In Patey's mastectomy the step not done is
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. the whole breast the poion of skin overlying the tumor, which includes the nipple-areola complex. 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 sternum to the anterior border of lattissimus dorsi pectoralis major muscle pectoralis minor muscle and clavipectoral fascia the upper pa of the aponeurosis of the external oblique and anterior pas of a few digitations of the serratus anterior muscle all fatty and loose areolar tissue along with level I, II & III axillary lymph nodes Structures saved are : the axillary vein and the cephalic vein the long thoracic nerve of Bell (Nerve to serratus anterior). The nerve to latissimus dorsi may be sacrificed if required. Also know Extended Radical Mastectomy - Radical mastectomy + removal of internal mammary lymph nodes Super Radical Mastectomy - Radical mastectomy + removal of internal mammary, mediastinal and supraclavicular lymph nodes. Ref : S. Das 3/e, p 725; Schwaz 9/e p461
Nipple and areola removed
Surrounding normal tissue of tumor is removed.
Pectoralis major removed
Pectoralis minor removed
Endocrinology and breast