Modified radical mastectomy

概述

A modified radical mastectomy (MRM) is a type of surgery to treat breast cancer. It may be recommended in some situations, such as when cancer has spread to lymph nodes under the arm.

During a modified radical mastectomy, the surgeon removes all breast tissue from one breast. The surgeon also removes many of the lymph nodes under the arm. This part of the surgery is called an axillary lymph node dissection.

Modified radical mastectomy differs from:

• A total mastectomy, also called a simple mastectomy, which removes all breast tissue from a breast but does not include axillary lymph node dissection.
• A radical mastectomy, also called a Halsted radical mastectomy, which removes the breast, axillary lymph nodes and chest muscle. This surgery is rarely done today. In comparison, a modified radical mastectomy preserves the chest muscle.
• A Patey modified radical mastectomy and an Auchincloss modified radical mastectomy, which are older variations of modified radical mastectomy surgery.
• A bilateral mastectomy, which removes both breasts. The word "bilateral" tells you how many breasts are removed. But it does not describe whether or how many axillary lymph nodes are removed.
• Nipple-sparing mastectomy and skin-sparing mastectomy procedures, which leave certain tissues in place that are removed in modified radical mastectomy.

目的

Modified radical mastectomy may be recommended when you have:

• A biopsy before surgery that shows the cancer has spread to lymph nodes under the arm, also called axillary lymph nodes.
• Inflammatory breast cancer.
• A sentinel node biopsy that finds cancer in three or more lymph nodes.
• Breast cancer that has spread nearby, such as to the chest wall or skin. This is called local spread.
• Cancer remaining in the lymph nodes after chemotherapy treatment given before surgery, in some situations.

Cancer in the axillary lymph nodes does not always mean you need a modified radical mastectomy. For example, for some people with cancer in one or two sentinel lymph nodes, other treatment such as radiation therapy may be an option.

When recommending modified radical mastectomy, your care team considers many factors. Examples include your age, the type of cancer you have and how far the cancer has spread. The number of lymph nodes involved and what other treatments you've already had are important too.

风险

Modified radical mastectomy has many of the same risks as other types of mastectomy.

Modified radical mastectomy also has other risks related to removal of the lymph nodes under the arm. These effects sometimes last a long time and include:

• Arm swelling called lymphedema. Removing lymph nodes can cause fluid to build up in the arm or chest. This can cause lymphedema.
• Arm and shoulder pain or trouble moving. Arm pain, stiffness and trouble moving your arm or shoulder can happen.
• Numbness or tingling. You may have these sensations in your arm if nerves in the underarm and upper arm are injured during surgery.

Surgeons take steps to protect important nerves and limit unnecessary tissue removal during axillary lymph node dissection. Exercises after surgery may help maintain movement in the arm and shoulder.

如何进行准备

Preparing for a modified radical mastectomy is much like preparing for other types of mastectomy.

Planning your surgery

Before surgery, discussions with your care team may include a review of:

• Imaging and biopsy results that show the size and location of the cancer and whether it has spread to lymph nodes under the arm.
• The cancer type and stage.
• Chemotherapy or other cancer treatment you had before surgery and any treatment planned after surgery.
• Your health history and any treatment-related side effects that could affect surgery or recovery.
• Your personal preferences.

If you had chemotherapy before surgery, the surgery usually happens about a month or two after your last chemotherapy treatment. This allows time for you to recover from the chemotherapy before you have surgery.

It may help to bring someone with you to your appointments to help you remember all the information you receive.

Planning breast reconstruction

If you're considering breast reconstruction, such as with an implant or flap surgery, talk with your care team before surgery. Breast reconstruction is possible after modified radical mastectomy. Immediate breast reconstruction may more often be planned with a skin-sparing or nipple-sparing mastectomy. But immediate reconstruction after modified radical mastectomy is an option for some people.

If you're interested in breast reconstruction, you may meet with a plastic surgeon before surgery. Your treatment plan, including whether you may need radiation therapy, can affect the type and timing of reconstruction.

