Mastectomy can be performed to examine the cells from a lump that is suspicious for cancer.
can be performed to examine the cells from a lump that is suspicious for cancer. The diagnosis of the extent
surgical removal of one or both breasts, partially or completely.
done to treat breast cancer
have the operation prophylactically that is, to prevent cancer rather than treat it
based on various factors including breast size, number of lesions, biologic aggressiveness of a breast
cancer, the availability of adjuvant radiation, and the willingness of the patient to accept higher rates of
tumor recurrences after lumpectomy and radiation
A surgical procedure that removes the breast, surrounding tissue, and nearby lymph nodes that are
affected by cancer.
Purpose
removal of breast cancer (abnormal cells in the breast that grow rapidly and replace normal healthy
tissue)
Modified radical mastectomy is the most widely used surgical procedure to treat operable breast
cancer
○ This procedure leaves a chest muscle called the pectoralis major intact.
○ Leaving this muscle in place will provide a soft tissue covering over the chest wall and a
normal-appearing junction of the shoulder with the anterior (front) chest wall
○ . This sparing of the pectoralis major muscle will avoid a disfiguring hollow defect below the
clavicle.
○ Additionally, the purpose of modified radical mastectomy is to allow for the option of breast
reconstruction, a procedure that is possible, if desired, due to intact muscles around the
shoulder of the affected side.
○ The modified radical mastectomy procedure involves removal of large multiple tumor
growths located underneath the nipple and cancer cells on the breast margins.
indications
 women with a cancer that is large relative to her breast size
 Women who have tested positive for a deleterious mutation on the BRCA1 or BRCA2 gene and opt for
prophylactic removal of the breasts
women with a tumor larger than 5 cm (2 inches) that doesn't shrink very much with neoadjuvant
chemotherapy
demographics
There is a strong genetic correlation since breast cancer is more prevalent in females who had a close relative
(mother, sister, maternal aunt, or maternal grandmother) with previous breast cancer. Increased susceptibility
for development of breast cancer can occur in females who never breastfed a baby, had a child after age 30,
started menstrual periods very early, or experienced menopause very late.
Description
surgeon's goal during this procedure is to minimize any chance of local/regional recurrence; avoid any loss of
function; and maximize options for breast reconstruction. Incisions are made to avoid visibility in a low
neckline dress or bathing suit. An incision in the shape of an ellipse is made. The surgeon removes the
minimum amount of skin and tissue so that remaining healthy tissue can be used for possible reconstruction.
Skin flaps are made carefully and as thinly as possible to maximize removal of diseased breast tissues. The
skin over a neighboring muscle (pectoralis major fascia) is removed, after which the surgeon focuses in the
armpit (axilla, axillary) region. In this region, the surgeon carefully identifies vital anatomical structures such
as blood vessels (veins, arteries) and nerves. Accidental injury to specific nerves like the medial pectoral
neurovascular bundle will result in destruction of the muscles that this surgery attempts to preserve, such as
the pectoralis major muscle. In the armpit region, the surgeon carefully protects the vital structures while
removing cancerous tissues. After axillary surgery, breast reconstruction can be performed, if desired by the
patient.
Diagnosis/Preparation
The first clinical sign for approximately 80% of women with breast cancer is a mass (lump) located in the
breast. A lump can be discovered by monthly self-examination or by a health professional who can find 10–
25% of breast cancers that are missed by yearly mammograms (a low radiation x ray of the breasts). A biopsy
of cancer and spread to regional lymph nodes determines the treatment course (i.e., whether surgery,
chemotherapy, or radiation therapy, either singly or in combinations). Staging the cancer can estimate the
amount of tumor, which is important not only for diagnosis but for prognosis (statistical outcome of the
disease process). Patients with a type of breast cancer called ductal carcinoma in situ (DCIS), which is a stage
0 cancer, have the best outcome(nearly all these patients are cured of breast cancer). Persons who have
cancerous spread to other distant places within the body (metastases) have stage IV cancer and the worst
prognosis (potential for survival). Persons affected with stage IV breast cancer have essentially no chance for
cure.
