Radical Mastectomy — Procedure Guide, Recovery & Risks | MyMedicPlus

Radical mastectomy removes the entire breast, overlying skin, nipple-areola complex, pectoralis major and minor muscles, and Level I-III axillary lymph nodes en bloc. It is reserved for advanced or recurrent breast cancer with chest wall invasion.

Indicated for locally advanced breast cancer invading the chest wall, inflammatory breast cancer not responding to chemotherapy, and recurrent tumors after prior breast-conserving surgery when pectoral muscle involvement is confirmed.

Under general anaesthesia, an elliptical incision removes breast tissue, skin, and pectoralis muscles. Level I-III axillary lymph node dissection follows. The wound is irrigated, closed-suction drains placed, and the chest wall closed in layers.

Hospital stay is 3-5 days; drains removed when output falls below 30 mL per day (7-14 days). Arm exercises begin within 48 hours to prevent stiffness. Full recovery takes 4-6 weeks. Lifelong lymphedema surveillance is required.

Lymphedema occurs in 20-30% of patients. Other risks include seroma formation, wound infection, shoulder stiffness, intercostal nerve injury, phantom breast pain, and chest wall skin necrosis requiring re-grafting.

Local recurrence rates fall below 10% in appropriately selected patients. Adjuvant chemotherapy and radiotherapy improve overall survival. Physiotherapy restores shoulder function and quality of life within 6-12 months post-operatively.