Modified Radical Mastectomy

A modified radical mastectomy (MRM) is a type of breast cancer surgery that removes your entire breast. This includes:

• Your breast tissue
• The lining of your main chest muscle
• Your breast skin
• Your nipple and areola

It also removes most or all of the lymph nodes in your underarm area (axillary lymph nodes). This is often the first place that breast cancer spreads.

Having a mastectomy can feel overwhelming, even when you know it’s the right step for your health. It’s OK to have questions or mixed emotions as you learn what the surgery involves. Your care team will be there to guide you, listen to your concerns and help you feel supported every step of the way.

When might I need a modified radical mastectomy?

Your surgeon might recommend this type of mastectomy if cancer is widespread throughout your breast tissue and lymph nodes. They want to remove any tissue where they think cancer may have spread.

Your provider may use modified radical mastectomy to treat:

• Invasive ductal carcinoma
• Invasive lobular carcinoma with axillary lymph node involvement
• Locally advanced breast cancer, including inflammatory breast cancer

What happens before a modified radical mastectomy?

If your provider thinks a modified radical mastectomy is best for you, they’ll talk to you about how the surgery fits into your treatment plan. They might want to do other tests or treatments first. Or they might want to do other treatments after your surgery.

Your provider will discuss with you whether you want to have breast reconstruction after modified radical mastectomy. If so, they’ll work with you to figure out where that fits into the plan. It may happen during the mastectomy (immediate) or after cancer treatment (delayed).

How should I prepare?

Your provider might ask you to:

• Stop smoking and drinking alcohol several weeks in advance
• Stop taking certain medications several days in advance
• Stop eating and drinking several hours in advance

You might also want to plan ahead for what happens after surgery. For example, you’ll need someone to drive you home. And you may want to arrange for someone to help you at home during recovery.

What happens during a modified radical mastectomy procedure?

First, a healthcare provider will give you general anesthesia, so you won’t be aware of or feel any pain. Then, your surgeon will:

1. Make a cut (incision) in your breast.
2. Remove your breast tissue, chest muscle lining, skin, nipple and areola.
3. Remove most — or very infrequently, all — of the lymph nodes under your arm. This is called an axillary lymph node dissection.
4. Place one or more surgical drains to collect fluid.
5. Close the incision.

If you and your surgeon planned for it, they’ll perform breast reconstruction before closing the incision.

How long does it take?

A modified radical mastectomy may take two to three hours. It may take longer if you’re having reconstructive surgery at the same time. Your provider will tell you what to expect.

What are the benefits and risks of modified radical mastectomy?

Treating breast cancer is a balancing act. Your provider wants to remove all the cancer without causing any more harm than they have to. Modified radical mastectomy has become less common. But there are still times when it may be necessary.

But more extensive surgeries do carry a higher risk of long-term complications. This is especially true when they involve your lymph nodes. Complications of modified radical mastectomy may include:

• Breast skin wound problems
• Body dysmorphia
• Lymphedema
• Phantom breast syndrome
• Post-mastectomy pain syndrome

What happens after a modified radical mastectomy?

After surgery, you’ll spend some time at the hospital and have pain medication on demand in safe doses. Your healthcare team will watch for any problems. They’ll talk to you about what happens next in your treatment plan. They’ll also coach you on how to care for your wounds and surgical drains before you go home.

What is recovery like?

Once you’re home, your healthcare provider will advise you not to lift weight with your arms right away. But you’ll be up and walking a little each day. You’ll care for your wounds and drains for about two to three weeks. You’ll continue to feel tired and sore for about four to six weeks.

During your recovery, your healthcare provider will give you arm exercises to practice. These are important to recover your range of motion. Your nerves may continue to heal for several months. As they do, you may feel odd sensations in your chest sometimes, like tingling or twinges.

When should I call my healthcare provider?

You’ll have scheduled follow-ups with your care team during your recovery. But be sure to contact them sooner if you develop signs of complications, like:

• Unusual swelling
• Worsening pain
• Fever
• Redness or discoloration in the surgical area

Be sure to contact them again if you have complications that last after you finish treatment. These may include lasting pain or mental health concerns. Your team will put you in touch with someone who can help.

Modified radical mastectomy vs. radical mastectomy

Radical mastectomy is an outdated type of breast cancer surgery. Surgeons used it to remove all of your breast tissue, all of your armpit (axillary) lymph nodes and the chest muscles under your breast. It was once common. In the past, extensive surgery was the only way providers knew how to effectively treat breast cancer.

Surgeons don’t perform this kind of mastectomy anymore. Instead, they may perform modified radical mastectomy. This type removes your breast tissue and axillary lymph nodes, but it spares your chest muscles.