Background Information:

What are the other Names for the Procedure?

• Breast Removal Surgery
• Total Mastectomy

What is Modified Radical Mastectomy surgical procedure?

• Mastectomy is a surgical procedure that involves the complete removal of the breast, including skin, nipple, and axillary lymph nodes (collection of immune cells)
• The procedure is called Modified Radical Mastectomy, because the muscle under the breast is spared and not removed

What part of the Body does the Procedure involve?

A Mastectomy procedure involves the breast and lymph glands in the axillary region.

Why is the Modified Radical Mastectomy surgical procedure Performed?

The Modified Radical Mastectomy procedure (or Total Mastectomy procedure) is performed in case of breast cancer.

What are some Alternative Choices for the Procedure?

Modified Radical Mastectomy is the standard surgical procedure for breast cancer; currently, there are no other alternatives.

What are the Recent Advances in the Procedure?

Use of advanced techniques to identify sentinel lymph node in axilla is a recent advancement

Sentinel lymph node identification with frozen section helps in avoiding axillary lymph node dissection, in some cases

What is the Cost of performing the Modified Radical Mastectomy surgical procedure?

The cost of Modified Radical Mastectomy surgical procedure depends on a variety of factors, such as the type of your health insurance, annual deductibles, co-pay requirements, out-of-network and in-network of your healthcare providers and healthcare facilities.

In many cases, an estimate may be provided before the procedure. The final amount depends upon the findings during the surgery/procedure and post-operative care that is necessary. 

When do you need a Second Opinion, prior to the Procedure?

• It is normal for a patient to feel uncomfortable and confused with a sudden inflow of information regarding Modified Radical Mastectomy procedure and what needs to be done
• If the patient needs further reassurance or a second opinion, a physician will almost always assist in recommending another physician
• Also, if the procedure involves multiple surgeries or has many alternatives, the patient may take a second opinion to understand and choose the best one. They can also choose to approach another physician independently

What are some Helpful Resources?

Complete Guide to Symptoms, Illness & Surgery; Written by H Winter Griffith, M.D.; Revised and updated by Stephen Moore, M.D. and Kenneth Yoder, M.D.; The Berkley Publishing Group, 5^th Edition, New York, 2006

http://www.surgery.com/procedure/modified-radical-mastectomy (accessed on 08/10/2014)

http://www.breastdiseases.com/mast.htm (accessed on 08/10/2014)

Prior to Modified Radical Mastectomy surgical procedure:

How is the  Modified Radical Mastectomy surgical procedure Performed?

A Modified Radical Mastectomy surgical procedure is performed in the following manner:

• The procedure is performed under general anesthesia
• The surgeon makes a skin incision in the shape of an ellipse. The nipple and the areola (the dark area surrounding the nipple) are included in this incision.
• Skin flaps are raised from the edges of the incision
• The surgeon removes the breast tissue while carefully preserving the underlying muscles
• The surgeon  then extends the procedure into the armpit, where he/she removes the  lymph nodes (collections of immune cells) while taking care not to injure important blood vessels or nerves
• This may be followed by a reconstruction procedure, or the incision is closed after placing a drain to remove any fluid accumulation

Where is the Procedure Performed?

A Modified Radical Mastectomy surgical procedure is performed at a hospital.

Who Performs the Procedure?

A general surgeon or an oncological surgeon performs the Breast Removal (or Mastectomy) surgery.

How long will the Procedure take?

The Modified Radical Mastectomy procedure can take anywhere between 2-4 hours.

What do you need to tell your Physician before the Procedure?

It is very important to provide the following information to your healthcare provider. This enables your healthcare provider in assessing the risks for the Modified Radical Mastectomy surgical procedure and helps avoid unnecessary complications.

• Provide a complete list of medications you are currently, taking to your physician. This information is useful for a variety of reasons. For example, it can help your healthcare provider prevent complications due to a drug interaction
• If you are allergic to any specific medication or food items
• If you are taking blood thinners, such as aspirin, warfarin, herbal supplements, or any other such medications
• If you or your family members, have a history of bleeding disorders, or if there is a tendency to bleed more than normal
• If you have diabetes, high blood pressure, chest pains, or have previously suffered from a heart attack
• If you have ever been diagnosed with blood clots in your leg (deep vein thrombosis) or lung (embolism of lung)
• If you have a history of frequent bone fractures (this may affect bone-healing, if bones are involved as part of your procedure)
• A list of all previous surgical procedures you have undergone, like for example: Removal of appendix, gallbladder, or any other part, of your body; surgical repair of any body part, such as hernia repair, perforation of bowel wall, etc.

