Breast Cancer

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 has already spread to the lymph nodes. A modified radical mastectomy without reconstruction takes 2 to 4 hours and usually involves a one- to two-night hospital stay. A single incision across half the chest usually allows the surgeon to remove the breast and the lymph nodes.

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-sized suction device. Patients are instructed in the care and monitoring of the drains and drainage until the drains are removed several days after surgery. Although some women find this bothersome, it's 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. In addition to the emotionally draining experience of facing cancer surgery, it is physically taxing as well. Health care providers recommend that patients plan a lighter schedule, with the possibility of daily naps, for the weeks following surgery.

In most cases of early-stage breast cancer, radiation treatment is not recommended after modified radical mastectomy. However, radiation may be recommended if any of the following is true:

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