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It is an education of mrm

1. MODIFIED RADICAL MASTECTOMY

2. CASE CAPSULE 50/F, presented – lump over right breast x 2 months Insidious onset, rapidly progressive, initially small, grew to present size H/o Pain over lump + + No h/o nipple inversion/discharge/ulcers No h/o edema over breast/ axillary adenopathy H/o Early menarche and late menopause (P2L2) Late age at first childbirth, breast feeding adequate No family history/ comorbidity history/ prior surgeries

3. CASE CAPSULE On examination Vitals stable General exam normal Local Examination A 4 x 3 cm lump noted over right breast, firm consistency, irregular margins, smooth surface, skin over swelling stretched, No peau d’orage , no ulcers, no satellite nodules No axillary adenopathy Opposite breast and axilla normal Spine ,cranium normal Diagnosis – ? Carcinoma right breast cT2N0M0

4. CASE CAPSULE Investigations USG Breast – BIRADS 5 lesion 4 x 3 x 2.8 cmwith irregular spiculated margins, Zone 2 at 11’o’Clock position Xray mammogram - lesion 4.5 x 3.3 x 2.8 cm with irregular margins and microcalcifications , Zone 2 at 11’o’Clock position Core Needle biopsy – F/s/o Invasive Ductal carcinoma ( IHC ER + PR + Her2Neu - ) X ray Chest Normal

5. QUESTION 1 ! What are the boundaries of mastectomy???!!

6. ANSWER 1 ANS : Superior – Clavicle Inferior – Inframammary crease Laterally – Latissimus dorsi Medially - Sternum

7. QUESTION 2 ! Injury to long thoracic nerve causes ???!!

8. ANSWER 2 ANS :

9. QUESTION 3 ! What are the types of incisions for MRM???!!

10. ANSWER 3 ANS :

11. Planned Surgery : Modified radical mastectomy Position – Supine with Arm abducted at 90 Degrees Anaesthesia - General Anaesthesia