Total Skin-Sparing Mastectomy

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SAMPLE EXCERPT
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PRE-PROCEDURE
INDICATIONS
  • Prophylactic contralateral simple mastectomy may be indicated in those patients with a high risk for bilaterality or who cannot reliably be screened.
  • If the risk of undetected or underestimated invasive breast cancer is sufficiently high, consider a sentinel lymph node biopsy before removal of the breast.
  • Lumpectomy and axillary staging and final pathology has revealed positive margins, patients later develop a local recurrence, and patients who desire a mastectomy
CONTRAINDICATIONS
  • Inflammatory or invasive cancer and possible axillary lymphadenectomy in which the results will make a difference in the treatment plan
  • Patients with lesions directly under or involving the nipple–areolar complex or overlying skin
EQUIPMENT
  • Scalpel
  • Electrocautery
  • Four dilators: Pratt or Hager, 19 to 46 Fr
  • S Retractors
  • C-Strang retractor
  • St. Mark retractor
  • Long fine tonsils
  • Long sponge sticks
  • Allis clamps
  • 19 Fr Blake drain
  • 3.0 nonabsorbable suture
  • 4.0 Vicryl running stitch
ANATOMY

The borders of the simple mastectomy


PROCEDURE
Sample excerpt does not include step-by-step text instructions for performing this procedure
The full content of this section includes:
  • Step-by-step text instructions for performing the procedure
  • Clinical pearls providing practical clinical tips from medical experts
  • Patient safety guidelines consistent with Joint Commission and OHSA standards
  • Links to medical evidence and related procedures

POST-PROCEDURE
CARE
  • The patient usually requires an overnight hospital stay, but patients with comorbid conditions or who underwent bilateral reconstruction may require longer stays.
  • Instruct the patient to keep her elbow at the side.
  • Remove the drain after 7 days if drainage is less than 30 mL.
COMPLICATIONS
  • Hematomas
  • A significant amount of skin may have to be taken, making a simple closure impossible.
  • Loss of flap viability
  • Pneumothorax
  • Leaking drain
  • Seroma
  • Infected or uninfected flap necrosis
  • Cellulitis
  • Neurapraxia
  • Nerve transection
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