In a modified radical mastectomy, a surgeon removes the breast, including all or some overlying skin, the nipple and areola, most or all of the lymph nodes under the arm, and the lining over the chest muscles. This is a less extensive surgery than a radical mastectomy.
When treating breast cancer, a doctor's primary goal is to remove cancerous cells and reduce the risk of cancer spreading while preserving as much breast tissue as possible. Modified radical mastectomy is a way a surgeon achieves this goal.
This article focuses on modified radical mastectomy, its uses, and what to expect before, during, and after the procedure. We also look at the possible risks and complications.
A modified radical mastectomy is a surgical procedure that removes the entire breast, including all or some overlying skin, nipple and areola, the surrounding lymph nodes in the armpit, and the lining of the chest muscles.
The surgeon may also remove some of the chest wall muscle. The surgery will aim to preserve as much healthy tissue as possible.
Surgery is the primary treatment for breast cancer. Doctors often use systemic treatments, such as chemotherapy, hormone therapy, or radiation therapy, alongside surgery to prevent cancer cells from growing or to shrink tumors.
Some patients may have the option to have breast reconstruction surgery after they recover from a modified radical mastectomy.
A surgeon can often perform breast reconstruction during the modified radical mastectomy procedure unless the person requires radiation therapy after the surgery.
The American Cancer Society recommend that, if a person wants to get breast reconstruction surgery, they wait until they finish radiation therapy. This is because the radiation can delay healing of the tissues, and the outcome of reconstruction will be improved if it is performed well after any radiation treatments.
A doctor will recommend the best surgical option, depending on the stage of the cancer and the size of the breast.
The American Cancer Society describe several types of surgery for breast cancer. These surgeries are known as mastectomies and include the following:
- Simple or total mastectomy: Removing the entire breast and some underarm lymph nodes if needed.
- Modified radical mastectomy: A simple mastectomy that also removes the lymph nodes under the arm, known as an axillary lymph node dissection, along with the lining over the chest muscles. Surgeons may remove part of the chest wall muscles if needed.
- Radical mastectomy: Removing the entire breast, the lymph nodes, and the chest wall muscles.
People will usually have a simple mastectomy if their cancer has not spread beyond the breast tissue.
Radical mastectomy used to be very common but is now rare. Surgeons have found that the modified version can be just as effective and produces fewer side effects. People may still have a radical mastectomy if they have large tumors that are growing into the chest wall muscles.
Doctors use modified radical mastectomies to treat invasive breast cancer that has spread beyond the breast tissue. The surgery can treat any form of breast cancer that affects the axillary lymph nodes.
People who have early stage cancer may be able to choose between breast conserving surgery and mastectomy.
People will receive general anesthesia for a modified radical mastectomy, as the operation is an invasive procedure. A surgeon who specializes in treating breast cancer will perform the procedure.
The surgeon will begin by drawing marks around the breast and across the chest. These marks act as guidelines for the surgeon when they go to make incisions.
The surgeon will make an incision on one side of the chest and gently pull the skin back to reveal the breast tissue. They will remove the breast tissue and the axillary lymph nodes that are under the arm. Finally, the surgeon will insert thin tubes to drain any excess fluid from the breast area and then close the incision site.
If doctors undertake reconstruction immediately, either a tissue expander or permanent implant is placed in the pocket before they close the skin incision. Sometimes a patient's own tissues are used to build a breast after mastectomy. In these situations, there may be several drainage tubes put in place at the end of the surgery.
After removal of the lymph nodes, a healthcare professional will test these for any signs of cancer. If cancer has spread to the lymph nodes, it may mean it has also spread to other areas of the body.
A doctor may recommend chemotherapy if cancer has spread outside of the breast tissue.
As with any surgery, modified radical mastectomies come with potential risks and complications. These can include:
- pain, swelling, or tenderness near the incision site
- swelling in the arm
- decreased range of motion
People can usually expect to stay in the hospital for 2 days or fewer after a mastectomy.
If they have breast reconstruction at the same time, they may stay longer, anywhere from 2 days for an implant up to a week for reconstruction with the patient's own tissue.
Hospital staff will regularly monitor a person's heart rate and blood pressure and check for any signs of infection. They may also administer medication to relieve any uncomfortable side effects, such as pain or nausea.
A staff member will help people perform exercises that prevent shoulder stiffness during the healing process. An individual can continue doing these exercises on their own once they return home.
The following list covers general guidelines for people to use when they return home from the hospital:
- Get plenty of rest to avoid fatigue.
- Take over-the-counter or prescription pain relievers, as instructed.
- Carefully wash the incision site regularly.
- Perform arm exercises daily.
- Avoid wearing a bra until the incision site has completely healed.
A modified radical mastectomy removes the entire breast and the surrounding axillary lymph nodes. Unlike a radical mastectomy, it leaves the underlying muscle tissue intact.
A doctor might recommend a modified radical mastectomy for invasive breast cancer that has spread beyond the breast tissue or has a high likelihood of spreading to the lymph nodes.
People can discuss their treatment options with their doctor. It is important to weigh the costs and benefits of all potential treatments before coming to a decision.