What Is a Modified Radical Mastectomy?

With the widespread development of censuses and health education, the discovery of early cases has greatly increased, and improved radical cure has been widely carried out. Its therapeutic effect is equivalent to radical surgery. Therefore, since the 1970s, modified radical surgery has gradually become the standard for breast cancer surgery Technique.

Modified radical mastectomy

With the widespread development of censuses and health education, the discovery of early cases has greatly increased, and improved radical cure has been widely carried out. Its therapeutic effect is equivalent to radical surgery. Therefore, since the 1970s, modified radical surgery has gradually become the standard for breast cancer surgery Technique.

Chinese name

Modified radical mastectomy

Foreign name

Modified radical mastectomy

put forward

Fisher

Indication

Stage breast cancer, the tumor does not involve the pectoralis fascia

Surgical approach

Transverse crescent-shaped, longitudinal spindle incision

History of improved radical mastectomy for breast cancer

Radical mastectomy at the end of the 19th century (radical mastectomy);

Expanded radical mastectomy for breast cancer: Expanded radical mastectomy in the 1950s;

Modified radical mastectomy for breast cancer: Modified radical mastectomy in the 1960s, divided into:

Modified radical mastectomy with pectoralis major muscle resection and pectoralis minor muscle resection

Auchincloss Modified Radical Surgery Preserving Pectoral Large and Small Muscles.

Since the 1980s, radical surgery has been used less and less, and it has basically been replaced by modified radical surgery, and the modified I radical surgery is mostly used.

Modified radical mastectomy for breast cancer

The incision is designed according to the location of the tumor and the size and shape of the breast. A transverse crescent-shaped, longitudinal spindle incision can be used, and the incision should be more than 3 cm from the tumor edge.

After the free skin flap is used to cut the skin, it is best to use an electric knife for the free skin flap, which not only makes the surgical field clean, but also facilitates tumor-free operation. The thickness of the flap is preferably not retained or a little thin layer of adipose tissue, the free range is the same as that of Halsted radical surgery.

The breast is removed from the bottom to the top, and the breast is separated along with its deep pectoralis major fascia until it is under the outer edge of the pectoralis major.

Remove the pectoralis major lymph nodes (Rotter lymph nodes) to tighten the raised breast outward, pull the pectoralis major and small muscles inward, and make a longitudinal incision along the boundary between the pectoralis major muscle and the breast tissue, exposing the pectoralis major, Remove the fat and lymph tissue (Rotter lymph nodes) between the small muscles. During the operation, it is necessary to carefully separate the thoracic nerve and blood vessels, because the medial thoracic nerve is slanted in front of the pectoralis minor muscle and accompanies the thoracic acromion vessels. There are 2 to 4 branches that dominate the clavicle and sternum of the pectoralis major muscle. .

The axillary lymph nodes were lifted to lift the pectoralis minor inward and upward, and the subclavian vessels and axillary vessels were exposed throughout, starting from the subclavian vein into the chest, dissected along the lower edge of the subclavian vein, and ligating to cut all the downward branches. The lymphatic adipose tissue around the axillary veins and the fascia of the subscapular muscle group were completely removed, and Auchincloss surgery was performed. The pectoralis minor muscle was also removed for Patey Dyson surgery. When removing the pectoralis minor, the lateral branch of the thoracic nerve should be properly protected. Note that when removing the lymph nodes of each group of the axillary group, the long thoracic nerve, thoracic dorsal nerve and subscapular blood vessels should be retained. ^[3]

Drain the surgical wound, and then attract with negative pressure. Appropriate compression bandaging was applied to the chest strap, and the affected limb was taken into adduction after surgery. A rubber tube was placed under the axillary tube to drain the axillary cavity, and the layers could heal tightly under low tension. Within 3 to 5 days after the operation, the chest strap should be re-wrapped daily, and the subcutaneous and axillary fluid should be checked for fluid drainage, so that there is no residual cavity under the skin and underarms. ^[2]

Chemotherapy after modified radical mastectomy for breast cancer

The choice of radiotherapy after modified radical surgery is based on tumor size, location, and axillary lymph node status. According to the 2001 American Association of Clinical Oncology Guidelines, radiotherapy is recommended for patients with axillary lymph node metastases of 4 or more. In addition to the above indications, patients with internal breast or areola are also prone to metastasis, and radiation therapy is also recommended. The conventional irradiation of the chest wall and the supraclavicular region, the tumor is located in the inner quadrant plus the irradiation of the internal breast area, the number of axillary lymph node metastases 4 plus the irradiation of the axillary, the cumulative amount does not exceed 60Gy, mostly using conventional electronic wires. ^[4]