modified radical mastectomy

What exactly was modified?

The operation it replaced, the radical mastectomy, removed the breast, the armpit nodes and both chest muscles together. It left a hollow in the chest wall, a weakened shoulder and, very often, a permanently swollen arm. Trials comparing the two found that sparing the muscles did not shorten survival, so the muscle-sacrificing version fell out of use. The modified operation keeps the cancer clearance and drops the disability.

How do the breast operations compare?

What follows the operation?

A small nerve crossing the armpit is usually divided, leaving a patch of permanent numbness on the inner upper arm. Fluid gathers under the skin flap for a while and is drained. Shoulder movement stiffens without exercise. The most consequential long-term effect is arm swelling, and its likelihood rises with the number of nodes removed and rises further if the armpit is also irradiated. The nodes themselves are examined under the microscope, and how many contain tumor is one of the strongest guides to what treatment for breast cancer should follow.

When is the whole breast removed?

Removing the breast and keeping it give the same survival wherever either is suitable, so the decision rests on other things. A tumor large in relation to the breast, disease in more than one quadrant of the gland, cancer returning after earlier breast-conserving surgery, and situations where the radiation that normally follows a lumpectomy cannot be given all point toward removing the breast. Personal preference carries real weight, since both paths lead to the same place. Reconstruction may be built during the same operation or considered much later.