Radical Mastectomy – Total or Modified

Radical Mastectomy – Total or Modified are surgeries that are done as part of treatment for breast cancer. You will have one of those types of surgery. Both types involve removing a breast.

• In a total mastectomy (simple mastectomy), all breast tissue including the nipple will be removed.
• In a modified radical mastectomy, lymph nodes under the arm will be removed along with the breast and nipple. Some of the lining over the muscle tissues under the breast may also be removed.

These procedures may also be used to help prevent breast cancer. A preventive (prophylactic) mastectomy may be done if you are at an increased risk of breast cancer due to harmful changes (mutations) in certain genes (BRCA genes). In that case, the procedure involves removing both of your breasts. This can reduce your risk of developing breast cancer in the future.

For a transgender person, a total mastectomy may be done as part of a surgical transition from female to male.

Let your health care provider know about:

• Any allergies you have.
• All medicines you are taking, including vitamins, herbs, eye drops, creams, and over-the-counter medicines.
• Any problems you or family members have had with anesthetic medicines.
• Any blood disorders you have.
• Any surgeries you have had.
• Any medical conditions you have.
• Whether you are pregnant or may be pregnant.

What are the risks?

Generally, this is a safe procedure. However, problems may occur, including:

• Pain.
• Infection.
• Bleeding.
• Allergic reactions to medicines.
• Scar tissue.
• Chest numbness on the side of the surgery.
• Fluid buildup under the skin flaps where your breast was removed (seroma).
• Sensation of throbbing or tingling.
• Stress or sadness from losing your breast.

If you have the lymph nodes under your arm removed, you may have arm swelling, weakness, or numbness on the same side of your body as your surgery.

What happens before the procedure?

Staying hydrated

Follow instructions from your health care provider about hydration, which may include:

• Up to 2 hours before the procedure – you may continue to drink clear liquids, such as water, clear fruit juice, black coffee, and plain tea.

Eating and drinking restrictions

Follow instructions from your health care provider about eating and drinking, which may include:

• 8 hours before the procedure – stop eating heavy meals or foods such as meat, fried foods, or fatty foods.
• 6 hours before the procedure – stop eating light meals or foods, such as toast or cereal.
• 6 hours before the procedure – stop drinking milk or drinks that contain milk.
• 2 hours before the procedure – stop drinking clear liquids.

Medicines

• Ask your health care provider about:
  • Changing or stopping your regular medicines. This is especially important if you are taking diabetes medicines or blood thinners.
  • Taking medicines such as aspirin and ibuprofen. These medicines can thin your blood. Do not take these medicines unless your health care provider tells you to take them.
  • Taking over-the-counter medicines, vitamins, herbs, and supplements.
• Your health care team may give you antibiotic medicine to help prevent infection.

General instructions

• You may be checked for extra fluid around your lymph nodes (lymphedema).
• Plan to have someone take you home from the hospital or clinic.
• Plan to have a responsible adult care for you for at least 24 hours after you leave the hospital or clinic. This is important.
• Ask your health care provider how your surgical site will be marked or identified.
• You may be asked to shower with a germ-killing soap.

What happens during the procedure?

• To lower your risk of infection:
  • Your health care team will wash or sanitize their hands.
  • Your skin will be washed with soap.
• An IV will be inserted into one of your veins.
• You will be given a medicine to make you fall asleep (general anesthetic).
• A wide incision will be made around your nipple. The skin and nipple inside the incision will be removed along with all breast tissue.
• If you are having a modified radical mastectomy:
  • The lining over your chest muscles will be removed.
  • The incision may be extended to reach the lymph nodes under your arm, or a second incision may be made.
  • Lymph nodes will be removed.
• Breast tissue and lymph nodes that are removed will be sent to the lab for testing.
• You may have a drainage tube inserted into your incision to collect fluid that builds up after surgery. This tube will be connected to a suction bulb on the outside of your body to remove the fluid.
• Your incision or incisions will be closed with stitches (sutures).
• A bandage (dressing) will be placed over your breast area. If lymph nodes were removed, a dressing will also be placed under your arm.

The procedure may vary among health care providers and hospitals.

What happens after the procedure?

