Modified Radical Mastectomy
In a modified radical mastectomy, the entire breast is
removed, including the skin, areola and nipple, as well as
most of the lymph nodes in the armpit area.
Modified radical mastectomy is usually recommended if the
tumor is large and cancer has already spread to the lymph
nodes.
What to expect
A modified radical mastectomy without reconstruction takes
two to four hours and usually involves a one-night hospital
stay. A single incision across half the chest usually allows the
surgeon to remove the breast and the lymph nodes.
After modified radical mastectomy, small tubes are placed in
the breast area to draw off fluid. The ends of these drains are
attached to a pocket-sized suction device. Patients are
instructed in the care and monitoring of the drainage until the
drains are removed, a week or more after surgery.
Most women do not experience excessive pain following a
modified radical mastectomy. Patients often use pain
medication for one to two weeks following surgery and then
use over-the-counter pain relievers if needed.
Numbness may occur in the upper arm as a result of the loss
of small nerves where lymph nodes are removed. Some of the
numbness may fade over time.
Cancer surgery is emotionally draining and physically taxing.
Patients are advised to expect fatigue and plan a light
schedule for the first two weeks following modified radical
mastectomy.
A surgical procedure that removes the breast, surrounding
tissue, and nearby lymph nodes that are affected by cancer.
Purpose
The purpose for modified radical mastectomy is
the removal of breast cancer (abnormal cells in
the breast that grow rapidly and replace normal
healthy tissue). Modified radical mastectomy is
the most widely used surgical procedure to treat
operable breast cancer. This procedure leaves a
chest muscle called the pectoralis major intact.
Leaving this muscle in place will provide a soft
tissue covering over the chest wall and a normal-
appearing junction of the shoulder with the
anterior (front) chest wall. This sparing of the
pectoralis major muscle will avoid a disfiguring
hollow defect below the clavicle. Additionally, the
purpose of modified radical mastectomy is to
allow for the option of , a procedure that is
breast reconstruction
possible, if desired, due to intact muscles around
the shoulder of the affected side. The modified
radical mastectomy procedure involves removal
of large multiple tumor growths located
underneath the nipple and cancer cells on the
breast margins.
Demographics
The highest rates of breast cancer occur in Western countries
(more than 100 cases per 100,000 women) and the lowest
among Asian countries (10–15 cases per 100,000 women).
Men can also have breast cancer, but the incidence is much
less when compared to women. There is a strong genetic
correlation since breast cancer is more prevalent in females
who had a close relative (mother, sister, maternal aunt, or
maternal grandmother) with previous breast cancer. Increased
susceptibility for development of breast cancer can occur in
females who never breastfed a baby, had a child after age 30,
started menstrual periods very early, or experienced
menopause very late.
In the United States, there were approximately 175,000 cases
of breast cancer in 1999 with more than 43,000 deaths.
Breast cancer accounts for 30% of all cancer diagnosed in
American women and for 16% of all cancer deaths. Breast
cancer is a worldwide public health problem since there are
approximately one million new cases diagnosed annually. A
woman's lifetime risk of developing breast cancer is one in
eight. The incidence rose
Description
The surgeon's goal during this procedure is to minimize any
chance of local/regional recurrence; avoid any loss of
function; and maximize options for breast reconstruction.
Incisions are made to avoid visibility in a low neckline dress
or bathing suit. An incision in the shape of an ellipse is made.
The surgeon removes the minimum amount of skin and tissue
so that remaining healthy tissue can be used for possible
reconstruction. Skin flaps are made carefully and as thinly as
possible to maximize removal of diseased breast tissues. The
skin over a neighboring muscle (pectoralis major fascia) is
removed, after which the surgeon focuses in the armpit
(axilla, axillary) region. In this region, the surgeon carefully
identifies vital anatomical structures such as blood vessels
(veins, arteries) and nerves. Accidental injury to specific
nerves like the medial pectoral neurovascular bundle will
result in destruction of the muscles that this surgery attempts
to preserve, such as the pectoralis major muscle. In the
armpit region, the surgeon carefully protects the vital
structures while removing cancerous tissues. After axillary
surgery, breast reconstruction can be performed, if desired by
the patient.
