The modification was that the pectoralis minor muscle was spared. In a modified radical mastectomy, the entire mammary gland, most of the skin and most of the axillary lymph nodes are removed. The remaining skin is sewn together to close the wound so skin grafts are not necessary. This operation was performed regularly until the mid to late 1990s when complete axillary lymph node dissections were replaced with sentinel lymph node biopsies in patients who had normal-appearing lymph nodes. However, even today, this operation is indicated in advanced cancers including inflammatory breast cancer.
Even though it is considered major surgery, in the right hands a modified radical mastectomy iswell tolerated. I have done this operation on hundreds of patients. There is little blood loss (I’ve only required one intraoperative blood transfusion in a patient with extremely, extremely large breasts who had a double mastectomy) and it is not particularly painful. Patients stay in hospital overnight and go home the next day. Two drains are placed and can usually be removed in 10 to 14 days. Recovery is about 2 weeks.
Currently, most patients who need this operation also need post mastectomy radiation. Sometimes the axilla also requires radiation. The combination of an axillary lymph node dissection (removal of the lymph nodes in the arm pit) and axillary radiation is associated with a relatively high risk of arm swelling (upper extremity lymphedema). This risk is about 20% (1 in 5). In my opinion this is the biggest problem with this operation. But lymphedema can be detected early and in most cases, it can be either prevented or treated effectively by qualified physical therapists. All my patients see our physical therapist before and after a lymph node dissection.
Reconstruction is possible after a modified radical mastectomy.