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 under the arm. This surgery is most commonly recommended if the tumor is large and cancer is thought to have already spread to the lymph nodes. A modified radical mastectomy without reconstruction takes two to four hours and usually involves a hospital stay of one to two nights. A single incision across half the chest usually allows the surgeon to remove the breast and the lymph nodes.

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After the surgeon completes the mastectomy, two plastic tubes each about the width of a pen are gently sewn into place to draw off fluids. The ends of these drains are attached to a pocket-size suction device. Patients are instructed in the care of the drains and monitoring of the draining fluids until the tubes are removed seven to 10 days after surgery. Although some women find the tubes an irritant, having them in is usually not painful.

Most women do not experience excessive pain following a modified radical mastectomy. It is common to use some pain medication for the first week or two after surgery and then just an over-the-counter pain reliever, if needed. A sensation of numbness can occur in the upper arm, which results from the loss of small nerves where the lymph nodes are removed. Some of this numbness may fade over time.

Fatigue is to be expected following the surgery, which tends to be emotionally as well as physically taxing. Patients may need to plan a lighter schedule for the weeks following surgery.

Most women with early-stage breast cancer who undergo a modified radical mastectomy can forgo radiation therapy. However, radiation may be recommended if surgery uncovers any of the following:

• The tumor is larger than 2 inches (4 centimeters).
• Cancer cells are, in fact, found to be in the lymph nodes.
• Cancer cells are close to the chest wall, which increases the likelihood that the cancer cells may recur in the chest wall.