Which of the following is spared in modified radical mastectomy (MRM)?
Correct Answer: Pectoralis major
Description: Ans. a (Pectoralis major). (Ref. Bailey & Love Surgery, 25th ed., 842)MASTECTOMY is now only strictly indicated for large tumors, central tumor beneath or involving nipple, multifocal disease, and local recurrence or for patient preference.Simple mastectomyRadical mastectomy (Halsted)Modified radical Mastectomy (Patey's)# Only breast & Axillary tail of breast# Breast# Axillary lymph nodes# Pectoralis major# Pectoralis minor# Whole breast# Large portion of skin including nipple# Dissection of axilla# All fat, fascia & lymph nodes of axilla.# Pectoral minor either divided or retracted# Intercostal brachial nerves divided.STRUCTURES SPARED IN MRM1. Pectoralis major2. Axillary vein3. Nerve to serratus anterior & latissimus dorsiEducational points:# Conservative breast cancer surgery is QUART (Quadrantectomy Axillary Dissection & RT).# Sentinel node biopsy localized by radionuclide scan or by injection of patent blue dye.# Reconstruction materials:- Silicone gel,- Musculocutaneous Flaps {TRAM gives best cosmetic results)
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