Surgical Procedures: Modified Radical Mastectomy

Also called: 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 surgery done to remove your whole breast. Your whole breast is made up of the nipple, areola (area around the nipple), breast tissue, and most of the lymph nodes under the arm (called an axillary lymph node dissection).

Will I stay overnight?

Yes. Most people stay in the hospital for one or more days. Your stay may be longer if you have breast reconstruction.

What is recovery like?

Your care team will talk to you about recovery issues. Most times you will be up and moving the day after surgery. You will have to make some changes to your activity level in the first week or so. Surgical drains, placed during surgery, are used to remove fluid that builds up in the area after the procedure. They are placed under the arm on the side of surgery and stay in for about 7-10 days. When ready, they are removed in your provider’s office.

You will be given instructions on how to take care of the drain at home. After surgery, you could have any of the following:

• Feeling pain and/or being sensitive near the chest, reconstructed breast, underarm area, or back of the upper arm.
• Numbness along the chest or reconstructed breast. This numbness puts you at risk for a serious burn. Do notuse heating pads or hot packs on this area. If you have worries, please talk about these with your healthcare team.
• After the drain is removed, a seroma could form. A seroma is a buildup of fluid under the arm. It can be uncomfortable. Most go away over time. In some cases, they need to be drained in the office with a needle.
• Lymphedema, a long term swelling in the arm and/or breast on the side of surgery, can happen. Talk and learn about your risk of lymphedema with your care team.

Can I prevent infections?

Getting an infection after this procedure is not common. You can help prevent an infection by:

• Taking a shower the night before surgery and washing your body with soap and water.
• On the second day after surgery, making sure to shower or at least clean the incision (surgical cut) 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.
• Not putting your incision site under water (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?

• Gauze pads (4x4) to cover the drain, abdominal pads (also called surgi-pads) to place across your chest 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 your care team before going home. Write down in a notebook how much fluid is drained each time.
• Clean, supportive pillow(s) to put under your arm while sitting or to help with your position at night.
• You may have constipation after surgery. Over-the-counter medications, adding fiber to your 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.

How do I care for my incision

If you have a bandage, remove it when your provider said to do so (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. Don’t use 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 (stitches) inside your body that will go away on their own. On the outside, your surgeon may use stitches, surgical glue, or paper tape called "steri-strips." Both glue and steri-strips can get wet in the shower.

How can I care for myself?

You may need a family member or friend to help you with your daily tasks until you are feeling better. It may take some time before your team tells you that it is ok to go back to your normal activity.

Be sure to take your prescribed medications as directed to prevent pain, infection and/or constipation. Call your team with any new or worsening symptoms.

There are ways to manage constipation after your surgery. You can change your diet, drink more fluids, and take over-the-counter medications. Talk with your care team before taking any medications for constipation.

Taking deep breaths and resting can help manage pain, keep your lungs healthy after anesthesia, and promote good drainage of lymphatic fluid. Try to do deep breathing and relaxation exercises a few times a day in the first week, or when you notice you are extra tense.

• Example of a relaxation exercise: While sitting, close your eyes and take 5-10 slow deep breaths. Relax your muscles. Slowly roll your head and shoulders.

This article contains general information. Please be sure to talk to your care team about your specific plan and recovery.