• Your blood pressure, heart rate, breathing rate, and blood oxygen level will be monitored until the medicines you were given have worn off.
• You will be given pain medicine as needed.
• You will be encouraged to get up and walk as soon as you can.
• Your IV can be removed when you are able to eat and drink.
• You may have a drainage tube in place for 2–3 days to prevent a collection of blood (hematoma) from developing in the breast area. You will be given instructions about caring for the drain before you go home.
• A pressure bandage may be applied for 1–2 days to prevent bleeding or swelling. Ask your health care provider how to care for your pressure bandage at home.

Summary

• In a total mastectomy (simple mastectomy), all breast tissue including the nipple will be removed. In a modified radical mastectomy, the lymph nodes under the arm will be removed along with the breast and nipple.
• Before the procedure, follow instructions from your health care provider about eating and drinking, and ask about changing or stopping your regular medicines.
• You will be given a medicine to make you fall asleep (general anesthetic) during the procedure.

Total or Modified Radical Mastectomy, Care After

This sheet gives you information about how to care for yourself after your procedure. Your health care provider may also give you more specific instructions. If you have problems or questions, contact your health care provider.

What can I expect after the procedure?

After the procedure, it is common to have:

• Pain.
• Numbness.
• Stiffness in the arm or shoulder.
• Feelings of stress, sadness, or depression.

If the lymph nodes under your arm were removed, you may have arm swelling, weakness, or numbness on the same side of your body as your surgery.

Follow these instructions at home:

Incision care

• Follow instructions from your health care provider about how to take care of your incision. Make sure you:
  • Wash your hands with soap and water before you change your bandage (dressing). If soap and water are not available, use hand sanitizer.
  • Change your dressing as told by your health care provider.
  • Leave stitches (sutures), skin glue, or adhesive strips in place. These skin closures may need to stay in place for 2 weeks or longer. If adhesive strip edges start to loosen and curl up, you may trim the loose edges. Do not remove adhesive strips completely unless your health care provider tells you to do that.
• Check your incision area every day for signs of infection. Check for:
  • Redness, swelling, or more pain.
  • Fluid or blood.
  • Warmth.
  • Pus or a bad smell.
• If you were sent home with a surgical drain in place, follow instructions from your health care provider about emptying it.

Bathing

• Do not take baths, swim, or use a hot tub until your health care provider approves. Ask your health care provider if you may take showers. You may only be allowed to take sponge baths.

Activity

• Return to your normal activities as told by your health care provider. Ask your health care provider what activities are safe for you.
• Avoid activities that take a lot of effort.
• Be careful to avoid any activities that could cause an injury to your arm on the side of your surgery.
• Do not lift anything that is heavier than 10 lb (4.5 kg), or the limit that you are told, until your health care provider says that it is safe.
• Avoid lifting with the arm on the side of your surgery.
• Do not carry heavy objects on your shoulder.
• After your drain is removed, do exercises to prevent stiffness and swelling in your arm. Talk with your health care provider about which exercises are safe for you.

General instructions

• Take over-the-counter and prescription medicines only as told by your health care provider.
• You may eat what you usually do.
• Keep your arm raised (elevated) above the level of your heart when you are sitting or lying down.
• Do not wear tight jewelry on your arm, wrist, or fingers on the side of your surgery.
• You may be given a tight sleeve (compression bandage) to wear over your arm on the side of your surgery. Wear this sleeve as told by your health care provider.
• Ask your health care provider when you can start wearing a bra or using a breast prosthesis.
• Before you are involved in certain procedures such as giving blood or having your blood pressure checked, tell all your health care providers if lymph nodes under your arm were removed. This is important information.

Follow-up

• Keep all follow-up visits as told by your health care provider. This is important.
• Get checked for extra fluid around your lymph nodes (lymphedema) as often as told by your health care provider.

Contact a health care provider if:

• You have a fever.
• Your pain medicine is not working.
• Your arm swelling, weakness, or numbness has not improved after a few weeks.
• You have new swelling in your breast area or arm.
• You have redness, swelling, or more pain in your incision area.
• You have fluid or blood coming from your incision.
• Your incision feels warm to the touch.
• You have pus or a bad smell coming from your incision.

Get help right away if:

• You have very bad pain in your breast area or arm.
• You have chest pain.
• You have difficulty breathing.

Summary

• Follow instructions from your health care provider about how to take care of your incision. Check your incision area every day for signs of infection.
• Ask your health care provider what activities are safe for you.
• Keep all follow-up visits as told by your health care provider. This is important.
• Make sure you know which symptoms should cause you to contact your health care provider or to get help right away.