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.
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