RADICAL MASTECTOMY, STEP 3 and 4

RADICAL MASTECTOMY, STEP 3 and 4.

· Step 3: Dissection of the greater pectoral muscle almost as far as its humoral [upper arm] attachment. The entire mass [pectoral major muscle and mammary gland] is dissected away from the ribs. Fig. 13: A,B.




Fig 13:





A The cephalic vein is dissected free. Humeral [upper arm]

end of pectoral major is retracted downward.

1, Deltoid muscle; 2, cephalic vein; 3, pectoral major

muscle




B The clavicular origin of pectoral major is divided. The thoracic-acromial vessels are ligated: 1, coracoid process; 2, thoracic-acromial vessels; 3, costo-coracoid membrane; 4, pec toral minor.



C The costocoracoid membrane is open.The pectoral major is retracted down still more, exposing pectoral minor, which is divided along its attachment to the coracoid process:

1, Deltoid muscle; 2, coracoid process; 3, cephalic vein; 4, axillary vein; 5, thoracic-acromial vessels; 6, edge of costocoracoid membrane; 7, pectoral major muscle, 8, pectoral minor muscle.





· Step 4: Expose the outer edge of the pectoral minor in it’s entirely. The gland and major pectoral muscle now are attached only by connective tissue and armpit fat. Fig. 13: C.

[cont.]