MASTECTOMY STEP 6, 7 AND AFTER SURGERY.

MASTECTOMY STEP 6 , 7 AND AFTER SURGERY.

• Step 6: Ligate or tie and divide all tributary vessels in this locality: this is to go hand to hand with the removal of all fat, lymph nodes and other elements, Fig 15 .

Fig. 15:

A moist gauze is packed in the axilla [armpit] after it is cleaned. The sternocostal attachments of pectoral muscles are divided next. The perforating branches of the interior mammary artery tied with transfixing sutures. Fibers of the serratus anterior muscle should not be disturbed.

1, Serratus anterior muscle; 2, pectoral major and minor muscles; 3, intercostal muscles.

• Step 7: Close the wound. Introduce a rubber or cigarette drain through a stab wound. Hemostasis [control of bleeding] must be perfect. The skin should be closed with interrupted sutures. Fig 16

Fig. 16:

A. Dissection is completed. Note that portion of anterior rectus sheath is also removed;

1, Axillary vein; 2, cephalic vein; 3, thoraco-dorsal nerve; 4, long thoracic nerve; 5, external abdominal oblique muscle; 6, rectus abdominal muscle.

B. Wound closed. Note position of drain, which passes through the lateral flap in region of axilla. A compression dressing completes the procedure.

After surgery.
If everything being satisfactory, the patient is permitted to leave the bed after 24 or 48 hours and to use her arm. Dress the wound and remove the drainage tube after 48 hours. Sutures should be removed gradually over a 12-day period.