19307 Mastectomy, modified radical, including axillary lymph nodes, with or without pectoralis minor muscle, but excluding pectoralis major muscle

Name of the Procedure:

Mastectomy, Modified Radical (including Axillary Lymph Nodes, with or without Pectoralis Minor Muscle, excluding Pectoralis Major Muscle)

Summary

A modified radical mastectomy is a surgical procedure for breast cancer treatment. It involves removing the entire breast along with axillary (underarm) lymph nodes and, depending on the case, the pectoralis minor muscle. The pectoralis major muscle is preserved.

Purpose

This procedure addresses breast cancer by removing cancerous tissues. The goals are to eliminate cancer cells, prevent the spread of cancer to other parts of the body, and reduce the risk of recurrence.

Indications

• Diagnosed with invasive breast cancer.
• Large tumor size relative to breast size.
• Multiple areas of cancer in the breast.
• Patient preference for mastectomy over breast-conserving surgery.
• Recurrence of cancer after lumpectomy.
• High risk of future breast cancer due to genetic factors.

Preparation

• Fasting typically required overnight before surgery.
• Medication adjustments as directed by the physician.
• Diagnostic tests such as blood work, mammograms, or breast MRIs.
• Pre-operative evaluation by the surgical team and anesthesiologist.

Procedure Description

1. Anesthesia: Administer general anesthesia to the patient.
2. Incision: Make an incision over the breast to gain access to the breast tissue, lymph nodes, and muscles.
3. Removal of Breast Tissue: Carefully excise the entire breast tissue.
4. Axillary Lymph Nodes: Remove several axillary lymph nodes for examination and staging of the cancer.
5. Pectoralis Minor Muscle: Decision made intraoperatively whether to remove or preserve the pectoralis minor muscle.
6. Closure: Close the incisions with sutures and apply a sterile dressing.

Tools used include surgical scalpels, retractors, and electrocautery devices. The procedure is done under general anesthesia.

Duration

The surgery typically takes 2 to 3 hours.

Setting

Performed in a hospital's operating room or in a specialized surgical center.

Personnel

• Lead Surgeon specialized in breast surgery.
• Surgical assistants and scrub nurses.
• Anesthesiologist or nurse anesthetist.
• Operating room nurses.

Risks and Complications

• Common risks: bleeding, infection, pain, swelling, bruising, seroma (fluid accumulation).
• Rare risks: blood clots, adverse reactions to anesthesia, lymphedema (chronic swelling of the arm).

Benefits

• Removal of malignant tissue to prevent cancer spread.
• Reduction in the risk of cancer recurrence.
• Provides more information on cancer staging and further treatment decisions.

Recovery

• Patients may stay in the hospital for 1 to 2 days after the procedure.
• Pain management includes prescribed medications.
• Instructions for wound care and managing surgical drains if placed.
• Restricted physical activity for about 4 to 6 weeks.
• Follow-up appointments for monitoring and removal of stitches/drains.
• Physical therapy may be recommended to regain arm mobility and strength.

Alternatives

• Lumpectomy (breast-conserving surgery): removes only the tumor and a margin of surrounding tissue.
• Radiation therapy: may be used alone or alongside lumpectomy.
• Chemotherapy or hormonal therapy: used either before surgery (neoadjuvant) or after surgery (adjuvant) to address systemic disease.

Patient Experience

Patients will experience the effects of general anesthesia and post-surgical pain, managed with medications. Some discomfort and restricted movement are expected post-operatively. Pain and mobility significantly improve over a few weeks. Emotional support and counseling may be beneficial during the recovery period.