A patient presenta with a unilateral ca breast of 4 cm size with skin ulceration involving the nipple. On palpation axillary lymph nodes are positive. FNAC showed intrductal ca. Management would involve
.Modified radical mastectomy- * Patey's operation: It is total mastectomy along with clearance of all levels of axillary nodes and removal of pectoralis minor muscle. It is enblock dissection of breast and axilla. An elliptical incision is made from medial aspect of the second and third intercostal space enclosing the nipple, areola and tumour extending laterally into the axilla along the anterior axillary fold. Upper and lower skin flaps are raised. Breast with tumour is raised from the medial aspect of the pectoral major muscle. Dissection is proceeded laterally with ligating pectoral vessels. Once dissection reaches axilla, lateral border of pectoralis major muscle is cleared with level I nodes. Pectoralis minor is divided from coracoid process to clear level II nodes. Medial and lateral pectoral nerves should be preserved (otherwise atrophy of pectoralis minor muscle occurs). Later from the apex of axilla level III nodes are cleared. Nerve to serratus anterior, nerve to latissimus dorsi, intercostobrachial nerve, axillary vein, cephalic vein and pectoralis major muscle are preserved. Wound is closed with a suction drain. ref:SRB&;s manual of surgery,ed 3,pg no 482
Breast conserving procedure
Simple mastectomy
Modified radical mastectomy
Palliative treatment
Endocrinology and breast