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Modified radical mastectomy, Step by step
- Arm on the affected side is extended on a side table. The patient is draped and the affected breast and axilla are exposed.
- Drawing incision line (an optimal wound closure without any redundant skin must be taken into account)
- Skin incision and formation of upper flap
- Proceed cranially towards the pectoralis fascia just below the clavicula and laterally until the lateral margin of the pectoralis major muscle
- Formation of lower flap from medial to lateral
- Continue laterally until the latissimus dorsi muscle has been reached
- Dissection of the breast from medial to lateral including pectoralis major 's fascia
- Follow the lateral margin of the pectoralis major muscle and opening clavipectoral fascia
- Identification of upper axillary margin (=axillary vein)
- Dissection of axillary top (along axillary vein)
- Identify and preserve thoracodorsal nerve/vessels
- Identify and preserve long thoracic nerve
- Finalize axillary dissection and remove all level I and II lymph nodes (for a complete oncologic resection it is sometimes necessary to cut the intercostobrachial nerve)
- Remove axillary content en bloc with the breast
- positioning of two drains (axilla-lower flap and upper flap)
- Woundclosure, avoid any redundant skin
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