Modified radical mastectomy

A modified radical mastectomy removes all breast tissue, the nipple-areola complex, necessary skin, and the level I and II axillary lymph nodes.

The Patey modification of the modified radical mastectomy also removes the pectoralis minor muscle, which permits complete dissection of the apical (level III) axillary lymph nodes

Modified Radical Mastectomy

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Lymphedema: This complication occurs less frequently with the standard axillary dissections performed nowadays ( level I and II). It is more frequently seen when an axillary dissection is combined with axillary radiation.

Seroma: One of the main reasons for drain positioning is to avoid seromas (closed simple drain or suction drain). These drains are left in for approximately four to five days, however occasionally this is not long enough and some patients will develop seromas. This can be drained percutaneously using a large gauge needle. There is no evidence to support the role of fibrin glue to prevent seroma formation after breast surgery

complications

Anatomic Complications of the Modified Radical Mastectomy

Vascular Injury The first and second perforating vessels are too large for cautery.They are ligated. The axillary vein, if torn, is repaired. Ligation may cause chronic edema. Nerve Injury Intercostobrachial nerve When cut, circumscribed numbness of the medial aspect of the ipsilateral upper arm results. Long thoracic nerve If cut, winging of scapula deformity results. Medial and lateral thoracic nerves If cut, the pectoralis muscles atrophy. Thoracodorsal nerve If cut, internal rotation and abduction of the shoulder are weakened.

Step by step 1. Arm on the affected side is extended on a side table. The

patient is draped and the affected breast and axilla are exposed. 2. Drawing incision line (an optimal wound closure without any

redundant skin must be taken into account) 3. Skin incision and formation of upper flap.

Modified Radical Mastectomy

steps

The boundaries of dissection for a modified radical mastectomy are (a) the subclavius muscle superiorly, (b) the anterior border latissimus dorsi muscle laterally, (c) the sternum medially, and (d) the caudal extension of the breast (3 to 4 cm inferior to the inframammary fold) inferiorly.

7. Dissection of the breast from medial to lateral including pectoralis major 's fascia

8. Follow the lateral margin of the pectoralis major muscle and opening clavipectoral fascia

9. Identification of upper axillary margin (=axillary vein)

steps

10. Dissection of axillary top (along axillary vein) 11. Identify and preserve thoracodorsal nerve/vessels 12. Identify and preserve long thoracic nerve

steps

13. Finalize axillary dissection and remove all level I and II lymph nodes (for a complete oncologic resection it is sometimes necessary to cut the intercostobrachial nerve)

14. Remove axillary content en bloc with the breast 15. positioning of two drains (axilla-lower flap and upper flap) 16. Woundclosure, avoid any redundant skin

steps