Mastectomy
In cases of diagnosed carcinoma:
• Removal of the Breast:
a. Partial mastectomy (Lumpectomy): Excision
of a breast tumor with appropriate tumor-free margins.
b. Simple mastectomy: Removal of entire
breast.
c. Modified radical mastectomy: Removal of
breast and axillary lymph nodes; most frequently performed radical procedure.
d. Radical mastectomy: Includes the removal of the entire
breast, pectoralis muscles, axillary lymph nodes, fat, fascia and adjacent
tissues. A skin graft may be necessary for skin closure. Less frequently
employed, unless there is an invasion of deeper structures.
e. Extended radical mastectomy: En bloc removal of the breast,
axillary contents, pectoralis muscles, and internal mammary lymph nodes.
Resection of the ribs and sternum may also be included. A skin graft may be
required for closure of the wound; rarely performed today.
Position
The patient is supine with arms extended on arm boards, a folded
sheet is under the shoulder on the affected side. Apply electrosurgical
dispersive pad.
Anesthesia
General anesthesia.
Procedure
1. In partial mastectomy,
the incision is usually made over the lesion.
2. The skin is elevated and
the breast mass is excised with healthy tissue around. Hemostasis is obtained.
3. In subcutaneous
mastectomy, the incision is generally made in the inframammary fold.
4. In modified radical
mastectomy, usually a transverse or longitudinal incision is used.
5. Skin flaps are developed
and pectoralis fascia is dissected free from underlying structures.
6. The axillary contents are
dissected free from vascular and nervous structures and are removed.
7. Care is taken to avoid
injury to the nerve supply to various muscles.
8. After hemostasis is
achieved, the skin flaps are approximated over the drains or suction catheters
(e.g. Hemovac). A skin graft may be required for skin closure.
In radical mastectomy
Additional structures
including the pectoralis major and minor muscles and the intervening lymphatic
and fatty tissues are excised.
Instruments
General set
• Additional curved crile
clamps and large towel clips hemoclip appliers (small, medium, large) (Fig.
17.25)
• Rake retractors (4 or 6 prong)
• Electrosurgical unit
• Suction tubing
• Needle magnet or counter
• Tube (or impervious) stockinette
• Electrosurgical pencil holder (optional)
• Dermatome (for skin graft) (e.g., Brown and
necessary supplies including mineral oil, saline, tongue blades, and
petroleum-impregnated gauze)
• Drainage unit (e.g. Hemovac)
• Pressure dressing
• Marlex mesh, optional
Any questions be sent to drmmkapur@gmail.com
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