19305 Mastectomy, radical, including pectoral muscles, axillary lymph nodes

Name of the Procedure:

Radical Mastectomy (also known as Halsted Mastectomy)

Summary

A radical mastectomy is a surgical procedure to remove an entire breast, including the breast tissue, skin, nipple, areola, pectoral muscles, and axillary lymph nodes. This operation is typically performed to treat or prevent the spread of breast cancer.

Purpose

The primary purpose of a radical mastectomy is to treat breast cancer by removing all the tissue that might be affected by cancer cells. The goal is to prevent the cancer from spreading to other parts of the body and to reduce the risk of recurrence.

Indications

• Diagnosis of invasive breast cancer, particularly in cases where it has spread to the chest muscles.
• Large tumor size relative to the breast.
• Cancer that has not responded to other treatments.
• Multiple tumors in different areas of the breast.
• Recurrence of breast cancer after previous treatment.

Preparation

• Patients may be required to fast for several hours before the surgery.
• Medications, especially blood thinners, should be adjusted as per the doctor's instructions.
• Pre-operative assessments such as blood tests, imaging studies (like mammograms or MRI), and heart evaluations may be performed.

Procedure Description

1. Anesthesia is administered to ensure the patient is asleep and pain-free.
2. An incision is made around the breast to be removed.
3. The entire breast tissue, including the skin, nipple, and areola, is excised.
4. Pectoral muscles under the breast tissue are also removed.
5. Axillary lymph nodes (located under the arm) are identified and removed.
6. The incision is closed with sutures, and a drain may be placed to remove excess fluids.
7. The patient is then taken to the recovery room to be monitored.

Tools used include scalpel, surgical scissors, retractors, and suction devices.

Duration

The procedure typically takes about 2-3 hours.

Setting

A radical mastectomy is performed in a hospital operating room.

Personnel

• Breast surgeon or surgical oncologist
• Anesthesiologist
• Surgical nurses
• Operating room technicians

Risks and Complications

• Common risks: Infection, bleeding, pain, and swelling.
• Rare risks: Lymphedema (swelling due to lymph fluid buildup), nerve damage, and complications related to anesthesia.
• Management includes antibiotics for infections, pain medications, compression sleeves for lymphedema, and physical therapy.

Benefits

• Removal of all detectable cancerous tissues.
• Reduced risk of recurrence and spread of breast cancer.
• In some cases, it may be the only option when other treatments are ineffective.

Recovery

• Post-procedure care includes pain management, wound care, and possibly physical therapy.
• Patients may need to limit physical activity for 4-6 weeks.
• Follow-up appointments are necessary to monitor recovery and for further cancer treatment if needed.

Alternatives

• Lumpectomy (removing only the tumor and some surrounding tissue)
• Mastectomy (simple or modified without muscle removal)
• Radiation therapy
• Chemotherapy
• Each alternative has its pros and cons, including less extensive surgery or reduced cosmetic impact versus potentially less comprehensive cancer removal.

Patient Experience

• During the procedure, the patient is under general anesthesia and will not feel anything.
• After the procedure, patients may experience pain, swelling, and a sense of tightness in the chest area.
• Pain management includes prescribed medications.
• Emotional support and counseling may be beneficial as patients adjust to changes in body image.