Toilet mastectomy: A useful adjunct to palliative Toilet mastectomy: A useful adjunct to palliative care in metastatic and locally advanced breast care in metastatic and locally advanced breast cancer patientscancer patients..

Dr.Ketan VagholkarMS,DNB,MRCS,FACS.

Consultant General Surgeon

Toilet mastectomy: A useful adjunct to palliative Toilet mastectomy: A useful adjunct to palliative care in metastatic and locally advanced breast care in metastatic and locally advanced breast cancer patientscancer patients..

Toilet mastectomy continues to be a excellent adjunct to palliative care in advanced breast cancer patients.

Local complications such as bleeding and secondary infection with sloughing of the growth are most distressful to the patient.

A well done toilet mastectomy can provide satisfactory relief from these complications.

The response to chemotherapy is also quite better.

Salient features of toilet mastectomy.Salient features of toilet mastectomy.

Wide excision taking into consideration the limitations imposed by the paucity of surrounding skin for closure.

Reaching up to the muscle and in some cases removing a part of the adherent muscle fibers.

Avoid going into the axilla in view of adherent lymph node masses engulfing the axillary vessels.

Rigorous intraoperative lavage with hypertonic saline to destroy spilled cancer cells during surgery.

Clinical CaseClinical Case

68 year old lady with locally advanced breast cancer with liver metastases and local complications of severe intermittent bleeding from the growth.

Specimen removed at toilet Specimen removed at toilet mastectomymastectomy

The entire fungating mass along with a narrow rim of skin is removed.

The deep dissection should extend upto the underlying pectoral muscles.

Final outcome of surgeryFinal outcome of surgery