MODIFIED RADICAL MASTECTOMY

Operative Technique:

Patient supine under General Anesthesia

Ipsilateral arm abducted from axilla

Pad placed underneath patient’s scapula and posterior hemithorax

Asepsis and antisepsis technique

Sterile drapes placed

Elliptical incision made encompassing mass with 3-5cm margin together with the nipple-areola complex. Depth of incision carried from skin through subcutaneous tissue.

Towel clips applied to edge of skin on flap about 2 – 3cm apart

Ask Assistant to elevate skin flap by drawing towel clips upward making it perpendicular to the breast tissue while applying countertraction by depressing breast.

Dissection carried out by use of electrocautery incising cooper’s ligaments which attach breast to subcutaneous tissue

Skin flaps extended: Superiorly – subclavius muscle; Medially – sternum; Inferiorly – about 2 – 3 cm inferior to the inframammary fold; Laterally – anterior border of the latissimus dorsi

From the sternum to the lateral margin, fascia incised with the use of electrocautery overlying pectoralis major muscle. Bleeders either electrocoagulated or suture-ligated.

At the lateral margin of the pectoralis major elevate the edge of the pectoral muscle from its investing fascia using blunt and sharp dissection maintaining continuity between the breast, the pectoral fascia, and the lymph nodes of the axilla

Pectoralis minor preserved

Axillary vein identified, adventitial sheath incised

Level I and II axillary nodes and Rotter’s nodes removed

Thoracodorsal and long thoracic nerve identified and preserved

Copious saline irrigation

Hemostasis

Complete sponge and instrument count

Closed-suction drain placed laterally and medially and positioned in the inferior flap

Subcutaneous tissue approximated with vicryl 2.0 sutures

Skin closed interruptedly with silk 3.0

Drain secured with silk 2.0 sutures

Fluffy dressing applied