Steps Of Modified Radical Mastectomy..MRM

Modified Radical Mastectomy

1. Arm on the affected side is extended on a side table. The patient is draped and the affected breast and axilla are exposed.
2. Drawing incision line (an optimal wound closure without any redundant skin must be taken into account)
3. Skin incision and formation of upper flap
4. Proceed cranially towards the pectoralis fascia just below the clavicula and laterally until the lateral margin of the pectoralis major muscle
5. Formation of lower flap from medial to lateral
6. Continue laterally until the latissimus dorsi muscle has been reached
7. Dissection of the breast from medial to lateral including pectoralis major 's fascia
8. Follow the lateral margin of the pectoralis major muscle and opening clavipectoral fascia
9. Identification of upper axillary margin (=axillary vein)
10. Dissection of axillary top (along axillary vein)
11. Identify and preserve thoracodorsal nerve/vessels
12. Identify and preserve long thoracic nerve
13. Finalize axillary dissection and remove all level I and II lymph nodes (for a complete oncologic resection it is sometimes necessary to cut the intercostobrachial nerve)
14. Remove axillary content en bloc with the breast
15. positioning of two drains (axilla-lower flap and upper flap)
16. Woundclosure, avoid any redundant skin