What the operation involves
A modified radical mastectomy, often shortened to MRM, removes the whole breast along with the nipple and areola, the skin over the tumour, and the lymph nodes in the armpit on the same side. The chest wall muscle (pectoralis major) is left in place. Keeping that muscle is the "modified" part, and it is the reason recovery and arm movement are much better than with the older radical mastectomy.
The lymph nodes are sent to the laboratory together with the breast tissue. Whether cancer has reached those nodes is one of the most important findings for planning treatment after surgery.
When it is advised
Dr. Naeem may suggest MRM when:
- the tumour is large compared with the size of the breast, so removing it would leave little breast behind
- cancer is found in more than one area of the same breast
- cancer has spread to the underarm lymph nodes
- radiotherapy after breast conserving surgery is not possible or not wanted, for example after earlier radiation to the chest or during pregnancy
- a lumpectomy did not get clear margins even after a second attempt
- the patient prefers to have the breast removed after hearing both options
Sometimes chemotherapy is given first to shrink the tumour, and surgery follows a few months later.
Getting ready
Before the operation you will usually have blood tests, a chest X ray, an ECG if needed and a check by the anaesthesia team. Tell Dr. Naeem about every medicine you take, especially blood thinners, aspirin and diabetes medicines, because some need to be stopped or adjusted.
You will be asked not to eat for several hours before surgery. Arrange for a family member to stay with you in hospital and to help at home for the first week or two.
On the day of surgery
The operation is done under general anaesthesia and usually takes about two to three hours. Through an oval shaped cut around the nipple and the tumour, the breast tissue and armpit nodes are removed. One or two thin tubes called drains are left under the skin to carry away fluid, and the wound is closed with stitches.
Recovery at home
Most patients stay in hospital for one to three nights. Pain is usually moderate and controlled with tablets. Drains often stay in for one to two weeks and are removed in the clinic once the fluid drops.
- Start the gentle arm and shoulder exercises you are shown, because they prevent stiffness
- Keep the wound dry and clean as instructed, and wear loose front opening clothes
- Avoid lifting heavy things with the operated arm for a few weeks
- Most people return to light daily activity in two to four weeks
The final histopathology report usually arrives within one to two weeks and decides whether chemotherapy, hormone therapy or radiotherapy is needed.
Possible complications
Every operation carries some risk. With MRM the ones to know about are:
- seroma, a collection of fluid under the skin that may need draining in the clinic
- wound infection or slow healing, more likely in smokers and people with diabetes
- numbness on the inner arm and chest wall, which often improves over months
- shoulder stiffness, reduced by doing the exercises
- lymphoedema, a long term swelling of the arm after lymph node removal
Call the clinic or go to the emergency department if you have fever, spreading redness, pus from the wound, sudden swelling of the chest or arm, or bleeding that does not stop.
Breast reconstruction and prosthesis
After mastectomy some women choose breast reconstruction, either at the same time or later, while others use an external breast form (prosthesis) inside a special bra. Both are reasonable choices. Ask Dr. Naeem about these options at your consultation so you can plan ahead.
Questions patients ask
Is a modified radical mastectomy the same as a radical mastectomy?
No. A radical mastectomy also removes the chest wall muscles. In a modified radical mastectomy those muscles are kept, which means less disability and better arm movement afterwards.
How long will I stay in hospital?
Most patients stay one to three nights. You may go home with a drain, and it is removed at a clinic visit once the fluid output has settled.
Will I need chemotherapy or radiotherapy after MRM?
It depends on the final report, including tumour size, lymph node involvement and receptor status. Some patients need further treatment and some do not.
When can I go back to work?
People with desk or light work often return in about two to four weeks. Heavier physical work needs longer. Dr. Naeem will advise based on your recovery.
This page is a general guide. Your own plan depends on your reports and examination, so use it to prepare questions for your consultation.