Definition A modified radical mastectomy is a surgical treatment for breast cancer. The surgeon removes the entire breast and nipple and the lymph nodes under the arm on the same side as the cancer. Lymph nodes are part of the immune system. They are small, round masses of tissue found throughout the body.
Who is a candidate for the procedure? Candidates for modified radical mastectomy are:
women with a diagnosis of breast cancer
women whose cancer has recurred in a breast that was previously treated
women who want to have a double mastectomy where both breasts are removed as a preventive measure, because of their genetic or family history of breast cancer. This is rarely done but if indicated, a bilateral simple mastectomy would be performed.
How is the procedure performed? The woman is put to sleep under general anaesthesia. The skin over the affected breast, the chest, and the upper arm is cleansed with an antiseptic and covered with sterile drapes. An incision is made to include the nipple and the pigmented skin around the nipple, called the areola. The surgeon may be able to include any previous biopsy incision, for cosmetic reasons.
All the breast tissue is carefully cut away from the skin down to the chest wall muscles and removed. None of the chest wall muscle is removed unless there is reason to think that the cancer has invaded the muscle. The lymph nodes and fatty tissue under the arm are identified and removed. Care is taken to identify and preserve the nerves and blood vessels in the area. The entire specimen is sent to a pathologist, a specialist in examining cancer under the microscope. All bleeding is controlled, and the wound is washed.
The chest wall incision is closed with sutures or staples. Small tubes are placed through the skin to drain any fluid that might build up in the area. A large bandage is placed over the incision and taped firmly in place. This pressure dressing keeps the skin against the chest wall muscles to lessen the fluid build-up and help it to drain properly.
What happens right after the procedure? The woman will wake up in the recovery room with an intravenous or IV, and oxygen tubes. The throat may be sore from the breathing tube used during the surgery. The nurses will ask the woman to cough and breathe deeply to clean out the lungs and prevent pneumonia. Analgesia will begin as soon as needed. The woman may be thirsty and or nauseated, and will have a bulky bandage and drains.
Back in the hospital room, women usually need help getting up the first time, but can go to the bathroom and walk as soon as they are able. Most women can go home within a few days. The bandages remain in place until they are removed by the surgeon. Home care instructions are given.
The woman may need to periodically empty a reservoir attached to the drains. Care must be taken to keep all items clean whenever handling the drains or bandages. Proper hand washing is very important before and after emptying the drains or changing dressings. The colour and amount of drainage should be noted and reported to the doctor.
Analgesics are given, but the pain is not usually severe. The surgeon will let the woman know what activities are allowed in the first few days after surgery.
After healing, the woman will have a flat, normally shaped chest wall. The scar runs diagonally or horizontally from near the breastbone to the edge where the breast tissue was. Reconstructive surgery can be done at any time to improve the cosmetic results.
What happens later at home? The surgeon will give the woman detailed instructions for care at home. It is important to follow these instructions for best results.
Many women feel sad or depressed after mastectomy, and have concerns about body image and sexuality. Any diagnosis of cancer brings with it the issues of death and dying as well as fears of recurrence. A doctor can provide support with these issues, and recommend other resources for support.
What are the potential complications after the procedure? All surgeries carry the risk of complications. The risks and benefits of any surgery should be discussed with the surgeon beforehand. Possible problems include:
fluid accumulation under the skin flaps. This can happen if the drains are not being emptied often enough, or they become plugged.
cell death, called necrosis, of the skin edges of the incision. This is uncommon, but may occur if the skin flaps are very thin or if there is tension at the incision site.
numbness along the skin in the underarm area and upper arm caused by damage to the nerves. These nerves travel through the area of the lymph nodes that are removed during surgery. Stretching or cutting these nerves usually results in numbness or a tingling, or a "pins and needles" sensation. Although it might take some time, this complication may go away.
postmastectomy pain syndrome. Some people have severe, sharp, shooting, or burning pain along the chest wall. This is frequently caused by nerve damage.
swelling of the arm on the side of the surgery, called lymphoedema. This is often a late complication, which means that it can occur months or even years after surgery. Most large centres have a lymphoedema clinic which will treat this condition.
To avoid lymphoedema:
Do not have blood drawn from the involved arm.
Do not have injections given in the involved arm.
Do not have blood pressure taken in the involved arm.
Avoid any injury to the involved arm, such as cuts, insect bites, or burns.
Keep physically active, within the limits set by the doctor.
Author: Susan Woods, MD Reviewer: eknowhow Medical Review Panel Editor: Dr John Hearne Last Updated: 8/11/2004 Contributors Potential conflict of interest information for reviewers available on request
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