Modified radical mastectomy: what it involves and who needs it

A modified radical mastectomy is an operation that removes the whole breast, including the nipple, the areola and some of the overlying skin, together with most of the lymph nodes in the armpit. The armpit part of the operation is called an axillary clearance or axillary dissection. The chest muscles are left in place, which is what makes it "modified" compared with the older radical mastectomy, where the muscles were removed as well. Surgeons usually recommend this operation when cancer has already spread to the armpit lymph nodes, when the tumour is large compared with the size of the breast, when there are several separate areas of cancer in the breast, or for locally advanced and inflammatory breast cancer, often after chemotherapy given before surgery. It is a common operation in India, partly because many women are diagnosed at a later stage. The operation is done under general anaesthetic and usually takes a few hours. Most women go home within a few days with one or two drains. Recovery involves caring for the wound, doing arm and shoulder exercises and watching for swelling of the arm, called lymphedema. Radiotherapy, chemotherapy, hormone therapy or targeted treatment may follow, depending on what the final report shows. Reconstruction can often be done at the same time or later.

Breast and armpit nodes are removed

The whole breast and most of the lymph nodes under the arm come out in one operation, usually through a single scar.

The chest muscles stay

Keeping the muscles protects the shape of the chest wall and the strength of your arm and shoulder.

It is chosen for a reason

It is usually advised when the armpit nodes are involved or breast-conserving surgery would not remove the cancer well.

This is a well-established operation, but it is a significant one, and some effects last.

Arm swelling is a lifelong possibility

Removing many nodes raises the chance of lymphedema compared with sentinel node biopsy alone. It can appear months or even years later, so early signs are worth knowing.

Numbness is common

Most women notice numbness in the inner upper arm and across the chest wall. It often improves slowly but may not go away completely.

Surgery is rarely the only treatment

Radiotherapy and medicines often follow. The operation removes visible disease, while other treatments lower the chance of the cancer coming back.

What this page cannot tell you

It cannot say whether you need a full node clearance or whether a smaller operation would do. That depends on your scans, biopsy results and response to any earlier treatment.

Breast cancer surgery has become less extensive over time. Whether a smaller operation is safe depends on the stage of the cancer and how it responds to treatment.

Sentinel node biopsy instead of clearance

If scans and needle tests show the armpit nodes are clear, removing only the first few nodes is usually enough, and the risk of arm swelling is lower.

Breast-conserving surgery

If the tumour is small compared with the breast, removing the lump with a margin followed by radiotherapy can work as well as mastectomy for many women.

Chemotherapy first

Treatment before surgery can shrink the tumour and clear the nodes in some women, which may allow a less extensive operation. Ask your surgeon whether this applies to you.