1.
MODIFIED RADICAL MASTECTOMY

2.
Anatomy
Thoracodorsal nerve (M)
Long thoracic nerve (M)

3.
Anatomy
Intercostobrachial n. (S)

4.
Anatomy
Axillary lymph node
Supraclavicular lymphnode
Supraclavicular
lymphnode

5.
Anatomy
Axillary lymph node
l
ll
lll

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

9.
Axillary LN dissection (ALND)
 ALND
 Sentinel lymphnode biopsy  +/- ALND

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

13.
Sentinel lymph node biopsy

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

16.
Indication
MulticentricityMultifocal

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

18.
Mastectomy

19.
Mastectomy
SKIN-SPARING MASTECTOMY

20.
Incision

21.
Incision

22.
Flap

23.
Chest wall drain
Axilla drain

24.
Post operative care
Pain control
Drain
Exercise

25.
Complication
Bleeding
Seroma
Flap necrosis
Infection

26.
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.

27.
Complication
Lymphedema
Pressure garment
Avoid wearing tight sleeve
clothes or accessories
Keep the arm raised