Infusion of the breast with a tumescent solution of dilute epinephrine hydrochloride in lactated Ringer solution in patients undergoing modified radical mastectomy allows the procedure to be performed rapidly with scalpel dissection and minimal blood loss. The classic technique of modified radical mastectomy with addition of the tumescent solution is described herein.
Subcutaneous infiltration of tumescent solution (intended skin incision line has been sketched using marking pen).
Superior skin flap is raised sharply using the scalpel.
Lateral skin flap is raised until latissimus dorsi muscle is identified (superior, medial, and inferior flaps have already been created).
Breast and pectoral fascia are taken off the pectoralis major muscle.
Axillary vein is identified and cleaned off in a lateral-to-medial fashion.
Identification of the thoracodorsal nerve.
Tissue between the thoracodorsal neurovascular bundle and the long thoracic nerve is encircled with a right-angle clamp before being divided and ligated.
Tissue is swept inferiorly using a gauze sponge. Forceps identify the long thoracic nerve.
Completed axillary dissection. Scissors indicate the position of the long thoracic nerve. The preserved intercostobrachial nerve is seen crossing the midportion of the axilla.
Close-up of completed axillary dissection. The 2 preserved intercostobrachial nerves are seen.
Closure of the incision. Lack of redundant skin in closure is seen.
Thank you for submitting a comment on this article. It will be reviewed by JAMA Surgery editors. You will be notified when your comment has been published. Comments should not exceed 500 words of text and 10 references.
Do not submit personal medical questions or information that could identify a specific patient, questions about a particular case, or general inquiries to an author. Only content that has not been published, posted, or submitted elsewhere should be submitted. By submitting this Comment, you and any coauthors transfer copyright to the journal if your Comment is posted.
* = Required Field
Disclosure of Any Conflicts of Interest*
Indicate all relevant conflicts of interest of each author below, including all relevant financial interests, activities, and relationships within the past 3 years including, but not limited to, employment, affiliation, grants or funding, consultancies, honoraria or payment, speakers’ bureaus, stock ownership or options, expert testimony, royalties, donation of medical equipment, or patents planned, pending, or issued. If all authors have none, check "No potential conflicts or relevant financial interests" in the box below. Please also indicate any funding received in support of this work. The information will be posted with your response.
Some tools below are only available to our subscribers or users with an online account.
Download citation file:
Web of Science® Times Cited: 6
Customize your page view by dragging & repositioning the boxes below.
More Listings atJAMACareerCenter.com >
Enter your username and email address. We'll send you a link to reset your password.
Enter your username and email address. We'll send instructions on how to reset your password to the email address we have on record.
Athens and Shibboleth are access management services that provide single sign-on to protected resources. They replace the multiple user names and passwords necessary to access subscription-based content with a single user name and password that can be entered once per session. It operates independently of a user's location or IP address. If your institution uses Athens or Shibboleth authentication, please contact your site administrator to receive your user name and password.