Studying

1. MODIFIED RADICAL
MASTECTOMY

2. INDICATIONS
• IN CA.BREAST-
• LARGE TUMOR IN SMALL BREAST
• CENTRAL TUMORS
• MULTIFOCAL DISEASE
• LOCAL RECURRENCE
• PATIENT PREFERENCE

3. POSITION
• SUPINE POSITION
• ARM ABDUCTED
• PILLOW UNDER THE SHOULDER

4. ANAESTHESIA
• GENERAL
• THORACIC EPIDURAL

5. INCISION
• ELLIPTICAL INCISION ENCIRCLING THE TUMOR
AND NIPPLE AREOLA COMPLEX
• AXIS OF ELLIPSE DEPENDS ON SITE OF TUMOR
• TRANSVERSE ELLIPSE IS USUALLY SUFFICIENT

6. PROCEDURE
• SKIN FLAPS ARE RAISED UPTO CLAVICLE AND
COSTAL MARGIN
• EN BLOC DISSECTION OF:
• BREAST WITH TUMOR AND NIPPLE
• PECTORALIS MAJOR
• PECTORALIS MINOR
• AXILLARY FAT,LYMPHATICS,NODES
• WOUND DRAINED
• SKIN CLOSED

7. STRUCTURES PRESERVED
• AXILLARY VIEN
• CEPHALIC VEIN
• NERVE TO SERRATUS
• NERVE TO LATISSIMUS

8. COMPLICATIONS
• SEROMA
• INFECTION
• AXILLARY VEIN DAMAGE
• SHOULDER STIFFNESS

9. RELEVENT QUESTIONS
• What is Halsted’s mastectomy
• Patey’s mastectomy
• QUART
• Non surgical treatment
• Chemo regimes
• Harmonal Rx
• Simple mastectomy
• Prophylactic mastectomy
• Triple assessment
• Conservative surgery

10. R Q CONTD
• Features of lymphatic obstruction
• Axillary node groups
• Levels of axillary nodes
• Tamoxifen
• Prognostic indicators
• LCIS,DCIS
• Familial ca.breast