Radical Mastectomy: What You Need to Know

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.

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What is a radical mastectomy?

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.

Studies from the 1970s and 1980s showed that breast-conserving surgery followed by radiation treatment was a valid alternative to radical mastectomy in early-stage breast cancer. Other research found that more extensive surgery didn’t improve overall survival. In addition, less aggressive procedures are associated with better cosmetic outcomes and fewer serious side effects.

A 2019 study found that patients treated with breast-conserving surgery and radiation had an improved outcome over those who had radical mastectomy alone. In most cases, your doctor is likely to recommend a less invasive mastectomy. One exception might be when a large tumor invades the chest muscle.

What’s the difference between a radical mastectomy and a modified radical mastectomy?

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.

How to prepare for a radical mastectomy

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.

What to expect: How a radical mastectomy is performed

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.

How painful is a radical mastectomy?

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.

After a radical mastectomy

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
• bathing
• rest
• exercise
• 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.

Benefits vs. risks of a radical mastectomy

The potential benefit of a radical mastectomy is that a cancerous tumor might be eliminated.

Risks of surgery include:

• reaction to anesthesia
• infection
• bleeding or clotting

When compared to other types of mastectomy, radical mastectomy tends to cause more:

• pain
• 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.

What’s the outlook after radical mastectomy?

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

The takeaway

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.