Modified Radical Mastectomy

Procedure Snapshot

• Indication: Invasive breast cancer not amenable to BCT.
• Expected duration: ___
• Special instruments: Flap knife, cautery, drains.

Step Workflow

1. Elliptical incision encompassing nipple-areolar complex.
2. Raise skin flaps to clavicle, sternum, latissimus, inframammary fold.
3. Remove breast en bloc with pectoral fascia.
4. Perform axillary dissection (level I–II).
5. Hemostasis and drains.

Key Pimp Questions

• Q: Difference between MRM and simple mastectomy? A: MRM includes axillary node dissection.
• Q: Lymphedema rate? ___ (PMID 31178992).

Critical Anatomy

• Landmarks: Axillary vein, latissimus dorsi, pectoralis major/minor.
• Danger zones: Long thoracic and thoracodorsal nerves.

Informed Consent Highlights

• Bleeding, infection, seroma, numbness, lymphedema.

Post-op Considerations

• Drain removal < 30 mL/day; shoulder ROM.

References

• Chassin’s, Breast surgery. Clinical Scenarios, Breast.
• NEJM Z0011 (PMID 21388309).