, you go to reach for something, and you can’t actually do the full reach. So you’ve got to actually support the muscle, and, you know, eventually you do get further and further, back to normality. So I think at the moment I’ve got about, probably about 95 per cent of the rotational movement that I had before. So quite comfortable with that. And I can life – you’re not supposed to lift heavy weights for six months but to be quite honest with you your body tells you whether or not you can or can’t, you know, you’re always aware that you possibly can’t do something, so you never do lift anything too heavy.
But because of the recovery process, you have to do physio, you have to do exercises, just to, you know, if you hadn’t done that, or if I hadn’t done that, then the arm wouldn’t, I might be possibly not, you know, I wouldn’t be functioning like I am now. You need the exercises to free up the area. The lymph tract is still very tight, and that is just because everything is in a tighter situation than it was. And there’s no fat to buffer anything, which I’ve got on this side (indicating left). So I’ve just got to be aware of that, the skin moving against muscle tissue, instead of being buffered by fat.
It’s very hard to imagine what that feels like. It’s just a…
It’s just a very raw sensation. It’s not a painful sensation, it’s a weird sensation, if you’ve not experienced it before.
And has that changed over the six months, or is it...?
No, it’s pretty, I think, once I got over the infection, which was quite painful, it sort of settled down quite well, and, you know, I can touch it now – I would say just after Christmas it was still very, very sore, and it is just like having severe sunburn, that’s what it feels like. It’s very topical, very on top of the skin pain, not a deep pain. But since I’ve been doing muscle manipulation, the pain is a little bit deeper. But it’s not a bad pain, it’s a pain that you know you’ve got. But day-to-day, you forget about it, you just, you know, if you sat down and said, “Am I in pain?” you’d think about it and say, “Yes, I’ve got a bit of pain there.” But it doesn’t disrupt your life at all. It’s pretty good.
Roy had a bilateral mastectomy and chest muscles removed on both sides. He had been working as a builder up until his operation but was not able to carry on with such heavy work afterwards.
Roy had a bilateral mastectomy and chest muscles removed on both sides. He had been working as a builder up until his operation but was not able to carry on with such heavy work afterwards.
Age at interview: 67
Sex: Male
Age at diagnosis: 65
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See, coz what it was – I worked right up to the day of me operation, and I haven’t been able to work, obviously, I haven’t worked since. I was retiring age anyway, but I haven’t worked since. Whether it’s the sort of packing up work’s caused it, or whether that had anything to do with it, I don’t know.
What kind of work did you do before?
I was a builder.
Yeah.
What they’re doing over there was the type of work you know that type of stuff.
Right, so you’d have been used to being very physical?
Yeah, it was very physical, yeah.
Yeah.
Yeah. You know, and I mean, even at sixty-six, you know, when I was sixty-five, I got it when I was sixty-five. I mean, I did hope to carry on, you know? I always thought I’d carry on until I was seventy you know what I mean, no problem, but I couldn’t, you know what I mean? Once I got this sorted, that was sort of me working life over, you know? I had to pack up then, so I can’t lift things and that now.
Is that coz you don’t feel you’ve got the strength in the arms, or is it painful?
Well, see, I mean, see, I mean I’m used to lifting really sort of heavy stuff, you know, like kerbs and stuff like that, which probably weigh sort of 112 pounds, you know, type of thing, you know, which is heavy, you know? I mean, I could just lift them up and – but I couldn’t even lift them off the ground, now. But I think you’d get, coz I lost the muscles. I lost me chest muscles as well.
And that would have been on both sides, as well, just, yeah.
That’s right. Yeah – they sort of, he said to me, “We’ve had to virtually go to the bone.”
Yeah.
So I obviously lost me chest, but you do get a lot of strength from your chest, you know? Obviously a man’s mostly comes from his chest, you know? Whether it’s something to do with that – but you know, obviously I couldn’t carry on doing any physical work and stuff like that.
Last reviewed June 2017.
Last updated October 2013.
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