A mastectomy is surgery to remove a breast. There are several types of mastectomy, including total, modified radical, and radical.
A radical mastectomy is the most extensive type. During the procedure, the surgeon removes the entire breast along with the underarm (axillary) lymph nodes and chest wall muscles.
In this article, we’ll take a closer look at radical mastectomy, when it might be needed, and why it’s seldom used.
A radical mastectomy (Halstead mastectomy) is a surgical treatment for breast cancer. It’s the most complex type of mastectomy, in which the surgeon removes:
- the entire breast including the skin, nipple, and areola
- all axillary lymph nodes
- major, minor, and fascia pectoral muscles
For many decades, radical mastectomy was the “gold standard” in breast cancer treatment. With today’s improved imaging techniques and more treatment options, it’s rarely necessary.
Both radical and modified radical mastectomy include removing the entire breast. During a modified radical mastectomy, the surgeon removes some underarm lymph nodes.
The key difference is that in a radical mastectomy, the surgeon removes all the underarm lymph nodes plus the entire chest muscle.
In contrast, a total (simple) mastectomy is removal of the entire breast. The axillary lymph nodes and chest muscles are left in place. In some cases, the sentinel lymph nodes are removed and checked for cancer.
Before your mastectomy, you’ll want to give some thought to reconstructive surgery. It can start at the same time as your mastectomy or it can wait. You can also choose not to have reconstruction.
The surgical team can factor your choice into their surgical plan.
Plan to be in the hospital at least 1 or 2 nights. You might need a longer stay if surgery involves reconstruction or if there are complications.
Here are a few tips for getting ready:
- Pack a light bag for toiletries, personal items, and a change of clothes. Include a loose, comfortable top that doesn’t need to go over your head to wear home. An oversize zip-up hoodie works well.
- Stop eating and drinking at the specified time directed by your doctor, usually midnight the night before surgery.
- If you take regular medication, ask if you should continue or stop before the day of surgery.
- Arrange transportation in advance, and bring a small pillow to protect your chest from the seatbelt strap.
- Stock up on groceries and arrange for help when you get home.
Questions to ask your doctor before a radical mastectomy
The best way to prepare is to ask questions. Here are some questions to get the conversation started.
- Why do you recommend radical mastectomy over modified radical mastectomy?
- Are there less invasive alternatives?
- Will I need chemotherapy, radiation, or other treatments?
- What are my options for breast reconstruction?
- How long will I be in the hospital?
- What do I need to know about wound care, drains, and follow-up visits?
- What are the biggest side effects and risks?
- What do I need to know about lymphedema?
- What type of after-care will I need?
- How long will recovery take?
You’ll report to the hospital the day of your surgery. After changing into a hospital gown, a nurse will insert an IV into your arm for fluids, antibiotics, and other medicines. Usually, you can have someone stay with you until it’s time to go to the operating room.
The surgical team will review the plan before administering general anesthesia.
The surgeon will make an incision, then remove the entire breast, pectoral muscles, and all axillary lymph nodes. The lymph nodes will go to a laboratory to see if they contain cancer cells. After inserting several thin tubes to drain fluids, the surgeon will close the wound.
Radical mastectomy can take several hours. It’ll take longer if you’re starting reconstructive surgery at the same time.
Radical mastectomy is major surgery. Post-op tenderness and pain is normal.
Persistent post-mastectomy pain is common, especially with the removal of axillary lymph nodes. Reconstruction might make it more painful.
Treatment for post-mastectomy pain may include:
- physical therapy
- over-the-counter (OTC) or prescription pain relievers
- psychological therapies
- care that addresses specific side effects
Your doctor will likely prescribe pain medication when you leave the hospital. It’s helpful to take it before pain becomes too severe.
When you wake up, your chest will be bandaged. You’ll notice that you have surgical drains coming from your chest or underarms. The tubes have bulbs on the end to capture excess fluid as it drains.
In the recovery room, nurses will monitor your vital signs. Once you’re awake, you’ll be moved to a regular hospital room for a few days.
When you leave the hospital, you’ll have instructions regarding:
- caring for your dressing and drains
- signs of infection or serious side effects
- your follow-up visit
- when it’s safe to wear a bra or breast form
Common side effects include:
- bruising, swelling
- numbness, tingling
- shooting pains in the chest or underarms
- limited arm or shoulder mobility
You’ll need several weeks of rest to promote healing. Recovery time varies, depending on:
- breast reconstruction procedures
- other treatments
- overall health
- complications or side effects
You may be able to return to regular activities within 4 to 6 weeks, but it can take months.
The potential benefit of a radical mastectomy is that a cancerous tumor might be eliminated.
Risks of surgery include:
- reaction to anesthesia
- bleeding or clotting
When compared to other types of mastectomy, radical mastectomy tends to cause more:
- arm mobility problems
- cosmetic issues
Removal of all axillary lymph nodes is also more likely to cause lymphedema, difficulties with your lymphatic system. This system is part of your immune system that helps remove toxins, waste, and immune cells from your body via lymph nodes and vessels.
Symptoms of lymphedema include:
- swelling of the arm, shoulder, or chest
- redness of the skin
- skin feels hot to the touch
- changing texture of the skin
- numbness, tingling, aching
- feeling of fullness or heaviness
- less flexibility in your shoulder
Lymphedema can become a serious, chronic condition.
Most people recover from a mastectomy within a few weeks to a few months. But many factors go into your overall outlook, such as:
- reconstructive surgeries, if any
- other treatments
- type and stage of breast cancer
- overall health
- development of chronic side effects such as lymphedema
Radical mastectomy is a surgical treatment for breast cancer. It involves removal of the breast, pectoral muscles, and all underarm lymph nodes. Radical mastectomy was once a standard treatment for breast cancer. Today, it’s seldom needed.
Less invasive procedures, such as modified radical or total mastectomy, along with radiation and systemic therapies are usually quite effective. A radical mastectomy might be considered if a cancerous breast tumor has grown into the chest wall.