Mastectomy refers to the largest surgical operation on a woman’s breast beyond the field of plastic surgery. The procedure consists mainly of the removal of the breast as well as dissecting axillary contents. This procedure is often used in Australia in the event that a breast tumour is too large to be removed without damaging the surrounding breast tissue. One can conveniently settle for mastectomy over conservational breast surgery in the attempt of avoiding radiotherapy. There is the incident of double mastectomy, which is the removal of the two breasts.

Australian women can opt to undergo prophylactic mastectomy in the event that they have a significant risk of contracting breast cancer at some point in their lifetimes. Mastectomy is an operation with low morbidity and mortality, and is well-tolerated by Austrians. However, it is not without complications, including wound infection and skin flap necrosis.

Procedure Steps in Mastectomy

The following are the main procedural steps involved in mastectomy: breast incised elliptically, incision deepened to incorporate the whole breast, breast removal, axillary lymph nodes removal, and wound closure. The doctor incises the skin around the breast elliptically, and he or she deepens the incision in order to create lateral extension toward the axilla through the subcutaneous tissue. Bleeding is managed with ligatures.

The doctor then separates the breast skin from the underlying tissue. Beren’s retractors are used in the elevation of skin flaps, at the same time Allis clamps are positioned along the breast tissue edges and then retracted up by the surgeon. The margins of the skin flaps are enclosed with warm moist lap pads, and they are held away with retractors. The intercostal arteries as well as veins are fastened and ligated. The axillary flap is retracted for complete segmentation of the axilla. The fascia is separated from the lateral edge of the pectoralis.

Thereafter, ligation of vessels is carried out in the axilla and nearby to sternum. Afterwards, the fascia is dissected to the serratus anterior muscles. At this stage, the thoracic along with thoracodorsal nerves are well preserved. The surgeon does keep exposed tissue moist with lap packs in order to protect them. The surgeon then separates the breast and axillary fascia away from the latissimus dorsi muscle and suspensory ligaments, from adjacent the clavicle to the mid part of the sternum.

At this stage, the pectoralis major muscle is left intact. The specimen is passed to STSR. Thereafter, wound is inspected for bleeding places, which are then ligated and electro-coagulated, and then irrigated. The surgical doctor places closed wound suction drainage tubes through stab wounds and secured to skin with non-absorbable suture on a cutting needle. Surgeon closes wound with interrupted non-absorbable sutures, and connects the wound to closed suction reservoir. Dressing of the wound may be done with simple gauze, bulky or gauze and elastic wrap.

Postoperative care involves the following steps: anaesthesia recovery, pain management, assessing dressing for bleeding, observe incision for swelling and infection, maintenance of skin integrity, prevention of infection, and drainage tube care. The choice of incision depends on a number of issues, comprising the location of the lesion, and prior biopsy incisions, and planned reconstruction. All these factors do determine the kind of postoperative care needed for an Australian patient.

References:

1) Breast reconstruction and mastectomy: http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Breast_reconstruction_and_mastectomy?OpenDocument

2) What is a mastectomy?: http://www.myvmc.com/treatments/mastectomy/

3) Types of surgery Breast conserving surgery: https://www.bcna.org.au/new-diagnosis/treatment/surgery/types-surgery