Radical and Modified Radical Mastectomy

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What is a radical or modified radical mastectomy?

A radical mastectomy removes all breast tissue, including the nipple, areola and skin, along with numerous underarm lymph nodes. It also removes the chest wall muscles under the breast. This is the most extensive version of mastectomy. It used to be the standard surgery for breast cancer. However, doctors rarely use it today. Unless cancer has spread to the chest wall muscles, modified radical mastectomy works just as well and is less disfiguring.

What is modified radical mastectomy?

Modified radical mastectomy removes all breast tissue like a radical mastectomy. However, it removes fewer lymph nodes and leaves the chest wall muscles intact. It is a common procedure for invasive breast cancer because doctors can look at the lymph nodes to see if cancer has spread there. Some people may call this version “modified mastectomy.”

Other mastectomy surgeries, such as subcutaneous mastectomy, are more appropriate when cancer remains confined to the breast. The subcutaneous mastectomy procedure removes all visible breast tissue, but leaves the nipple-areola complex intact. Nipple-sparing mastectomy is another name for this surgery. This may also be an option in high-risk women looking to reduce their risk of developing breast cancer.

With radical or modified radical mastectomy, breast reconstruction is an option either at the same time or in the future. Some women opt to reconstruct the breast; other women prefer to use a breast prosthesis or special bras that give the appearance of a natural breast. Still other women choose to leave the chest “breast-free.” Talk with your doctor and other women who have had mastectomies to decide which one is right for you.

Who performs radical and modified radical mastectomies?

The surgeon performing your mastectomy will most likely be a general surgeon. Board-certified general surgeons treat many different kinds of diseases, disorders and conditions, but some further specialize in treating breast disease. These surgeons may use the term breast surgeon. If you want breast reconstruction, a plastic surgeon will work with your general surgeon. Plastic surgeons use surgery and other procedures to correct physical defects that affect a person’s appearance or ability to function.

Who performs radical and modified radical mastectomies?

The surgeon performing your mastectomy will most likely be a general surgeon. Board-certified general surgeons treat many different kinds of diseases, disorders and conditions, but some further specialize in treating breast disease. These surgeons may use the term breast surgeon. If you want breast reconstruction, a plastic surgeon will work with your general surgeon. Plastic surgeons use surgery and other procedures to correct physical defects that affect a person’s appearance or ability to function.

How are radical and modified radical mastectomies performed?

Radical and modified radical mastectomy surgeries take place in a hospital. Your doctor will use a general anesthetic. This combination of IV (intravenous) medicines and gases will put you in a deep sleep.

In a modified radical mastectomy procedure, your doctor will make an oval incision in your breast. I will go around your nipple-areola complex to remove the nipple, areola, skin, and breast tissue. Your doctor will also remove some axillary lymph nodes in your underarm. This procedure will take about three hours. A radical mastectomy procedure is more extensive. It involves removing more lymph nodes and the chest wall muscles. This surgery will take longer than a modified procedure.

If you are having breast reconstruction at the same time, a plastic surgeon will reconstruct the breast. If you are delaying reconstruction, your surgeon will place a tissue expander. This device will remain in place for several weeks to make room for the reconstruction. A second surgery will be necessary. Both of these options will lengthen the amount of time you spend in surgery.

Once all surgical procedures are complete, your doctor will close the incision across your breast with stitches. There will be a thin tube or tubes coming out of the incision to drain fluid from the site. These tubes are temporary.

What to expect the day of your surgery

In general, this is what happens the day of your surgery: 

  • You will change into a hospital gown and talk with a preoperative nurse. The nurse will ask about your preoperative instructions and may perform a brief exam.
  • You will talk with an anesthesiologist or nurse anesthetist about your medical history and the anesthesia you will have.
  • You will get a sedative to help you relax before the team takes you to the operating room (OR).
  • Your team will start general anesthesia in the OR. With general anesthesia, you won’t remember anything else until you wake up in the recovery room.

What are the risks and potential complications of radical or modified radical mastectomy?

All surgeries carry a certain amount of risk and have the potential to cause complications. These complications can occur during the surgery or during the recovery period. Some complications can be serious or even life threatening.