What Preparations are needed, prior to the Procedure?

• The physician may evaluate the individual’s medical history to gain a comprehensive knowledge of the overall health status of the patient including information related to the medications that are being currently taken
• Some medications increase a person’s chances of bleeding and it may be recommended to discontinue them for a period of time, before the procedure is performed
• Blood tests may be performed to determine if there is a bleeding tendency or any other medical conditions that prevents the person from undergoing the procedure
• Normally local anesthesia is not used; however do inform the physician if you are allergic to any local anesthetics, lidocaine, etc
• Avoid application of any cosmetics, deodorant, or topical medicines on the area, prior to the procedure
• It is advisable to quit smoking and the use of any nicotine based products, for a while, before the surgery
• Consumption of alcoholic drinks must also be avoided for a period of time, as instructed
• The patient must avoid eating or drinking at least 8 hours prior to the surgical procedure, depending on when the procedure is arranged
• For persons suffering from diabetes, it is important that the blood sugar stays within the normal range; if not their diabetologist may have to control blood sugar by recommending insulin and/or a combination of oral medicines

What is the Consent Process before the Procedure?

A physician will request your consent for the Modified Radical Mastectomy procedure using an Informed Consent Form.

Consent for the Procedure: A “consent” is your approval to undergo a procedure. A consent form is signed after the risks and benefits of the procedure, and alternative treatment options, are discussed. This process is called informed consent.

You must sign the forms only after you are totally satisfied by the answers to your questions. In case of minors and individuals unable to personally give their consent, the individual’s legal guardian or next of kin, shall give their consent for the procedure.

What Tests are needed, before the Modified Radical Mastectomy surgical procedure?

Before a Modified Radical Mastectomy procedure, the patient may have to undergo certain tests, such as:

• Routine blood and urine analysis
• Mammogram
• Needle biopsy of breast, or lumpectomy of breast
• Chest X-ray

What are some Questions for your Physician?

Some of the basic questions that you might ask your physician are as follows:

• What is a Modified Radical Mastectomy procedure?
• Why is this procedure necessary?  How will it help?
• How soon should I get it done? Is it an emergency?
• Who are the medical personnel involved in this procedure?
• Where is the procedure performed? 
• What are the risks while performing the procedure?
• What are the complications that might take place, during recovery?
• How long will it take to recover? When can I resume normal work?
• How many such procedures have you (the physician) performed?
• Are there any follow-up tests, periodic visits to the healthcare facility required, after the procedure?
• What are the costs involved?

During the Modified Radical Mastectomy surgical procedure:

What kind of Anesthesia is given, during the Procedure?

General anesthesia by injection and inhalation is administered prior to the Modified Radical Mastectomy procedure.

How much Blood will you lose, during the Procedure?

An uncomplicated Breast Removal Surgery does not involve any significant blood loss.

What are the possible Risks and Complications during the Modified Radical Mastectomy surgical procedure?

There are general factors that increase the risk of getting complications during surgery and they include:

• Obesity: Generally greater the degree of obesity, greater is the surgical risk
• Smoking: Longer the smoking history (in pack years smoked), greater the surgical risk
• Advancing age
• Poorly controlled diabetes, as evidenced by a high hemoglobin A1c and a high fasting glucose
• Poorly functioning kidney, as evidenced by increased BUN (blood urea nitrogen) and blood creatinine
• Poorly functioning liver, as evidenced by increased blood liver function tests
• Hypertension (increased blood pressure), especially if it is poorly controlled
• Poor nutritional status (malnutrition with mineral and vitamin deficiencies)
• Poor lung function, as evidenced by abnormal lung function tests
• History of bleeding disorders
• Longstanding illness, such as autoimmune disorders, chronic infections
• Poor immune system due to a variety of causes

The possible risks or complications that may arise during the Modified Radical Mastectomy surgery are:

• Excessive bleeding
• Infection surrounding the surgical wound
• Injury to nerves
• Anesthetic complications

What Post-Operative Care is needed at the Healthcare Facility after the Modified Radical Mastectomy surgical procedure?

