Radical mastectomy

Radical mastectomy is a surgical procedure in which the breast, underlying chest muscle (including pectoralis major and pectoralis minor), and lymph nodes of the axilla are removed as a treatment for breast cancer.

It was developed and first performed by William Stewart Halsted in 1882. From about 1895 to the mid-1970s about 90% of the women being treated for breast cancer in the US underwent the radical mastectomy. This is a very morbid surgery and is not performed except in extreme cases.

Technique

Incision :

(1) elliptical skin incision ( mayer's incision ) including akin , nipple and areola overlying the tumour extending 5 c.m around tumour

(2) linear incision extending from coracoid process of scapula down to midline below xiphoid process.

Steps :

(1) Elevate skin flaps ( upward - downward - medially - laterally )

(2) Remove : skin areola nipple, all breast tissue , Clavi-pectoral fascia, pectoralis major ( sternal head only ), pectoralis minor muscle, rotor lymph nodes and axillary lumph nodes - fat - fascia

(3)structures preserved: Clavicular head of pectoralis major , nerve to serratus anterior ( long thoracic nerve of pell ) and nerve to latissmus dorsi ( can be sacrificed if surrounded by infiltrated lymph nodes )

Disadvantages : ugly scar (psychologically ) and weakness of upper limb

Today, there are three main categories of mastectomy:

  1. total (simple) mastectomy,
  2. modified radical mastectomy,
  3. partial mastectomy.

Modified radical mastectomy either pattey's operation or Auchincloss operation

(1) Pattey's Operation as Radical mastectomy with preservation of sternal head of pectoralis major muscle with complete axillary dissection

(2) Auchincloss Operation as Radical mastectomy with preservation of sternal head of pectoralis major muscle and preservation of pectoralis minor muscle with incomplete axillary dissection

Post-Surgery:

Administration of a plasma volume expander could be beneficial in reducing edema in the arms of women who have had radical mastectomy with removal of axial lymph node


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