Diagnosis/Preparation
Modified radical mastectomy is a surgical procedure to treat
breast cancer. In order for this procedure to be an operable
option, a definitive diagnosis of breast cancer must be
established. The first clinical sign for approximately 80% of
women with breast cancer is a mass (lump) located in the
breast. A lump can be discovered by monthly self-
examination or by a health professional who can find 10–
25% of breast cancers that are missed by yearly
mammograms (a low radiation x ray of the breasts). A biopsy
can be performed to examine the cells from a lump that is
suspicious for cancer. The diagnosis of the extent of cancer
and spread to regional lymph nodes determines the treatment
course (i.e., whether surgery, chemotherapy, or radiation
therapy, either singly or in combinations). Staging the cancer
can estimate the amount of tumor, which is important not
only for diagnosis but for prognosis (statistical outcome of
the disease process). Patients with a type of breast cancer recurrence. It is recommended that
called ductal carcinoma in situ (DCIS), which is a stage 0
annual mammograms, physical
cancer, have the best outcome
examination, or additional tests
(biopsy) be performed annually.
In a modified radical mastectomy, the skin on the breast Aftercare can also include
is cut open (A). The skin is pulled back, and the tumor, psychotherapy since mastectomy is
lymph nodes, and breast tissue are removed (B and C). emotionally traumatic. Affected women
The incision is closed (D). (
Illustration by GGS Inc.
may be worried or have concerns about
) appearance, the relationship with their
(nearly all these patients are cured of breast cancer). Persons sexual partner, and possible physical
who have cancerous spread to other distant places within the limitations. Community-centered
body (metastases) have stage IV cancer and the worst
prognosis (potential for survival). Persons affected with stage
support groups usually made up of
IV breast cancer have essentially no chance for cure. former breast cancer surgery patients
can be a source of emotional support
Persons affected with breast cancer must undergo the staging after surgery. Patients may stay in the
of the cancer to determine the extent of cancerous growth and hospital for one to two days. For about
possible spread (metastasis) to distant organs. Patients with five to seven days after surgery, there
stage 0 disease have noninvasive cancer with a very good
outcome. Stages I and II are early breast cancer, without
will be one or two drains left inside to
lymph node involvement (stage I) and with node positive remove any extra fluid from the area
results (stage II). Persons with stage III disease have locally after surgery. Usually, the surgeon will
advanced disease and about a 50% chance for five-year prescribe medication to prevent pain.
survival. Stage IV disease is the most severe since the breast
cancer cells have spread through lymph nodes to distant areas
Movement restriction should be
and/or other organs in the body. It is very unlikely that specifically discussed with the surgeon.
persons with stage IV metastatic breast cancer survive 10
years after diagnosis.
Risks There are several risks associated with
modified radical mastectomy. The
It is also imperative to assess the degree of cancerous spread
to lymph nodes within the armpit region. Of primary
procedure is performed under general
importance to stage determination and regional lymph node anesthesia, which itself carries risk.
involvement is identification and analysis of the sentinel Women may have short-term pain and
lymph node. The sentinel lymph node is the first lymph node tenderness. The most frequent risk of
to which any cancer would spread. The procedure for sentinel
node biopsy involves injecting a radioactively labeled tracer breast cancer surgery (with extensive
(technetium 99) or a blue dye (isosulphan blue) into the lymph node removal) is edema, or
tumor site. The tracer or dye will spread through the swelling of the arm, which is usually
lymphatic system to the sentinel node, which should be mild, but the presence of fluid can
surgically removed and examined for the presence of cancer
cells. If the sentinel node and one or two other neighboring increase the risk of infection. Leaving
lymph nodes are negative, it is very likely that the remaining some lymph nodes intact instead of
lymph nodes will not contain cancerous cells, and further removing all of them may help lessen
surgery may not be necessary. the likelihood of swelling. Nerves in the
area may be damaged. There may be
Once a breast lump (mass) has been identified by numbness in the arm or difficulty
mammography or physical examination , the patient
should undergo further evaluation to histologically (studying moving shoulder muscles. There is also
the cells) identify or rule out the presence of cancer cells. A the risk of developing a lump scar
procedure called fine-needle aspiration allows the clinician to (keloid) after surgery. Another risk is
extract cells directly from the lump for further evaluation. If a that surgery did not remove all the
diagnosis cannot be established by fine-needle biopsy, the
surgeon should perform an open biopsy (surgical removal of cancer cells and that further treatment
the suspicious mass). Preparation for surgery is imperative. may be necessary (with chemotherapy
The patient should plan for both direct care and recovery and/or radiotherapy). By far, the worst
time after modified radical mastectomy. Preparation risk is recurrence of cancer. However,
immediately prior to surgery should include no food or drink
after midnight before the procedure. Post-surgical preparation immediate signs of risk following
should include caregivers to help with daily tasks for several surgery include fever, redness in the
days. incision area, unusual drainage from
the incision, and increasing pain. If any
Aftercare After breast cancer surgery, women of these signs develop, it is imperative
should undergo frequent testing to to call the surgeon immediately.
