MODIFIED RADICAL MASTECTOMY-OPERATIVE PROCEDURE.pptx

MODIFIED RADICAL MASTECTOMY-OPERATIVE PROCEDURE with anatomy of breast

1. MODIFIED RADICAL MASTECTOMY-OPERATIVE PROCEDURE By: Dr. Rajesh Kakkeri

2. Introduction Latin word Breast = Mammary gland. Modified sweat gland. Accessory organ of female reproduction system.

3. Situation and extend Lies in superficial fascia of pectoral region. Extended Vertically - from 2 nd to 6 th ribs. Horizontally – lateral border of sternum to maxillary line Lies on deep fascia (pectoral fascia) and separated from fascia by retro mammary space. 2 nd RIB 6 th RIB Pectoral fascia Pectoralis minor Pectoralis Major Retro mammary space

4. Situation and extend Lymphatics are present in retro mammary space. That is why in MRM we dissect the breast tissue with pectoral fascia .

5. Situation and extend Breast is divided in four quadrants Upper inner Upper outer Lower outer Lower inner Nipple areola complex should be mentioned separately while describing breast examination.

6. Situation and extend Upper lateral quadrant has lateral extension – known as axillary tail of Spence. It piers deep pectoral fascia – known as foramen of langer. It has direct communication with anterior group of axillary lymph nodes. That is why we need to remove axillary LN with breast tissue with connecting axillary tail in continuity .

7. Structure of breast It can be divided in 3 components Skin with nipple areola Parenchyma Stroma

8. Structure of breast Parenchyma It is a compound tubulo- alveolar gland which secretes milk. The gland consists of 15 to 20 lobes. Each lobe is a cluster of alveoli, and is drained by a lactiferous duct. The lactiferous ducts converge towards the nipple and open on it. Near its termination each duct has a dilatation called a lactiferous sinus

9. Blood supply The mammary gland is extremely vascular. Internal thoracic artery, a branch of the subclavian artery, through its perforating branches. The lateral thoracic, superior thoracic and acromiothoracic (thoracoacromial) branches of the axillary artery. Lateral branches of the posterior intercostal arteries.

10. Lymphatic drainage Supraclavicular group Breast lymph Anterior and Posterior group Central and Lateral group Apical group

11. Lymphatic drainage The lymphatics from the deep surface of the breast pass through the pectoralis major muscle and the clavipectoral fascia to reach the apical nodes, and also to the internal mammary nodes.

12. Lymphatic drainage Lymphatics from the lower and inner quadrants of the breast may communicate with the sub diaphragmatic and sub peritoneal lymph plexuses after crossing the costal margin and then piercing the anterior abdominal wall through the upper part of the linea alba.

13. Lymphatic drainage Three anatomic levels defined by their relationship to the pectoralis minor muscle. Level I nodes are located lateral to the lateral border of the pectoralis minor muscle. Level II nodes are located posterior to the pectoralis minor muscle. Level III nodes include the sub clavicular nodes medial to the pectoralis minor muscle.

14. Lymphatic drainage The anterior (pectoral) group lie along the lateral thoracic vessels. The posterior (scapular) group lie along the subscapular vessels. The lateral group lie along the upper part of the numerus, medial to the axillary vein. The central group lie in the fat of the upper axilla. The apical (infraclaaicular) group lie deep to the clavipectoral fascia, along the axillary vessels.

15. Lymphatic drainage Lymph nodes in the space between the pectoralis major and minor muscles are termed the interpectoral group, or Rotter’s nodes.

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