Surgeon:Yin Luk MD
ASSISTANT:
C. Loh, MD
ANESTHESIA: General.
PREOPERATIVE DIAGNOSIS:
Left Breast cancer
POSTOPERATIVE DIAGNOSES: Same
SURGERY PERFORMED:
Left Modified Radical Mastectomy
FINDINGS:
Left breast cancer
COMPLICATIONS: None.
POSTOP CONDITION: Stable.
BLOOD LOSS: Minimal. < 100 cc
SPECIMEN:
Left total mastectomy
axillary lymph node dissection
DRAINS:
10 Fr JP x 2
INDICATION: This is a patient with the above diagnosis. The patient was consented for the above procedure. Risks, benefits, and alternatives were discussed with the patient. Risks include, but are not limited to, bleeding, infection, damage to surrounding structures, nerves, or vessels, seroma, hematoma, abscess, dehiscence, lymphedema, discovery of metastasis, and even systemic complications such as cardiopulmonary, thromboembolic, hepatic, renal, neurologic or infectious complications which may even lead to death. All questions were answered. The patient agreed to proceed.
-A surgical assistant was deemed medically necessary for the safe and efficient completion of this case.
TECHNIQUE:
After adequate preparation, the patient was taken to the operating room where GETA was initiated. The area was shaved, prepped and draped in the standard fashion. The arm was draped within the field. Time out is performed. Preoperative antibiotics was administered.
Left mastectomy was performed. A elliptical skin incision centered around the nipple
was created and skin flaps were raise in all directions, medially to the sternum, laterally to the anterior axillary line, superiorly to the clavicle, and inferiorly to the inframammary fold. All breast tissue including the tail of Spence were excised including the deep margin which is the anterior fascia of the pectoralis major. Hemostasis was excellent.
A 10 mm Jackson-Pratt drain was placed in the axilla and brought out through a separate stab incision.
A transverse incision extending up along the pectoralis muscle and down posteriorly along the latissimus dorsi was made, incising through skin and subcutaneous tissue. The flap was developed over the pectoralis major muscle. The edge of the pectoralis major muscle was identified and it was used to dissect up to the axillary vein. Dissection then occurred toward the axillary vein pulling down as much of the axillary contents as possible. The entire dissection was carried up to the undersurface of the pectoralis minor right at the very apex. Lymph-bearing tissue was peeled down from just above the axillary vein inferiorly. The branches of the axillary vein were divided with Harmonic focus, maintaining good hemostasis. The entire axillary contents were peeled off the vein and posterior to the vein down to the thoracodorsal vessels and nerve, which were clearly identified and preserved throughout the entire procedure, as well as the long thoracic nerve. The long thoracic nerve was dissected free from the entire axillary contents and was preserved as well. All the palpable lymph nodes were removed. The entire specimen was ultimately removed. Inspection of the axilla revealed the thoracodorsal nerve and the long thoracic nerve, both of which were functioning with compression. There was no other lymph-bearing tissue left in the axilla.
The area was then irrigated with sterile water. It is noted there was good hemostasis.
A 10 mm Jackson-Pratt drain was placed in the axilla and brought out through a separate stab incision.
At the end of the case, counts were carried out. Instrument, sponge, and needle counts were completed and reported to me as correct.
The skin incision was then closed using 3 Vicryl suture, followed by 4 Monocryl suture in the layered closure fashion.
The patient tolerated procedure well , no complications, extubated, and was transferred recovery room stable satisfactory condition.