ensure early detection of cancer Normal results
If no complications develop, the surgical area should completely heal
within three to four weeks. After mastectomy, some women may The surgeon's goal during this procedure
undergo breast reconstruction (which can be done during
mastectomy). Recent studies have indicated that women who desire
is to minimize any chance of
cosmetic reconstructive surgery have a higher quality of life and better local/regional recurrence; avoid any loss
sense of well-being than those who do not utilize this option.
of function; and maximize options for
Morbidity and mortality rates
breast reconstruction. Incisions are made
to avoid visibility in a low neckline dress
The outcome of breast cancer is very or bathing suit. An incision in the shape
dependent of the stage at the time of of an ellipse is made. The surgeon
diagnosis. For stage 0 disease (5–10% of removes the minimum amount of skin
the cases), the five-year survival is 99%. and tissue so that remaining healthy
For stage I (early/lymph node negative), tissue can be used for possible
which comprises 40–45% of total cases, the five-year survival is reconstruction. Skin flaps are made
85–95%. For stage II (early/lymph node positive), which comprises
35–40% of total cases, the five-year survival decreases to 65–75%.
carefully and as thinly as possible to
For stage III disease (locally advanced), which accounts for 10–15% maximize removal of diseased breast
of total cases, the five-year survival is 45–50%. Women with stage IV
(metastatic) breast cancer account for about 7% of total cases; the tissues. The skin over a neighboring
five-year survival is 20–30%. Less than 1% of these women survive
past 10 years. Alternatives muscle (pectoralis major fascia) is
removed, after which the surgeon
There are no real alternatives to mastectomy. Surgical requirement is
clear since mastectomy is recommended for tumors with dimensions
focuses in the armpit (axilla, axillary)
over 2 in (5 cm). Additional treatment (adjuvant) is typically region. In this region, the surgeon
recommended with chemotherapy and/or radiation therapy to destroy
any remaining cancer during surgery. Modified radical mastectomy is carefully identifies vital anatomical
one of the standard treatment recommendations for stage III breast
cancer.
structures such as blood vessels (veins,

arteries) and nerves. Accidental injury to

Description specific nerves like the medial pectoral
neurovascular bundle will result in breast cancer have essentially no chance
destruction of the muscles that this for cure.
surgery attempts to preserve, such as the
pectoralis major muscle. In the armpit Persons affected with breast cancer must
region, the surgeon carefully protects the undergo the staging of the cancer to
vital structures while removing determine the extent of cancerous
cancerous tissues. After axillary surgery, growth and possible spread (metastasis)
breast reconstruction can be performed, to distant organs. Patients with stage 0
if desired by the patient. disease have noninvasive cancer with a
very good outcome. Stages I and II are
Diagnosis/Preparation early breast cancer, without lymph node
involvement (stage I) and with node
positive results (stage II). Persons with
Modified radical mastectomy is a
stage III disease have locally advanced
surgical procedure to treat breast cancer.
disease and about a 50% chance for five-
In order for this procedure to be an
year survival. Stage IV disease is the
operable option, a definitive diagnosis of
most severe since the breast cancer cells
breast cancer must be established. The
have spread through lymph nodes to
first clinical sign for approximately 80%
distant areas and/or other organs in the
of women with breast cancer is a mass
body. It is very unlikely that persons
(lump) located in the breast. A lump can
with stage IV metastatic breast cancer
be discovered by monthly self-
survive 10 years after diagnosis.
examination or by a health professional
who can find 10–25% of breast cancers
It is also imperative to assess the degree
that are missed by yearly mammograms
of cancerous spread to lymph nodes
(a low radiation x ray of the breasts). A
within the armpit region. Of primary
biopsy can be performed to examine the
importance to stage determination and
cells from a lump that is suspicious for
regional lymph node involvement is
cancer. The diagnosis of the extent of
identification and analysis of the sentinel
cancer and spread to regional lymph
lymph node. The sentinel lymph node is
nodes determines the treatment course
the first lymph node to which any cancer
(i.e., whether surgery, chemotherapy, or
would spread. The procedure for sentinel
radiation therapy, either singly or in
node biopsy involves injecting a
combinations). Staging the cancer can
radioactively labeled tracer (technetium
estimate the amount of tumor, which is
99) or a blue dye (isosulphan blue) into
important not only for diagnosis but for
the tumor site. The tracer or dye will
prognosis (statistical outcome of the
spread through the lymphatic system to
disease process). Patients with a type of
the sentinel node, which should be
breast cancer called ductal carcinoma in
surgically removed and examined for the
situ (DCIS), which is a stage 0 cancer,
presence of cancer cells. If the sentinel
have the best outcome (nearly all these
node and one or two other neighboring
patients are cured of breast cancer).
