McKesson Clinical Reference Systems: Women's Health Advisor 2002.2

What is a modified radical mastectomy?

A modified radical mastectomy is a procedure in which the doctor removes your breast and the lymph nodes in your armpit.

When is it used?

This procedure is done when cancer is found in the breast.

Depending on the type of breast cancer and the extent or spread of the breast cancer when it is discovered, some alternatives to this procedure may be available. Examples of other treatments are:

• lumpectomy (removing only the tumor, some surrounding tissue, and lymph nodes under the arm)
• simple mastectomy (removing only the breast).

You should ask your doctor about these choices.

Other treatments used with surgery are:

• Radiation therapy, which uses radiation to prevent cancer from regrowing, is a part of the treatment when breast-sparing surgery (lumpectomy) is done.
• Chemotherapy and hormonal therapy are used, in addition to surgery and radiation therapy, when there is a chance that the tumor has spread to the rest of the body. Chemotherapy is sometimes used to reduce the tumor size before surgery.

How do I prepare for a modified radical mastectomy?

Plan for your care and recovery after the operation. Allow for time to rest and try to find people to help you with your day-to-day duties. Ask your doctor if there is a breast cancer support group you could contact. This group can help you find and talk with other women who have had a mastectomy.

Follow the instructions provided by the doctor. Eat a light meal, such as soup or salad, the night before the procedure. Do not eat or drink anything after midnight or the morning before the procedure. Do not even drink coffee, tea, or water.

What happens during the procedure?

You are given a general anesthetic. A general anesthetic relaxes your muscles, puts you to sleep, and prevents you from feeling pain.

The doctor makes a cut over the breast and lifts the skin away from the breast tissue. The doctor separates this tissue, including the nipple, from the muscle that lies between the breast and rib cage. Once the doctor has removed the breast and tissue around it, the skin flaps are sewn in place and a tube is temporarily put under them to drain fluid. If the breast is rebuilt, these skin flaps are used in the reconstruction.

The doctor also removes tissue under the armpit. This tissue contains lymph nodes that may also have cancer. When the lymph nodes are removed, the nerves that provide feeling to the underside of the upper arm may be removed or injured.

What happens after the procedure?

• You may stay in the hospital about 24 hours. Talk with your surgeon about the plan for your discharge from the hospital.
• Ask your doctor how to take care of yourself at home during the first days after surgery.
• For 5 to 7 days you will have 1 or 2 drains that remove extra fluid from the area of the surgery.
• You will have medicine to prevent pain.
• The breast area will heal fully in about 3 to 4 weeks.
• Follow your doctor's recommended schedule for checkups.

What are the benefits of this procedure?

It may provide your best chance to survive breast cancer.

What are the risks associated with this procedure?

• There are some risks when you have general anesthesia. Discuss these risks with your doctor.
• Fluid may collect under the skin flaps and need to be drained by the surgeon.
• Nerves in the area of the surgery may be damaged. As a result, the underside of your arm may be numb. After the surgery you may have trouble moving some of your shoulder muscles. Special exercises will help you regain normal movement of your shoulder.
• You may develop lymphedema, which is swelling of the arm resulting from interference of normal drainage of lymph after the surgery.
• There is a chance a lumpy scar, called a keloid, will develop.
• This procedure may not remove all of the cancer cells and further treatment may be necessary.
• The cancer may recur.
• You may have infection or bleeding.

You should ask your doctor how these risks apply to you.

When should I call the doctor?

Call the doctor immediately if:

• You develop a fever.
• The area of the incision is red.
• You have unusual drainage from the incision.
• You have pain that gets worse.
• Fluid collects under the skin flaps.

Call the doctor during office hours if:

• You have questions about the procedure or its result.
• You want to make a follow-up appointment.

This content is reviewed periodically and is subject to change as new health information becomes available. The information is intended to inform and educate and is not a replacement for medical evaluation, advice, diagnosis or treatment by a healthcare professional.