Mastectomy and axillary dissection

Mastectomy is a surgical procedure to remove one or both breasts, typically performed to treat or prevent breast cancer. Axillary dissection, often performed in conjunction with mastectomy, involves the removal of lymph nodes from the underarm area to assess for cancer spread.

Different breast surgeries includs

• modified radical mastectomy - removal of entire breast and axillary lymph nodes

• breast conservation - tumor and some healthy tissue

• skin spairing - breast tissue removed through areolar incision

• radical mastectomy - removal of breast, chest muscle, all axillary lymph nodes

• sentinel lymph node biopsy - removal and examination of a limited number of lymph nodes to evaluate cancer spread.

• partial mastectomy - removal of the tumor along with a margin of surrounding healthy tissue, preserving most of the breast.

surgery depends on

• breast size, type, location,

• stage of cancer

• radiation

• if spread to lymph nodes

• age/health

• general anesthesia

• position supine arms less then 90*

  Procedure

• incision transverde eiliptic with knife

• SA responsible for counter traction

• curved metz and bovie to free skin edges from fascia

• freeman retractors

• coagulate with hemostates and ligate with suture or bovie

• SA clamps bleeder and ties with 3-0 vicryl

• protect skin edges with warm lap sponges

• grasp with allis forcepts surgeon dissects from perctoral fascia with metz

• tumor breast tissue removed

• bleeding vessels ligated with 3-0 suture

• JP drain inserted through small incision with hemostats

• secure drain with silk suture

• dressing 4×4s, fluff, surgical bra

  Post-op

• taken to PACU

• pain numbness inching in underarm

• pain medication possible antibiotics

  Complications

• bleeding

• infection

• pain

• swellin in axilla

• hard scar tissue

• shoulder pain/ stiffness

• numbness

• hematoma ( build up of blood)

  Modified Radical Mastectomy

• general anestesia

• supine arms less then 90*

• tumor examined for size, type, grade, incision, lymphocytic response, clear margins

Proceedure

• oblique elliptic incision with lateral incision towards axilla

• bleeding controlled with hemostats, ligature and bovie

• under cut skin with bovie, metz, or 10 blade

• cover margins of skin flap with moist laps

• dissect at clavicla down medsternum

• fascia and breast tissue resected from perctoralis muscle

• pectoralis major muscle unharmed

• clamp and ligate intercostal veins and arteries

• protect axillary veins and medial and leteral nerves of pectoralis major muscle

• dissect fascia off pectoralis muscle (lateral edges)

• dissect fascia off serratus antrior muscle

• preserve thoracic and thorocondorsal nerve

• breast and axilla fasic freed from latissimus dorsi muscle and suspensory ligament

• irrigate with normal saline

• JP drain inserted and sectured with non-absorbable susture

• close subcutaneousu tissue with absorbable suture

Dressing

• tape, ointment, non-adherent wond dressing

• secured with surgical bra or ace bandage

Complications

• excessive bleeding

• infection

• depression

• fluid accumulation

• lymphedema

• reduced range of motion

• loss of skin

Post Op

• regular activity slowly

• warm compression for pain

• unscented saop

• elevated legs ( prevents blood clotts)

• stole softeners

• antibiotic medication

• avoid heavy activity for 6 weeks

• resume driving after 2 weeks

• avoid sex

• clear liquid until GI tract functions properly

Axillary Node Dissection

• cancer spread first to axillary lymp nodes

• lymph nodes per person 20-40

• sentinel lymph nodes are the first lymph nodes that lymphatic fluid passes through

• biopsy done by removing 1-5 sentinel lymph nodes from under arm