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Unlike cosmetic procedures, such as a breast augmentation, a mastectomy scar is typically long in length. A mastectomy will usually involve one long incision across the side of the breast to be removed. This allows the surgeon access to the breast to remove the necessary tissue and the lymph nodes under the arm, if necessary. With a bilateral mastectomy, the scarring will likely cover the entire length of the chest to allow for removal of breast tissue on both sides and the lymph nodes under each arm, if necessary.