The document describes the steps of a modified radical mastectomy surgical procedure. It involves removing the breast tissue, nipple/areolar complex, pectoralis fascia, axillary lymphatics, and overlying skin near the tumor with a 2cm margin. The key steps include positioning and draping the patient, making a transverse skin incision, mobilizing and dissecting the breast tissue, managing the axilla by removing fatty tissue while preserving nerves and vessels, and closing the wound with drain placement. Pre-operative preparation such as assessments, investigations, and consent are also discussed.

1. Modified radical mastectomy
description & operative video

2. Dr. Muhammad Saleem Iqbal
Assistant Professor of surgery- Department of oncology
Deputy Controller of Examination
Certified in Medical Teaching,
Research & Clinical Coordinator VC FMU,
Spokesman FMU, Faisalabad
Focal person PMDU.
Production editor APMC
Faisalabad Medical University ,Faisalabad
Surgical Tutor
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3. Dedication
To my mentor
Prof .Dr. Zafar Ali Choudhry
Thanks sir for guiding me ,inspiring me & making
me what I am today
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4. Definition
‘Total mastectomy with en bloc removal of
breast tissue, nipple/areolar complex, ,
pectoralis fascia, axillary lymphatics, &
overlying skin near the tumor with a 2 -cm
margin .

5. Pre-operative preparation
✘ Triple assessment
✘ Metastatic workup
✘ Routine blood investigations & Fitness profile
✘ Pre-anesthesia evaluation
✘ Control of medical conditions like DM & HTN
✘ Counseling and written informed consent
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6. Types of modified radical mastectomy
✘ Patey’s : Pectoralis minor is transected to remove
level 3 nodes
✘ Scanlon’s : Pectoralis minor is cut and then sutured
after removal of lymphatic tissue
✘ Auchincloss : Pectoralis minor is only retracted to
remove lymph nodes
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7. Steps of modified radical
mastectomy

8. 1-Positioning & drapping
✘ Supine position with arm abducted and axilla shaved.
✘ Flat pillow /sandbag is placed under ipsilateral scapula to
elevate side
✘ After scrubbing ,the area is draped with triple sheath above
,below & medial side of breast. Laterally a big sterile sheath
is placed
✘ Ipsilateral arm is drapped separately and kept free for
performing axillary dissection
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9. 2-Skin incision
✘ Confirm side of surgery
✘ Transverse elliptical including any previous
scar-stewart incision
✘ Can be extended laterally for axillary dissection
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10. 3-Mobilization of flap
Raise flaps in avascular plane between the subcutaneous
tissue and breast tissue.Dermal plexus visibility show that flap
is of adequate thickness(3-5 mm):
✘ Superiorly to the clavicle.
✘ Medially to the sternum.
✘ Inferiorly to the anterior rectus sheath.
✘ Laterally to the anterior border of latissimus dorsi.
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12. 4-Dissecting breast tissue
✘ Remove breast tissue from medial to lateral, including
the pectoralis fascia with specimen.
✘ Excise disk of muscle deep to biopsy cavity if tumor is
encountered.
✘ At the lateral border of the pectoralis major muscle, allow
breast tissue to fall laterally & commence work under the
pectoralis major muscle.
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13. 5-Axillary management
✘ Incise the clavipectoral fascia.
✘ Dissect under the pectoralis major and minor muscles,
removing all fatty tissue but preserving the median pectoral
nerve.
✘ Identify the axillary vein.
✘ Clear of fatty tissue.
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14. ✘ Ligate the first major branch from the axillary vein to the
chest wall.
✘ Identify and preserve the thoracodorsal nerve.
✘ Identify and preserve the long thoracic nerve.
✘ Clear fatty areolar node-bearing tissue from beneath the
axillary vein.
✘ Sweep tissue inferiorly to expose muscular boundaries of
the axilla, preserving nerves.
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15. 15
Memorang
de Virgilio - Part II Breast Flashcards
International Scholarly Research Notices, vol. 2013, Article ID 279013, 7 pages, 2013.https://doi.org/10.1155/2013/279013

16. 6-Wound closure
✘ Remove the specimen by dividing the lateral
pedicle of subcutaneous fascia
✘ Attain hemostasis.
✘ Place closed suction drain(s}.
✘ Close the wound.
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Thanks!
Any questions?
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