Simple/Total Mastectomy ± Sentinel Node Biopsy

Procedure Snapshot

• Indication: DCIS, prophylactic mastectomy, multicentric disease.
• Expected duration: ___
• Special instruments: Electrocautery, drains, gamma probe.

Step Workflow

1. Elliptical incision encompassing nipple-areolar complex.
2. Raise flaps to clavicle, sternum, latissimus.
3. Remove breast tissue with pectoral fascia.
4. Perform SLNB if indicated.
5. Hemostasis, drains, closure.

Key Pimp Questions

• Q: SLNB mapping dyes? Tc-99 and blue dye.
• Q: Drain duration? Remove when < 30 mL/day.

Critical Anatomy

• Landmarks: Pectoralis major/minor, axillary vein.
• Danger zones: Thoracodorsal bundle, long thoracic nerve.

Informed Consent Highlights

• Bleeding, infection, seroma, numbness.

Post-op Considerations

• ROM day 1; drain care; compression bra.

References

• Chassin’s, Breast surgery. Clinical Scenarios, Breast.
• Giuliano 2017 (PMID 28390286).