This document discusses modified radical mastectomy, which involves removing the breast tissue, areolar complex, overlying skin near the tumor, pectoralis major fascia, and axillary lymph nodes. It describes the different types of axillary lymph node dissection and notes that removal of level III nodes is not routinely performed. Sentinel lymph node biopsy is an alternative to help reduce the risk of lymphadema by first identifying sentinel nodes for analysis before a possible axillary lymph node dissection. Complications of mastectomy can include bleeding, seroma, flap necrosis, infection, nerve injury, and lymphedema.
6. Types of Mastectomy
Operation Breast Lymph node
Pectoralis
major & minor
m.
Simple
mastectomy
Modified radical
mastectomy
Radical
mastectomy
7. Modified radical mastectomy
Areolar complex
overlying skin near the tumor with a 2-cm margin
Breast tissue
Pectoralis major fascia
Axillary LN
8. Axillary LN dissection (ALND)
Patey (I-ll-lll)
Removal of pectoralis minor muscle
Scanlon (I-ll-lll)
Incision at Pectoralis minor to reach Level lll node
Auchincloss (I-ll)
preservation of both pectoralis major and minor;
only Level I-II dissection
10. Axillary LN dissection (ALND)
About 10 nodes were removed
ALND level I-II lymphadema 30%
ALND level I-lII lymphadema 50%
Therefore, ALND level lll not routinely performed
except can be palpate intraop.
No difference in survival rate
between the 2 groups
11. Sentinel lymph node biopsy
Goal
Reduce risk of lymphadema
Criteria
1. Unicentric cancer
2. Tumor clinically < 5 cm.
3. No prior chemotherapy or hormonal therapy
4. Clinically node negative at time of diagnosis
12. Sentinel lymph node biopsy
Injection
Blue dye/ radioactive
substance
Detection
Of sentinel LN by
probe/visualization
Removal
Sentinel LN for
histopatho
14. Sentinel lymph node biopsy
Identify sentinel LN
Found Not found
Negative for
malignancy
Positive for
malignancy
No ALND Carry out ALND
15. Indication
Multicentricity or diffuse malignant appearing
microcalcifications
Positive margins after BCT
Recurrence after BCT
History of therapeutic irradiation to the breast
region
Pregnancy (first or second trimester)
History of collagen vascular disease
Tumor size > 4 cm
17. Indication
Multicentricity or diffuse malignant appearing
microcalcifications
Positive margins after BCT
Recurrence after BCT
History of therapeutic irradiation to the breast
region
Pregnancy (first or second trimester)
History of collagen vascular disease
Tumor size > 4 cm
30. Complication
Nerve injury
Long thoracic n. Thoracodorsal n. Intercostrobrachial n.
1 2 3
Adduction, extension
and medial rotation of
shoulder
Wing’s scapula
Intercostrobrachial n.