lymph nodes are negative, it is very
Persons who have cancerous spread to
likely that the remaining lymph nodes
other distant places within the body
will not contain cancerous cells, and
(metastases) have stage IV cancer and
further surgery may not be necessary.
the worst prognosis (potential for
survival). Persons affected with stage IV
Once a breast lump (mass) has been surgeon will prescribe medication to
identified by mammography or prevent pain. Movement restriction
physical examination, the patient should be specifically discussed with the
should undergo further evaluation to surgeon.
histologically (studying the cells)
identify or rule out the presence of
cancer cells. A procedure called fine-
needle aspiration allows the clinician to
extract cells directly from the lump for
Risks
further evaluation. If a diagnosis cannot
There are several risks associated with
be established by fine-needle biopsy, the
modified radical mastectomy. The
surgeon should perform an open biopsy
procedure is performed under general
(surgical removal of the suspicious
anesthesia, which itself carries risk.
mass). Preparation for surgery is
Women may have short-term pain and
imperative. The patient should plan for
tenderness. The most frequent risk of
both direct care and recovery time after
breast cancer surgery (with extensive
modified radical mastectomy.
lymph node removal) is edema, or
Preparation immediately prior to surgery
swelling of the arm, which is usually
should include no food or drink after
mild, but the presence of fluid can
midnight before the procedure. Post-
increase the risk of infection. Leaving
surgical preparation should include
some lymph nodes intact instead of
caregivers to help with daily tasks for
removing all of them may help lessen
several days.
the likelihood of swelling. Nerves in the
area may be damaged. There may be
After breast cancer surgery, women
numbness in the arm or difficulty
should undergo frequent testing to
moving shoulder muscles. There is also
ensure early detection of cancer
the risk of developing a lump scar
recurrence. It is recommended that
(keloid) after surgery. Another risk is
annual mammograms, physical
that surgery did not remove all the
examination, or additional tests (biopsy)
cancer cells and that further treatment
be performed annually. Aftercare can
may be necessary (with chemotherapy
also include psychotherapy since
and/or radiotherapy). By far, the worst
mastectomy is emotionally traumatic.
risk is recurrence of cancer. However,
Affected women may be worried or have
immediate signs of risk following
concerns about appearance, the
surgery include fever, redness in the
relationship with their sexual partner,
incision area, unusual drainage from the
and possible physical limitations.
incision, and increasing pain. If any of
Community-centered support groups
these signs develop, it is imperative to
usually made up of former breast cancer
call the surgeon immediately.
surgery patients can be a source of
emotional support after surgery. Patients
may stay in the hospital for one to two Normal results
days. For about five to seven days after
surgery, there will be one or two drains If no complications develop, the surgical
left inside to remove any extra fluid area should completely heal within three
from the area after surgery. Usually, the to four weeks. After mastectomy, some
women may undergo breast
reconstruction (which can be done
during mastectomy). Recent studies have
indicated that women who desire
cosmetic reconstructive surgery have a
higher quality of life and better sense of
well-being than those who do not utilize
this option.
during mastectomy). Recent studies have
indicated that women who desire
cosmetic reconstructive surgery have a
higher quality of life and better sense of
well-being than those who do not utilize
this option.

Aftercare
After breast cancer surgery, women
should undergo frequent testing to
ensure early detection of cancer
recurrence. It is recommended that
annual mammograms, physical
examination, or additional tests (biopsy)
be performed annually. Aftercare can
also include psychotherapy since
mastectomy is emotionally traumatic.
Affected women may be worried or have
concerns about appearance, the
relationship with their sexual partner,
and possible physical limitations.
Community-centered support groups
usually made up of former breast cancer
surgery patients can be a source of
emotional support after surgery. Patients
may stay in the hospital for one to two
days. For about five to seven days after
surgery, there will be one or two drains
left inside to remove any extra fluid
from the area after surgery. Usually, the
surgeon will prescribe medication to
prevent pain. Movement restriction
should be specifically discussed with the
surgeon.

Normal results
If no complications develop, the surgical
area should completely heal within three
to four weeks. After mastectomy, some
women may undergo breast
reconstruction (which can be done