A mastectomy is a surgery that involves removing a person’s breast, often as a treatment for cancer. A radical mastectomy involves removing the entire breast and nearby tissue.

It may also involve removing the lymph nodes under the arm and the muscles of the chest wall.

Previously, doctors would commonly recommend radical mastectomies to treat breast cancer. However, due to improved imaging and new treatment options, surgeons now perform fewer radical mastectomies.

This article examines the radical mastectomy procedure in more detail, including how the surgery takes place, typical recovery expectations, and the procedure’s benefits and risks.

An illustration of a radical mastectomy.Share on Pinterest
Design by Diego Sabogal mastectomy art by Diego Sabogal

A radical mastectomy is also called a Halstead mastectomy. For many decades, doctors considered it a first-line treatment for removing cancerous tissue.

A radical mastectomy removes a person’s:

  • entire breast, including the areola and nipple
  • lymph nodes underneath the arm and in the armpit
  • tissue that covers most of the rib cage
  • chest wall muscles underneath the breast

Doctors now only recommend radical mastectomy when a tumor spreads into a person’s chest wall. This is because there are newer surgeries with fewer risks that spare the breast and produce similar outcomes to a radical mastectomy.

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Design by Diego Sabogal mastectomy art by Diego Sabogal

In 1972, a breast surgeon named John Madden discovered that keeping the chest wall muscles intact during a radical mastectomy produced better outcomes in some people. This finding led him to create the modified radical mastectomy.

During a modified radical mastectomy, a surgeon removes a person’s breast, areola, and nipple, along with lymph nodes under the arm. Unless the surgeon discovers that the tumor has spread, they leave the muscles of the chest wall intact.

A radical mastectomy takes place in a hospital under general anesthesia. The surgery takes about 2–3 hours. During the surgery, a surgeon makes a horizontal or diagonal incision across the affected breast area.

After the surgeon removes affected breast tissue, lymph nodes, and muscle tissue, they place one or two drainage tubes to prevent fluid from collecting in the remaining space. These drains stay in place for several days until a doctor removes them.

Questions to ask a doctor

There are several questions that people can consider asking their doctor before mastectomy surgery. These include:

  • How many times have you performed a mastectomy?
  • What are the risks associated with this type of surgery?
  • What can I do to prepare for surgery?
  • How long will the surgery take, and how long will I be in the hospital?
  • Will you have to remove my lymph nodes?
  • Is there a risk of lymphedema (swelling) after surgery?
  • Will I need blood transfusions? If so, should I donate my own blood before surgery?
  • If I do not have immediate breast reconstruction, how will my breast look after surgery?
  • If I choose to have an immediate reconstruction, what are the risks? How will my breast look?
  • How long will recovery take?
  • What limitations will I have following surgery?
  • Are there certain exercises I need to do after surgery?
  • Are there precautions I need to take after surgery?

People should talk with their doctor about any other questions or concerns they have.

Before surgery

The surgeon’s office should provide individuals with instructions on how to prepare for the surgery.

They may recommend:

  • avoiding aspirin or aspiring-containing products for 10 days before surgery
  • refraining from eating or drinking after midnight the night before surgery
  • wearing loose, comfortable clothing to the hospital
  • having someone to accompany the person to and from the hospital and talk with the surgeon after the procedure
  • having someone to help with the person’s recovery at home

People may also want to bring the following items to the hospital:

  • a list of current medications
  • important phone numbers
  • a robe and sweater that open at the front
  • toothbrush, toiletries, and earplugs
  • slippers and socks
  • music player and headphones
  • reading materials

People should leave any valuables at home.

During surgery

Once a person is under general anesthesia, the surgeon will make an incision across the affected breast. They will remove the breast tissue between the collarbone and ribs, then remove the lymph nodes under the arm. Finally, if necessary, they will remove the muscles of the chest wall.

The surgeon will also place drains after the tissue removal to prevent fluid from pooling. They will use stitches to close the incision before covering the area with a bandage and placing a tight wrap around the chest.

Most people will likely feel some pain and numbness following the surgery. They may feel crawling sensations as the nerves grow back. Shooting pain may also occur. Additionally, because people will have a tube inserted into their throat during the surgery, they may have a sore throat afterward.

A doctor may prescribe pain medications, such as ibuprofen, acetaminophen, or opioids. Opioids can cause constipation, so a doctor will also prescribe a stool softener. People should make sure to eat high fiber foods and increase their fluid intake.

Hot and cold packs can also help reduce pain. People may also choose complementary therapies for pain management. These can include:

  • acupuncture
  • hypnosis
  • massage
  • chiropractic
  • Reiki
  • Shiatsu

Most people stay in the hospital for 1–2 nights after a radical mastectomy. At home, recovery time takes about 4 weeks. It can take longer if a person also has breast reconstruction surgery.

Bruising and some swelling is normal after surgery. People should follow the doctor’s instructions regarding dressings, wound closure strips, and stitches. The surgeon’s office should provide instructions on how to empty the drains.

People should avoid strenuous activity after surgery. They also cannot drive while taking opiates or while the drains are still in place.

A person should contact their doctor if they experience any of the following:

  • pain that does not go away with medication
  • fever greater than 100°F (37.7°C) or chills
  • bloody dressing
  • excessive swelling
  • discoloration that goes beyond the dressing
  • discharge
  • foul odor from the wound
  • allergic reaction to medication
  • constipation
  • anxiety, depression, or trouble sleeping

The primary benefit of a radical mastectomy is that it removes a cancerous tumor and reduces the risk of a future breast cancer diagnosis or recurrence.

Potential complications of a radical mastectomy include:

  • infection of the wound
  • swelling after the removal of lymph nodes
  • reaction to anesthesia
  • blood clots
  • fatigue and weakness
  • bleeding from the wound
  • fluid or blood collecting around the wound site
  • nerve pain or shoulder stiffness
  • scar tissue

A radical mastectomy is a highly invasive procedure, and it can take a person weeks or months to recover. Some people need follow-up treatments, such as radiation therapy or chemotherapy.

The following may affect a person’s recovery time after this type of surgery:

  • type and stage of cancer
  • whether they also had reconstructive surgery
  • complications

A radical mastectomy involves the complete removal of a person’s breast, areola, nipple, nearby lymph nodes, and muscles of the chest wall. Surgeons only perform this surgery when a tumor has grown into the chest wall muscles.

People will likely need assistance when recovering at home.

Less invasive surgeries, such as modified radical mastectomies, combined with radiation therapy or chemotherapy, are much more common and just as effective as radical mastectomies.