Following the Breast Removal (Total Mastectomy) surgical procedure, a brief hospital stay for a day or two may be required

• Medications to control pain may be given and drainage from the surgical site monitored

After the Modified Radical Mastectomy surgical procedure:

What are the possible Risks and Complications after the Modified Radical Mastectomy surgical procedure?

The possible risks and complications that may arise after the Total Mastectomy procedure are:

• Excessive bleeding
• Infection in the surgical wound
• Depression
• Fluid accumulation under the skin (seroma)
• Excess blood or serum accumulation within the underlying skin of the surgical wound
• Reduced range of motion of the shoulder, due to nerve damage
• Obstruction of the lymphatic system (lymphedema)
• Loss of skin surrounding the site of the surgical procedure

What is the Prognosis after the Surgery?

A complete recovery from the Breast Removal (Mastectomy) surgical procedure is usually achieved. The prognosis after the surgery is also excellent, if there are no serious complications.

When do you need to call your Physician?

Do contact your physician if you notice any of the following symptoms, after a Modified Radical Mastectomy procedure:

• Pain that worsens and swelling of the surgical wound
• Bleeding or fluid drainage from the surgical wound
• The occurrence of any symptom that causes uneasiness, such as nausea, vomiting, or constipation
• Signs of an infection
• Dizziness
• Muscle aches, headache
• Fever, feeling sick
• Complications associated with prescription medications used in treatment

What Post-Operative Care is needed at Home after the Modified Radical Mastectomy surgical procedure?

At home, the following post-operative care is recommended, after a Modified Radical Mastectomy procedure:

• Slowly resume regular/daily activities as soon as possible, which aids in faster recovery
• Use a heat pad or warm compress to relieve pain due to the incision
• Resume showering and keep the wound clean and dry. Avoid taking baths until the surgical wound is completely healed. Gently wash the surgical wound with unscented soap
• Elevate legs while resting, to prevent the formation of blood clots and reduce the possibility of swelling
• Take stool softeners to prevent constipation
• Take antibiotic medication to help combat or prevent infection
• Complete the course of prescribed medication under advice of the physician
• Individuals are encouraged to look for additional support from family members, friends, or support groups
• Avoid all activities that are physically strenuous for about 6 weeks after the procedure
• Resume driving only after 2 weeks of being discharged from the healthcare facility, or as determined by your physician
• Avoid sex, till a complete healing has taken place (under advise by the physician)
• Individuals are advised to have to a clear liquid immediately after surgery until the gastrointestinal tract begins properly functioning. After which, the individuals are advised to have a well-balanced diet, which can aid in a faster recovery

How long does it normally take to fully recover, from the Procedure?

For a complete healing to take place after the Modified Radical Mastectomy surgery, it may take about 3-4 weeks.

Additional Information:

What happens to tissue (if any), taken out during the Procedure?

The tissue is taken for further examination and later disposed as per the standard medical procedure.

When should you expect results from the pathologist regarding tissue taken out, during the Procedure?

• The tissue removed is processed in the laboratory under a pathologist's supervision
• Slide(s) are prepared once the tissue is processed and is examined by a pathologist and a pathology report issued
• Depending on the complexity of the case, issue of the report may take anywhere between 72 hours to a week's time

Who will you receive a Bill from, after the Modified Radical Mastectomy surgical procedure?

It is important to note that the number of bills that the patient may receive depends on the arrangement the healthcare facility has with the physician and other healthcare providers.

Sometimes, the patient may get a single bill that includes the healthcare facility and the consultant physician charges. Sometimes, the patient might get multiple bills depending on the healthcare provider involved. For instance, the patient may get a bill from:

• The outpatient facility or a hospital
• An anesthesiologist (if anesthesia was administered)
• A pathologist
• General surgeon or oncological surgeon

The patient is advised to inquire and confirm the type of billing, before the Modified Radical Mastectomy procedure is performed.

Thanks and Gratitude:

We sincerely acknowledge and thank Dr. Douglas J. Jones for reviewing the article. His valuable input and feedback has helped enrich the contents of this article.

Douglas J. Jones, MD FACS
Board Certified General Surgeon and Faculty Member
University of Illinois, College of Medicine at Urbana-Champaign
506 S. Mathews Ave., Urbana, IL 61801, USA