Surgical Procedures: Modified Radical Mastectomy
Also referred to as: Mastectomy and axillary lymph node dissection; MRM; Skin sparing modified radical mastectomy with same day breast reconstruction
What is a Modified Radical Mastectomy?
A modified radical mastectomy is a surgical procedure where a surgeon performs a mastectomy (removal of the nipple, areola, and breast tissue) as well as removing the majority of lymph nodes from under the arm, referred to as an axillary lymph node dissection.
Will I Stay Overnight
Yes. Most people will stay in the hospital for one or more days. Your stay may be longer if you have breast reconstruction.
What is Recovery Like?
Your surgeon will discuss specific recovery issues with you. In general, you will be up and moving the day after surgery, with some limitations to your normal schedule and exercise routine in the first week or so. Surgical drains, placed at the time of surgery, are used to remove fluid that builds up after this procedure. They are placed under the arm on the side of surgery and stay in for approximately 7-10 days. When ready, they are removed in the office, a quick and often painless procedure. You will be given instructions on how to take care of the drain at home. After surgery, you could experience any of the following:
- Pain and/or sensitivity along the chest wall or reconstructed breast or in the underarm or back of the upper arm.
- Numbness along the chest wall or reconstructed breast. **The numbness puts you at risk for a serious burn, so do not use heating pads or hot packs on this area. If you have concerns, please discuss this with your healthcare team.
- After the drain is removed, a seroma could develop. A seroma is when lymph fluid collects under the arm or chest wall instead of draining its normal route. It is not worrisome, but can be uncomfortable. Most go away naturally, over time, but occasionally need to be drained in the office with a needle (an easy, painless procedure).
- Lymphedema, a chronic swelling in the arm and/or breast on the side of surgery. Discuss your risk of lymphedema with your surgical team. Learn more about lymphedema and what you can do to minimize your risk of developing lymphedema.
Can I Prevent Infections?
Getting an infection after this procedure is not common. You can help prevent an infection by:
- Take a shower the night before surgery and wash your body with soap and water.
- On the second day after surgery make sure to shower or at least clean the incision with soap and water. Pat dry, do not rub the incision. Do this every day, or at least every other day, to keep the incision site clean.
- Do not immerse the incision site in water by soaking in a tub or swimming.
- Always wash your hands before and after touching the incision or changing the dressing.
What Will I Need at Home?
- 4 x 4 gauze pads to cover the drain, abdominal pads (also called surgi-pads) to place across your chest wall or reconstructed breast for padding/comfort, and 1-inch paper tape. These can be all be found at your supermarket or pharmacy.
- A specimen cup to measure fluid from the drain. This should be given to you by hospital staff before going home.
- Clean, comfy pillow(s) to put under your arm while sitting or to help with positioning at night.
- You may experience constipation after surgery due to anesthesia and pain medications. Over-the-counter medications, diet, exercise (as simple as walking) and fluids may ease constipation. Ask your health-care team about over-the-counter medications that may work for you.
Care of the Incision
If you have a post-surgical bandage, remove per your surgeon's instructions (often within 48 hours). Once the bandage is removed, you may shower, but do not scrub the incision. To dry, carefully pat the incision with a clean towel. Avoid lotions, powders or deodorant on or near the incision during the first 1-2 weeks until it is fully closed.
Most surgeons use dissolvable sutures so you won't see any sutures and they don't need to be removed. On the outside, some surgeons use surgical glue over the incision to give added protection, others use paper tape called "steri-strips" while some use nothing at all. Both glue and steri-strips can get wet in the shower.
How Can I Help Myself?
Walking is good. Take rest periods throughout the day as needed. Move your arm on the side of surgery as naturally as possible; do not feel as if you have to guard the area.
Deep breathing and relaxation are important to help with pain, keep lungs healthy after anesthesia and promote good drainage of lymphatic fluid. Try to perform deep breathing and relaxation exercises several times a day in the first week, or whenever you notice you are particularly tense.
- A simple exercise to do on your own: While sitting, close your eyes and take 5-10 slow deep breaths. Relax your muscles. Slowly roll your head and shoulders.
- Find more relaxation exercises on OncoLink.
This hand-out provides general information only. Please be sure to discuss the specifics of your surgical plan and recovery with your surgeon.