Mastectomy

mastectomy
-ranjana chaurasia

1. MASTECTOMY

2. Content: INTRODUCTION INDICATIONS TYPES OF MASTECTOMY TRATEMENT SURGERY POST OPERATIVE RADIOTHERAPY TYPES OF SURGERY TYPES OF INCISIONS COMPLICATIONS

3. INTRODUCTION: Mastectomy is the medical term for the surgical removal of one or both breasts, partially or completely. A mastectomy is usually carried out to treat breast cancer. In some cases, people believed to be at high risk of breast cancer have the operation prophylactically, that is, as a preventive measure.

4. INDICATIONS: 1) Large cancer tissue 2) centrally located tumors 3) lobular or multi centeric carcinoma 4) risk of invasive cancer 5) suspicious calcification 6) recurrent carcinoma 7) primary tumors following surgery 8) Patient's choice 9) family history - prophylactic mastectomy

5. TYPES OF MASTECTOMY Simple or Total Mastectomy Double Mastectomy Skin Sparing Mastectomy Nipple Spearing Mastectomy Modified Radical Mastectomy Radical Mastectomy

6. Treatment: POSTOPERATIVE RADIOTHERAPY SURGERY AIM OF TRATMENT: to achive a cure if, possible conserve the breast to achieve locoregional control

7. Types of surgery : Types of surgery Local wide excision(lumpectomy) Quadrantectomy Total mastectomy and axillary clearance Patey mastectomy Halstead radical mastectomy What it means Tumor along with 2cm of normal is tissue is removed with an ellipse of the skin over the lump Quadrant containing the tumor is removed Entire breast tissue is removed. Both pectaralis major and minor are preserved Breast tissue + pecoralis is removed and axillary block dissection Entire breast tissue and both the pectoral muscles are removed

8. Wide local excision (lumpectomy) It is indicated in tumors less than 4 cm in size and with well differentiated histology . It includes removal of the tumor plus a rim of at least 1cm of normal breast tissue .if the nodes are palpable and enlarged , this is combined with axillary block dissection, using a separate incision currently ,this procedure has become more popular and it is commonly known as breast conservative therapy (BCT) CONTRAINDICATIONS : MULTIFOCAL DISEASE PREGNANCY CENTRAL QUADRANT TUMOR PRIOR RADIOTHERAPY TO THE BREAST PRIOR CHEST IRRADIATION

9. Simple mastectomy with axillary clearance : It is equally good ( good retraction of pectoralis minor facilitates axillary dissection – A adimelon modification )

10. PATEY MASTECTOMY : This is the most accetable and widely practiced surgery . It is also called as modified radical mastectomy . In this, the entire breast including nipple and areola( simple mastectomy ) are removed with pectoralis minor followed by axillary block dissection . A complete axillary block dissection should include node clearance upto level III LEVEL-I :extends from axillary tail to the lateral border of pectoralis minor LEVEL-II : extends from lateral border of pectoralis minor to medial border of pectoralis minor LEVEL-III :up to the apex of axilla

11. QUART THERAPY BY VERONASI : It includes quadrectomy (the entire segment of the breast containing the tumor is removed ) axillary block dissection and radiotherapy to the breast or axilla Howerver , it gives rise to poorer cosmetic result

12. Radical mastectomy : In this operation , following structures are removed. Entire breast including nipple and areola with skin overlying the tumor along with the fat , fascia and lymphatics Axillary block dissection ,including complete learance of axillary fat up to level III nodes clearance Sternocoastal portion of pectoralis minor , few fibers and aponeurosis of internal oblique , serratus amterior , lattismus dorsi and subscapularis Three important structures should be preserved Axillary vein bell`s nerve Cephalic vein

13. Disadvantages of radical mastectomy Mutilating surgery Poor cosmetic results Lymphoedema of arm

14. II. POST OPERATIVE RADIOTHERAPY Indication for post operative radiotherapy Tumor margin is positive Pectoralis major is involved Inner quadrant tumor Axillary clearance not satisfactory Breast conservative surgery Tumor size more than 5cms

15. INCISIONS superolateral radial incision inferolateral radial incision superior circumareolar incision periareolar incision inframammary fold incision

16. COMPLICATIONS: Lymphedema Nerve damage Hematoma Seroma Lymphadenoma Chronic pain Blood loss Infection Adverse drug reaction

17. Thank you