In Patey&;s mastectomy the step not done is
Lets see the nomenclature of various surgeries on breast Simple or Total mastectomy * it removes all breast tissue, the nipple-areola complex, and skin. Extended simple mastectomy * Simple mastectomy + removal of level I axillary lymph nodes. Modified radical mastectomy it removes all breast tissue, the nipple-areola complex, skin and the level I and level II axillary lymph nodes. Halstead&;s Radical mastectomy removes all breast tissue and skin, the nipple areola complex, the pectoralis major and minor muscles and the level I, II and III axillary lymph nodes. Modified Radical Mastectomy Two forms of modified radical mastectomy are in use Auchincloss (pronounced as &;aushincloss&;) procedure * Here both the pectoralis major and minor muscles are preserved with removal of level I and II axillary lymph nodes Patey&;s Procedure here the pectoralis minor muscle is removed to allow complete dissection of level III axillary lymph nodes Scanlon&;s modification of Patey&;s procedure * here the pectoralis minor muscle is divided instead of removing. Division of pectoralis minor muscle allows complete removal of level III lymph nodes Halstead Radical Mastectomy In this operation following structures are removed. i) the whole breast ii) the poion of skin overlying the tumor, which includes the nipple-areola complex. iii) the subcutaneous fat and the deep fascia veically from the lower border of the clavicle upto the upper quaer of the sheath of the rectus abdominis and horizontally from the strenum to the anterior border of lattissimus dorsi iv) pectoralis major muscle v) pectoralis minor muscle and clavipectoral fascia vi) upper pa of the aponeurosis of the external oblique and anterior pas of a few digitations of the serratus anterior muscle vii) all fatty and loose areolar tissue along with level I, II & III axillary lymph nodes Ref: Sabiston 20th Ed. ; Schwaz 11th Ed.
Nipple and areola removed
Surrounding normal tissue of tumor is removed.
Pectoralis major removed
Pectoralis minor removed
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