Persons affected with breast cancer must undergo the staging of the cancer to determine the extent of
cancerous growth and possible spread (metastasis) to distant organs. Patients with stage 0 disease have
noninvasive cancer with a very good outcome. Stages I and II are early breast cancer, without lymph node
involvement (stage I) and with node positive results (stage II). Persons with stage III disease have locally
advanced disease and about a 50% chance for five-year survival. Stage IV disease is the most severe since
the breast cancer cells have spread through lymph nodes to distant areas and/or other organs in the body. It
is very unlikely that persons with stage IV metastatic breast cancer survive 10 years after diagnosis.
It is also imperative to assess the degree of cancerous spread to lymph nodes within the armpit region. Of
primary importance to stage determination and regional lymph node involvement is identification and
analysis of the sentinel lymph node. The sentinel lymph node is the first lymph node to which any cancer
would spread. The procedure for sentinel node biopsy involves injecting a radioactively labeled tracer
(technetium 99) or a blue dye (isosulphan blue) into the tumor site. The tracer or dye will spread through the
lymphatic system to the sentinel node, which should be surgically removed and examined for the presence of
cancer cells. If the sentinel node and one or two other neighboring lymph nodes are negative, it is very likely
that the remaining lymph nodes will not contain cancerous cells, and further surgery may not be necessary.
Once a breast lump (mass) has been identified by mammography or physical examination, the patient should
undergo further evaluation to histologically (studying the cells) identify or rule out the presence of cancer
cells. A procedure called fine-needle aspiration allows the clinician to extract cells directly from the lump for
further evaluation. If a diagnosis cannot be established by fine-needle biopsy, the surgeon should perform an
open biopsy (surgical removal of the suspicious mass). Preparation for surgery is imperative. The patient
should plan for both direct care and recovery time after modified radical mastectomy. Preparation
immediately prior to surgery should include no food or drink after midnight before the procedure. Post-
surgical preparation should include caregivers to help with daily tasks for several days.
Aftercare
After breast cancer surgery, women should undergo frequent testing to ensure early detection of cancer
recurrence. It is recommended that annual mammograms, physical examination, or additional tests (biopsy)
be performed annually. Aftercare can also include psychotherapy since mastectomy is emotionally traumatic.
Affected women may be worried or have concerns about appearance, the relationship with their sexual
partner, and possible physical limitations. Community-centered support groups usually made up of former
breast cancer surgery patients can be a source of emotional support after surgery. Patients may stay in the
hospital for one to two days. For about five to seven days after surgery, there will be one or two drains left
inside to remove any extra fluid from the area after surgery. Usually, the surgeon will prescribe medication to
prevent pain. Movement restriction should be specifically discussed with the surgeon.
Risks
There are several risks associated with modified radical mastectomy. The procedure is performed under
general anesthesia, which itself carries risk. Women may have short-term pain and tenderness. The most
frequent risk of breast cancer surgery (with extensive lymph node removal) is edema, or swelling of the arm,
which is usually mild, but the presence of fluid can increase the risk of infection. Leaving some lymph nodes
intact instead of removing all of them may help lessen the likelihood of swelling. Nerves in the area may be
damaged. There may be numbness in the arm or difficulty moving shoulder muscles. There is also the risk of
developing a lump scar (keloid) after surgery. Another risk is that surgery did not remove all the cancer cells
and that further treatment may be necessary (with chemotherapy and/or radiotherapy). By far, the worst risk
is recurrence of cancer. However, immediate signs of risk following surgery include fever, redness in the
incision area, unusual drainage from the incision, and increasing pain. If any of these signs develop, it is
imperative to call the surgeon immediately.
Normal Results
If no complications develop, the surgical area should completely heal within three to four weeks. After
mastectomy, some women may undergo breast reconstruction (which can be done during mastectomy).
Recent studies have indicated that women who desire cosmetic reconstructive surgery have a higher quality
of life and better sense of well-being than those who do not utilize this option.

Types of mastectomy
Modified radical mastectomy: The entire breast tissue is removed along with the axillary contents (fatty tissue
and lymph nodes). In contrast to a radical mastectomy, the pectoral muscles are spared.