可能出现的情况

Your care team gives you instructions before surgery. In general, you may need to:

• Tell your care team about any medicines, vitamins or supplements you take. Some may affect the surgery.
• Follow instructions about aspirin and blood-thinning medicines. Your care team tells you whether and when to stop these medicines before surgery.
• Stop nicotine use. Nicotine can interfere with healing and increase the risk of infection after surgery. It is best to stop nicotine for as long as possible before and after surgery. If you are having breast reconstruction, you may need to stop using all nicotine products for up to six weeks before surgery.
• Stop eating before surgery. Your care team might ask you to stop eating several hours before the surgery. They may say it's OK to drink liquids for a certain time before surgery. Follow your care team's instructions about when to stop eating and drinking.
• Make a plan for after surgery. Ask your care team if you'll need to stay in the hospital and for how long. Some people go home the same day after modified radical mastectomy. Some stay in the hospital. Plan for a ride if you're told you can go home the same day. If you need to stay in the hospital, bring a robe and slippers to help make you more comfortable. Pack a bag with your toiletries and something to help you pass the time, such as a book.

During the procedure

Modified radical mastectomy is done under general anesthesia. This means you're in a sleeplike state during the surgery.

The surgeon starts by making an opening in the breast called an incision. Next, the surgeon removes all the breast tissue. This includes the nipple, the dark area around the nipple called the areola, and the skin over or near the tumor. The thin lining over the main chest muscle, called fascia, also is removed. The main chest muscle usually is not removed.

The surgeon then removes many of the lymph nodes under the arm in an axillary lymph node dissection. There are three levels of these lymph nodes. The levels are numbered based on depth. A standard dissection usually removes lymph nodes from levels 1 and 2. The exact number of lymph nodes removed depends on a person's anatomy. Typically, 10 or more lymph nodes are removed. Level 3 lymph nodes usually are left in place unless tests before surgery suggest they contain cancer or the surgeon finds changes in them during surgery that suggest cancer.

You might have one or more small plastic tubes placed where your breast was removed and under your arm. The tubes drain any fluids that collect after surgery. The surgeon then closes the incision with stitches.

If immediate breast reconstruction is part of your surgical plan, the plastic surgeon starts the reconstruction after the mastectomy is complete.

After the procedure

After surgery, you move to a recovery area where your care team checks on you as the anesthesia wears off. You may go home the same day, or you may need to stay in the hospital. How long you stay depends on the surgery and your recovery.

You can usually expect to:

• Have a bandage over the surgery area. Your care team gives you instructions about how to care for the incision and watch for signs of infection.
• Have one or more drains to remove fluid that collects under the skin. Drains usually stay in place for 1 to 2 weeks.
• Receive medicine, including medicine to help manage pain. You may feel pain, numbness, tightness or pinching in the chest or underarm area as you recover.
• Get instructions on how to care for yourself while you heal. Your care team may recommend that you avoid certain activities for a time. Once drains have been removed and you've started to heal, your care team might recommend gentle arm and shoulder exercises. Unless the care team gives you other instructions, these gentle exercises typically can begin about a week after surgery. These exercises can help with movement after the lymph node dissection. Some people may need physical therapy if arm or shoulder movement remains limited.
• Learn what signs of lymphedema to watch for. These may include swelling, tightness or pain in the arm. Tell your care team right away if you notice these concerns. Your care team may refer you to a lymphedema specialist if needed.

Recovery takes time and is different from person to person. Complete recovery from breast surgery may take several weeks to months, although many people gradually increase their activity as they heal.

If breast reconstruction was not done at the time of your modified radical mastectomy, it may be possible later. The timing depends on your cancer treatment plan, including whether you need radiation therapy.

结果

After modified radical mastectomy, the breast tissue and lymph nodes that were removed are tested in a lab. The results give more information about the cancer, including how many of the lymph nodes that were removed contain cancer. The results also help decide the stage of the cancer and guide decisions about treatment after surgery.

Long-term outcomes after modified radical mastectomy depend on the breast cancer itself, including its stage, tumor features and how many lymph nodes contain cancer. Outcomes with modified radical mastectomy are similar to outcomes for radical mastectomy, but with fewer side effects. Talk with your care team about your results and next steps in your treatment.

If you need more treatment, you may be referred to:

• A radiation oncologist to discuss radiation therapy. Radiation after modified radical mastectomy may be recommended based on several factors. These include the number of lymph nodes that contain cancer, the size and stage of the tumor, whether cancer is found at or near the edges of the removed tissue and whether cancer has invaded the skin or chest wall.
• A medical oncologist to discuss treatment with medicines after surgery. This may include chemotherapy, hormone therapy, targeted therapy or other medicines, depending on the cancer and treatments you've already had.
• A plastic surgeon if you're considering breast reconstruction that was not done at the time of your mastectomy.
• A counselor or support group if you would like help coping with breast cancer and its treatment.