Modified radical mastectomy presentation

This file includes the details about Mastectomy and its classification. Mastectomy is the surgical procedure.

1. Modified radical mastectomy Presentation done by , d.priyadharshini bsc -operation theatre and anesthesia technician

2. Mastectomy: Surgical removal of breast tissue partially or completely.

3. Indication: Women with carcinoma breast. Men with carcinoma breast. Extensive benign disease of breast . Prophylactic. No/ minimal response to systematic therapy to CA breast.

4. Structure of Breast: Present ,bilaterally in the pectoral region ,in the both sexes. Made up of breast tissue and fat ,along with nerves, veins, arteries and connective tissues . Made up of 3components: Glandular tissue. Fibrous tissue. Interlobar fatty tissue.

5. Glandular tissue Consists of 15-20 pyramidal lobes. Each lobes is drained by a lactiferous duct. Fibrous tissue Supports the lobes ,connects the skin to the pectoral fascia. Inter lobar fatty tissue Makes the breast rounded in contour. Fat is absent beneath the nipple and areola.

6. Blood supply: Axillary artery , Internal thoracic artery, Superior thoracic artery. Axillary vein , Internal thoracic vein, Intercostal vein. Nerve supply: Intercostal nerves and Sympathetic fibres.

7. Lymph nodes of the breast: Axillary lymph nodes . The internal mammary lymph nodes. Some lymph also reaches Supraclavicular , Cephalic, Posterior, Intercoastal , Subdiaphgrametic and Subperitoneal lymph nodes .

8. Types of mastectomy

9. Total or Simple mastectomy : Removal of the entire breast . No dissection of lymph nodes or removal of muscle. Sometimes adjacent lymph nodes are removed along with the breast tissue.

10. Modified Radical Mastectomy ( MRM ) Removal of breast tissue and axillary lymph nodes. No removal of pectoral muscle. 3 modifications: Patey’s Scanlon’s Auchincloss

11. Types of MRM : Patey’s modified radical mastectomy: Pectoralis major muscle is maintained , but the Pectoralis minor muscle isn’t. Auchincloss modified radical mastectomy: Both the Pectoralis major and Pectoralis minor are maintained. Scalon modified radical mastectomy: P ectoralis minor is divided but not removed.

12. Risk factors: Age Gender Genetics related F amily history Personal history of breast cancer Menstural periods Pregnancy Birth control Breast feeding Alcohol/Smoke

13. Case Presentation: Patient name: Mrs. Palaniyammal Age /Sex : 50years/female Occupation : Home maker Patient came with the complaint of swelling on the left breast for past one month and also pains frequently. Patient where asked to do some investigations as per physician advises. The investigations showed the signs of carcinoma breast. The Physician advised the patient to undergo Mastectomy surgery. Plan : P atey’s Modified Radical Mastectomy.

14. Preoperative management: Triple assessment . Metastatic workup. Routine blood investigations. Pre- anaesthetic evaluation. Control of medical conditions like diabetics and hypertension. Counseling and written informed consent. Parts preparation – neck to mid thigh including pelvic region, axilla and arm . Pre-medications given as per order .

15. Intraoperative procedure : Anesthesia : General anesthesia Position : The patient is placed in supine position with the arm abducted < 90 degree. Sandbag or folded sheet is placed under the throx and shoulder of affected side

16. Procedure: Drape and painted the incision site with microbicidal solution. Encircling the nipple – aerola complex. Elliptical incision made on medial aspect enclosing the nipple , aerola and tumor with extends laterally into the Axilla along the anterior axillary fold. Skin flaps raised on both sides. Left breast along with the tumour removed completely. In axilla, lateral border of Pectoralis minor is divided from Coraciod process . Pectoralis minor removed.

17. Left axillary dissection done by removing pectoralis minor. Haemostasis attained. Flaps closed with keeping drains in axilla. Dressing done.

18. Post operative management: Wound examined on post-op day 3. Drained can be removed when it is < 30 ml. Any collection is to be aspirated under aseptic precautions. Staples can be removed after 10 days . Arm movements started in the first week. Active shoulder and upper limb exercises are started from second weeks.

19. Complications: Most common: Reduced range of motion of the shoulder. Numbness Lymphoedema Pain L ess common: Hematoma Skin flap necrosis Fibriosis Winging of scapula Postural changes Psychological implications Chronic /phantom pain

20. Reference: https://www.healthline.com/health/modified-radical-mastectomy http://www.slideshare.net/drshama65/breast-cancer-edited?from_m_app=android http://www.slideshare.net/assr9/breast-cancer-33974196?from_m_app=android http://www.slideshare.net/syazanimaziana/breast - cancer-13742273?from_m_app=android