General risks of surgery

The general risks of surgery include:

  • Anesthesia reaction, such as an allergic reaction and problems with breathing
  • Bleeding, which can lead to shock
  • Blood clot, in particular a deep vein thrombosis. It can travel to your lungs and cause a pulmonary embolism.
  • Infection

Potential complications of radical or modified radical mastectomy

Most mastectomy procedures are successful, but potential complications include:  

  • Delayed tissue healing, which is rare
  • Fluid collection, which may require drainage to heal
  • Lymphedema, which is severe swelling after lymph node removal
  • Nerve damage, which can cause numbness, tenderness, or extra sensitivity
  • Scarring problems, which can lead to pain and an unacceptable appearance

Reducing your risk of complications

You can reduce your risk of certain complications by:

  • Following activity, dietary and lifestyle restrictions and recommendations before your surgery and during recovery
  • Notifying your doctor immediately of any concerns, such as bleeding, fever, or increase in pain
  • Taking your medications exactly as directed
  • Telling all members of your care team if you have allergies
  • Wearing a postsurgical support bra as directed if you also have breast reconstruction

How do I prepare for this type of mastectomy?

Facing mastectomy surgery can be stressful. You can help yourself remember all the things you want to ask by making a list. Questions you may want to ask include:

  • Why are you recommending this type of mastectomy for me? What other options do I have?
  • What is involved in the mastectomy surgery you are recommending? What other treatments will I need?
  • If I decide to do breast reconstruction, what type of reconstruction procedure is best for me and why?
  • How long with the surgery take? When can I go home from the hospital?
  • What restrictions will I have after surgery? What kind of assistance will I need at home?
  • When can I return to work and other activities?
  • When will I start physical therapy? How many treatments are typically necessary for recovery?
  • How will you manage my pain?
  • What changes, if any, to my medication plan do I need to make?
  • When should I follow up with you?
  • How should I contact you after hours if I have a problem?

What can I expect after a radical or modified radical mastectomy?

Knowing what to expect after surgery makes it easier to plan and prepare for a successful recovery.

How long will it take to recover?

In general, radical mastectomy recovery takes longer than a modified procedure. You will have the extra hurdle of recovering from the removal of chest wall muscle. Your hospital stay may also be longer than the average 1 to 2-night stay. Your age and overall health can also affect how quickly you heal and recover. It can take 4 to 8 weeks for a full recovery from surgery, but it will be several months until you are back to your regular activity level (before surgery). This time will be longer if you have breast reconstruction.

Will I feel pain?

Both procedures will involve pain and discomfort. However, these effects will likely be greater with a radical mastectomy. Properly managing your pain is vital for your recovery. Pain management allows you to complete physical therapy and other rehabilitation activities. These activities are necessary for smooth healing and to restore function and range of motion in your arm and shoulder.

Tell your doctor if your pain increases or changes in any way. It could be a warning sign of a complication.

When should I call my doctor?

Call your doctor’s office during normal business hours if you have questions. Your doctor will give you contact instructions for issues that come up after hours. Call doctor right away or seek immediate medical care if you have:

  • Breathing problems or shortness of breath
  • Confusion or changes in level of alertness
  • Chest pain, pressure or tightness
  • Drainage of pus, redness or swelling around your incision
  • It’s common to have a fever right after surgery. Your doctor will give you instructions about when to call for a fever.
  • In ability to urinate or move your bowels
  • Leg pain, redness or swelling, which could mean you have a blood clot
  • Unexpected bleeding

How might radical or modified radical mastectomy affect my everyday life?

These mastectomy procedures greatly reduce the risk of breast cancer returning. However, you will still need mammograms on the remaining breast after either procedure. You will also still need follow-up exams with your doctor, even if you have a double mastectomy. It is still possible for breast cancer to recur in other areas.

You may find you are struggling emotionally after a radical or modified radical mastectomy. Some women feel a sense of loss or feel differently about their bodies after surgery. This can include difficult feelings about your sexuality or femininity after loss of one or both breasts. Breast reconstruction helps some women overcome these feelings. It is an option to consider even if you did not want it when you originally decided on mastectomy. It may also help to talk with a therapist, join a support group, or share your feelings with a trusted friend or family member. Your doctor is a good resource for finding support.

Sometimes, troublesome feelings persist and can turn into depression. If you continue to have problems for more than a couple of weeks, let your doctor know. Symptoms of depression can include:

  • Difficulty concentrating
  • Fatigue or constantly feeling tired
  • Fixation with dying or wanting to die
  • Feelings of sadness, hopelessness or worthlessness
  • Loss of interest or enjoyment in hobbies and other activities you previously liked
  • Sleep problems

Your doctor can help you find a solution for your struggles. Treatments are available to help you heal and return to your life.

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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2020 Aug 29
THIS TOOL DOES NOT PROVIDE MEDICAL ADVICE. It is intended for informational purposes only. It is not a substitute for professional medical advice, diagnosis or treatment. Never ignore professional medical advice in seeking treatment because of something you have read on the site. If you think you may have a medical emergency, immediately call your doctor or dial 911.