The modified radical mastectomy does no conserve the breast; the affected breast is completely removed. Indications for modified radical mastectomy include multi-centric disease (tumor is present in different quadrants of the breast), inability to have radiation therapy, preference of a large tumor in a small breast, and patient preference (Baron,2007). The modified radical mastectomy differs from the older Halsted radical mastectomy in that the surgeon leaves the pectoral muscles and nerves intact. Thus the breast tissue and skin and the axillary nodes are removed and the underlying muscles are left in place. The typical incision is a 4- to 5-inch-long elliptic incision from the midchest to the axilla. If reconstruction is to follow the procedure, the plastic surgeon may recommend a different location for the incision . when reconstruction is to be performed at the same time as the mastectomy, less invasive techniques, such as incision a 1/½-inch flap of skin around the nipple (excising the same amount of breast tissue as with conventional mastectomy),may be performed. Skin flaps or expanders may be used to create a breast mound at the time of the original procedure.