Modified radical mastectomy

General information

• A modified radical mastectomy removes all breast tissue, the nipple-areola complex, necessary skin, and the level I and II axillary lymph nodes.
• Currently, chemotherapy, hormone therapy, and radiation therapy for breast cancer have nearly eliminated the need for a Halstead radical mastectomy
• Incisions should be made to have optimal approximation without redundant skin
• Lymphedema: Thiscomplication occurs less frequently with the standard axillary dissections performed nowadays ( level I and II). It is more frequently seen when an axillary dissection is combined with axillary radiation.
• Seroma: One of the main reasons for drain positioning is to avoid seromas (closed simple drain or suction drain). These drains are left in for approximately four to five days, however occasionally this is not long enough and some patients will develop seromas. This can be drained percutaneously using a large gauge needle. There is no evidence to support the role of fibrin glue to prevent seroma formation after breast surgery

Nerve damage

• Long thoracic nerve (motor); Injury results in a palsy of the serratus anterior muscle. Clinically this leads to a winged scapula (scapula alata)
• Thoracodorsal nerve (motor); Injury results in a palsy of the latissimus dorsi muscle
• Intercostobrachial nerve (sensory); Injury of this nerve results in a numbness in the lateral aspect of the axilla and the medial aspect of the upper arm.

Literature
1. Closed simple drains are not inferior to suction drains in mastectomy wounds and, considering the cost saving and simplicity of postoperative care, they are preferable to suction drains. Ezeome ER, Adebamowo CA. S Afr Med J. 2008 Sep;98(9):712-5
2. Bland KI, Chang HR, Chandler GS, et al. Modified radical mastectomy and total (simple) mastectomy. In: Bland KI, Copeland EM III, eds. The breast: comprehensive management of benign and malignant disorders. Philadelphia: WB Saunders, 2004:865.
3. Maddox MA, Carpenter JT, Laws HL, et al. A randomized prospective trial of radical (Halstead) mastectomy versus modified radical mastectomy in 311 breast cancer patients. Ann Surg 1983;198(2):207.
4. Systematic review and meta-analysis of the use of fibrin sealant to prevent seroma formation after breast cancer surgery.Carless PA, Henry DA. Br J Surg 2006 Jul;93(7):810-9.